Adverse effects of tyrosine kinase inhibitors in cancer therapy: pathophysiology, mechanisms and clinical management
Tourette Syndrome
Tourette syndrome is a neurological (nervous system) tic disorder. It causes people to make sudden movements or sounds they can't control. These are called tics. For example, someone with Tourette's might blink or clear their throat over and over again. Some people may blurt out words they don't intend to say.
Some treatments may help control tics, but some people don't need to take medications unless their symptoms bother them.
About 100,000 Americans have full-blown Tourette syndrome, but more people have a milder form of the disease. It often starts in childhood and affects more boys than girls. Symptoms often get better as children grow up. For some people, they go away completely.
Tourette syndrome is also sometimes called Tourette's or Tourette disorder.
Doctors don't know yet what causes Tourette syndrome. It's been linked to different parts of the brain, including the basal ganglia, frontal lobes, and cortex. The basal ganglia is the area that helps control body movements. The frontal lobes manage muscle control, among other things, while the cortex plays a role in how some parts of the brain communicate with each other. Researchers think that disruption in this brain network causes Tourette syndrome.
It could also result from abnormalities in neurotransmitters, which are cells that transmit messages to the brain. These include dopamine, serotonin, and norepinephrine.
There are other possible causes, but they haven't been proven. They include:
Is Tourette syndrome genetic?
Researchers believe that some part of Tourette syndrome or a milder form of tic disorder might be genetic, passed down through families. It's not clear yet how this happens, but someone with Tourette's has a 50% chance of passing it down to a child. Some families have clusters, groups of people who have Tourette syndrome while other families may just have one affected member. That said, up to 1 in 20 children with Tourette's don't have it in their family.
Tourette syndrome does affect more boys than girls.
Tics are the symptoms of Tourette syndrome. Some are too mild to be noticeable. Others happen often and are obvious. Stress, excitement, or being sick or tired can make them worse. Severe tics can be embarrassing and can affect your social life or work.
Before a motor tic appears, you may get a sensation that can feel like a tingle or tension. The movement (the tic) makes the sensation go away. You might be able to hold your tics back for a little while, but you probably can't stop them from happening.
There are two types of Tourette syndrome tics: motor tics (which involve body movements) and vocal tics (which involve your voice). Each of these types can be further divided into simple and complex tics.
Motor tics
Motor tics involve motor movement, and they can be simple or complex. Simple motor tics affect only a few parts of your body and might cause:
Complex motor tics typically involve more than one part of your body at a time. They include:
Vocal tics
Like motor tics, vocal tics can be simple or complex. Simple vocal tics include:
Complex vocal tics include:
Tourette's and swearing
One of the most puzzling symptoms of Tourette syndrome is coprolalia — the medical term for involuntarily swearing or making socially inappropriate or offensive comments. There is a motor equivalent of coprolalia called copropraxia. This is a complex motor tic that involves making obscene gestures. Television and movie portrayals of people with Tourette's often use these tics for effect, so they may seem common, but they're not. Most people with Tourette's do not have coprolalia or copropraxia.
Researchers believe this happens when the brain messages that stop people from making those comments or movements are mixed up. And just as unwanted motor tics can happen, swearing or inappropriate language and behavior may come out without you being able to stop it.
Other symptoms
Doctors aren't sure why, but about half of people with Tourette's also have symptoms of attention deficit hyperactivity disorder (ADHD). You may have trouble paying attention, sitting still, and finishing tasks.
Tourette syndrome can also be associated with:
Tourette syndrome is most often diagnosed in children but it's possible to be diagnosed as an adult.
There are no specific tests for Tourette syndrome. So if you're concerned you or your child have it, the diagnosis is based on the information you provide and what the doctor sees. They might have to rule out other problems that cause tics though. Sometimes, tics have a simple explanation; for instance, constant blinking may be due to vision problems, or excessive sniffing may result from allergies. In such cases, you or your child might be sent for tests such as blood tests or imaging tests (such as an MRI). Another test that might be recommended is an electroencephalogram (EEG), which looks at your brain waves.
The questions your doctor might ask could include:
Your doctor will also evaluate certain criteria, such as if the tics:
Questions for your doctor
Learning about Tourette syndrome can be overwhelming. Here are some questions you may ask your doctor to understand what it means to have Tourette syndrome.
There is no cure for Tourette syndrome. For many people, the tics are mild and don't need to be treated. If they become a problem though, your doctor may prescribe medication. It can take a while to find the right dose that helps control tics but avoids or limits side effects, so you and your doctor will need to work together to find what works for you.
Medication for Tourette syndrome
There are several types of medications your doctor can choose from. You might recognize some of the names as drugs used to treat other diseases or disorders. This is because they're drugs that were originally approved for those conditions, but doctors found that they also can help reduce tics. They include:
Therapy
There are a few types of therapy that could be useful for some people with Tourette syndrome.
Talk therapy or psychotherapy
This type of therapy, usually with a psychologist or trained therapist, helps you learn how to deal with Tourette syndrome, as well as other problems that you may have. For example, you may also be dealing with ADHD, obsessions, depression, or anxiety. Dealing with one condition could help you manage others.
Cognitive behavioral therapy (CBT)
Like psychotherapy, cognitive behavior therapy (CBT) is done with a psychologistor trained therapist. The goal is to help you identify certain behaviors and modify them or your reaction to them. There is a type of CBT that is specific for Tourette syndrome, called Cognitive Behavioral Interventions for Tics.
