1. Understanding the misunderstood

2. What is Tourettes Syndrome?
Inherited neurological condition
1/100 School children
300,000+ children and adults in the UK
1:4 girls to boys
Complex condition with a wide spectrum

3. Symptoms

4. Relative likelihood of lifetime sensory tics in a given region as based on a self-report of patients with TS 7
10-12 18

5. Causes The Basal Ganglia Dopamine theory Genetics Childhood infection
-specialised brain cells involved in helping regulate the physical movements of the body
-higher brain functions such as motivation and decision-making
-temporary disruption scrambling decision making - sudden development unconscious motivation to perform an action (the tic) that the conscious mind regards as both unwanted and unexplained
-MRI and PET scans show different structure
Dopamine theory
-excessive levels for a person with TS effecting Basal Ganglia
-alternatively normal dopamine level but TS more sensitive to its effects
Genetics
-inherited - 50%
-in twins if one has TS other ½ chance
Childhood infection
-streptococcal throat infections, antibodies causing abnormal immune reaction
Other possible environmental factors contributing to onset or severity:
-pregnancy and birth related problems
-complications during pregnancy,
smoking during pregnancy,
severe nausea and/or vomiting during the first trimester
premature low birth weight children

6. MRI

7. Diagnosis Other possibilities to rule out:
Allergies – sniffing, coughing
Vision problems - blinking
Autistic spectrum disorder
Dystonia – condition causing involuntary muscle spasms
Huntington's disease – genetic condition that can cause a range of symptoms including muscle twitching
Referral
Neurologist – a doctor who specialises in treating conditions that affect the brain and nervous system
Psychiatrist – a doctor who specialises in treating mental health conditions
Educational psychologist - a health professional who works with children who have learning, developmental or behavioural difficulties
computerised tomography (CT) scan –  where a series of X-Rays are taken to build up a detailed 3D image of the brain
magnetic resonance imaging (MRI) scan – where strong fluctuating magnetic fields are used to produce a detailed image of the inside of the brain
Confirming the diagnosis
Not caused by other medical conditions or medication
Tics started before the age of 18.
Several physical tics and at least one phonic tic.
Tics occur many times during the day, nearly every day
Tics have been present for at least a year.

8. Research and Treatment
No cure at present
Medication: alpha2-adrenergic agonists (release noradrenaline, stabilize norepinephrine, clonidine), muscle relaxants and neuroleptics (risperidone, benzimides)
Therapy: behavioural, psychotherapy, muscle relaxation
Surgery : Limbic leucotomy, Deep Brain Stimulation

9. Obsessive compulsive disorder
Anxiety Disorder
chronic (long-term) mental health condition associated with obsessive thoughts and compulsive behaviour
OCD is one of the most common mental health conditions. It is estimated that up to 3 in 100 adults and up to 5 in 100 children and teenagers have OCD

10. Symptoms Intrusive thoughts -intentionally causing harm
-unintentionally causing harm
-fear of contamination
-need for symmetry or orderliness
-committing offensive acts
Common Compulsions
cleaning
hand washing
checking – such as checking that doors are locked, or that the gas or a tap is off 
counting
ordering and arranging
hoarding 
asking for reassurance
needing to confess
repeating words silently
prolonged thoughts about the same subject

11. Causes Genetic Brain abnormalities
-No specific gene isolated
-But 4 times likely to inherit OCD if a family member has it
Brain abnormalities
-Increased blood flow and activity
-Increased level of neurotransmitter serotonin
-Streptococcal throat infections, antibodies causing abnormal immune reaction
Life events, coping mechanisms and stress

12. PET scan showing increased brain activity due to hyper-vigilance

13. Diagnosis
GP questionnaire
Psychiatrist
Educational psychologist

14. Research and Treatment
Based on severity
mild functional impairment – obsessive thinking and compulsive behaviour occupy less than one hour of your day
moderate functional impairment – obsessive thinking and compulsive behaviour occupy one to three hours of your day
severe functional impairment – obsessive thinking and compulsive behaviour occupy more than three hours of your day
CBT, psychotherapy
Anti-anxiety medication
Surgery : Limbic leucotomy, Deep Brain Stimulation

15. Comorbidities
Over 85 percent of people with TS have more than just tics.
60% have OCD
70% have attention deficit hyperactivity disorder (ADHD).
More susceptible to fits of rage, depression and sleep disturbances
Co-morbidities often present more problems than the tics and can be less visible.