How is Tourette syndrome treated?

Because tic symptoms do not often cause impairment, the majority of people with Tourette syndrome require no medication for tic suppression. However, effective medications are available for those whose symptoms interfere with functioning. Neuroleptics are the most consistently useful medications for tic suppression; a number are available but some are more effective than others (for example, haloperidol and pimozide).

Unfortunately, there is no one medication that is helpful to all people with Tourette syndrome, nor does any medication completely eliminate symptoms. In addition, all medications have side effects. Most neuroleptic side effects can be managed by initiating treatment slowly and reducing the dose when side effects occur. The most common side effects of neuroleptics include sedation, weight gain, and cognitive dulling. Neurological side effects such as tremor, dystonic reactions (twisting movements or postures), parkinsonian-like symptoms, and other dyskinetic (involuntary) movements are less common and are readily managed with dose reduction.

Discontinuing neuroleptics after long-term use must be done slowly to avoid rebound increases in tics and withdrawal dyskinesias. One form of withdrawal dyskinesia called tardive dyskinesia is a movement disorder distinct from Tourette syndrome that may result from the chronic use of neuroleptics. The risk of this side effect can be reduced by using lower doses of neuroleptics for shorter periods of time. Other medications may also be useful for reducing tic severity, but most have not been as extensively studied or shown to be as consistently useful as neuroleptics. Additional medications with demonstrated efficacy include alpha-adrenergic agonists such as clonidine and guanfacine. These medications are used primarily for hypertension but are also used in the treatment of tics. The most common side effect from these medications that precludes their use is sedation. Effective medications are also available to treat some of the associated neurobehavioral disorders that can occur in patients with Tourette syndrome. Recent research shows that stimulant medications such as methylphenidate and dextroamphetamine can lessen ADHD symptoms in people with Tourette syndrome without causing tics to become more severe. However, the product labeling for stimulants currently contraindicates the use of these drugs in children with tics/Tourette syndrome and those with a family history of tics. Scientists hope that future studies will include a thorough discussion of the risks and benefits of stimulants in those with Tourette syndrome or a family history of Tourette syndrome and will clarify this issue. For obsessive-compulsive symptoms that significantly disrupt daily functioning, the serotonin reuptake inhibitors (clomipramine, fluoxetine, fluvoxamine, paroxetine, and sertraline) have been proven effective in some patients. Psychotherapy may also be helpful. Although psychological problems do not cause Tourette syndrome, such problems may result from Tourette syndrome. Psychotherapy can help the person with Tourette syndrome better cope with the disorder and deal with the secondary social and emotional problems that sometimes occur. More recently, specific behavioral treatments that include awareness training and competing response training, such as voluntarily moving in response to a premonitory urge, have shown effectiveness in small controlled trials. Larger and more definitive NIH-funded studies are underway.

Lets take a common problem in the workplace. Let's say for argument sake, employ someone like me. There are many employees/employers in South Africa with my symptoms. How will you cope with me, firstly, as an employee; or secondly, how would the employees react to my behaviour if I were their employer?

Lets take into account my diagnosis:

1. Bipolar Disorder Type 2

2. Tourettes Disorder

3. Advanced Personality Disorder

4. Klinerfelter Syndrome

All the above-mentioned disorders are only discovered when one or more of the symptoms become prevalent during the normal course of our work or social lives.

In my case, the Bipolar only started emerging 47 years after diagnosis. By the time I acknowledged I had bipolar there had been a major trail of damage left behind. In the Advanced Personality disorder there were two failed marriages and a string of "girlfriends". The Tourettes had caused a lot of work taken on but never completed. It also was the cause of me running away from my responsibility. The Bipolar brought on the guilt while the Klinerfelter brought in the lack of confidence to deal with my past and future relationships. Whether they be of a business or private nature.

In Part III we will discuss how to find and deal with employees with these hidden workplace hazards