Deep brain stimulation (DBS)
This type of therapy is in the early research stages for Tourette syndrome that doesn't respond to other treatments and is so severe that it's affecting your life. Researchers don't know yet if it's effective. DBS involves implanting a device into your brain. Once in place, the device sends out electrical impulses to stimulate the target areas that control movement.
Often, the hardest part of living with Tourette's is dealing with the embarrassment or frustration of having tics you can't control. While you're getting help from your doctor, you can do a few other things to feel better:
Educate yourself and others. Educating yourself about Tourette syndrome is important, but so is educating family and friends. The more they know about the condition, the better they can help you. You can give them pamphlets or brochures if you have any, or you can send them to a Tourette syndrome association site, such as the Tourette Association of America.
Get support. Your family, friends, health care team, or a support group can help you meet the challenges of Tourette's. Ask for that support and tell them what it is you need from them.
Follow your treatment plan. Whether it's meeting with a therapist or taking medications, be sure to follow your treatment plans. If you have trouble doing this, speak with your doctor. There may be other things you can do.
Stay active. Play sports, paint, or volunteer — anything that helps keep you busy and helps you feel good. These activities may take your mind off your symptoms.
Relax. Read a book, listen to music, meditate, or do yoga. Low-key activities you enjoy can combat the stress that can lead to tics.
Parenting a child with Tourette syndrome can be challenging. In many cases, Tourette syndrome tics peak when children are in their early teens, and they improve as they get older.
In the meantime, here are some things that might help:
Don't tell or ask your child to stop their tics. It can be frustrating to see or hear the tics, but asking your child to control them can add to their stress and make the tics worse.
Speak to the adults in your child's life. Talk to the staff at their school about your child's diagnosis. You can give them the facts about the condition and see what kind of support they can provide, such as extra tutoring or smaller classes, perhaps. You can also inform the school bus driver, after-school day care staff, coaches, tutors, and anyone else who your child interacts with regularly.
Help build your child's self-esteem. Every child has different interests, so it can take time to find the right ones for your child, but once you do, this can make a big difference. They can form friendships and learn new things that help build their self-esteem.
Join support groups. See if you can find a local Tourette syndrome support group for parents. If there isn't one available, maybe you could start one!
Practice with your child. Fitting in socially also can be hard for a child with Tourette syndrome. Help them practice ways to handle teasing or comments from other kids.
Tourette syndrome causes a range of tics, from mild to severe. For those with mild to moderate tics, there may be no other issues for them to deal with. However, there are people with Tourette syndrome who also have to deal with other conditions at the same time. The ones most often associated with Tourette syndrome are:
Tourette syndrome, also called Tourette's or Tourette disorder, can affect anyone, but it affects more boys than girls. Most people with Tourette syndrome have symptoms that start in childhood, peak in the early teen years, and then lessen. There's no cure for the condition, but there are treatments and therapies that could lessen the strength of the tics.
Can Tourette's go away?
About one-third of children with tics from Tourette syndrome get better after their early teens. Another third stay the same, while the rest get worse. However, only about 2%-5% of those in the last group need significant help.
What are some of the early signs of Tourette syndrome in children?
Some early signs of Tourette syndrome in children include squinting their eyes or blinking a lot, shrugging, grimacing, twitching their nose, jerking their head, and foot tapping or stomping.
Is Tourette's related to anxiety?
Anxiety doesn't cause Tourette syndrome, but it can make the tics worse.
Can you live a normal life with Tourette's?
Most people with Tourette's do go on to live a normal, active life.
What not to do to someone with Tourette's
An important thing not to do with someone who has Tourette syndrome is to tell them to stop or control their tics. This can trigger stress and anxiety as they attempt to hold the tic back. The tics will come out and may be more forceful or frequent.
Mesenteric Artery Disease
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Patients whose symptoms are mild to moderate can often manage their disease by making lifestyle changes such as quitting smoking, getting regular exercise, and working with their doctors to take care of related conditions such as diabetes, high blood pressure, and high cholesterol. Doctors often use minimally invasive procedures such as balloon angioplasty and stenting to relieve the narrowing and improve blood supply to the kidney and intestines. In severe cases, an abdominal bypass operation may be necessary to improve the blood flow to the intestine. These treatment options are listed as follows:
Balloon angioplasty. During this procedure, your doctor places a tiny, soft plastic tube called a catheter into the artery, usually in the groin, and inject a dye that makes the blood vessels clearly visible on an x-ray image. Your doctor can also use a special catheter that has a small balloon at the end, which can be inflated and deflated. The deflated balloon catheter is inserted through an artery in the groin and guided to the narrowed segment of the artery. When the catheter reaches the blockage, the balloon is inflated to widen the narrowed artery.
Stenting. In some cases, it may be necessary to place a stent. A stent is a small tube that holds open the artery at the site of the blockage. The stent is collapsed around a balloon when it is placed on the tip of the catheter and inserted into the body. Once the catheter reaches the blockage, the doctor expands the stent by inflating the balloon. The stent is left permanently in the artery to provide a reinforced channel through which blood can flow. Some stents (drug-eluting stents) are coated with medication that helps prevent the formation of scar tissue.
Arterial bypass surgery. If mesenteric artery disease is very advanced, or if blockages develop in an artery that is difficult to reach with a catheter, arterial bypass surgery may be necessary to restore blood flow. In this treatment approach, doctors place a bypass graft made of synthetic material or a natural vein taken from another part of the body. During the procedure, the surgeon will make an incision to expose the diseased segment of the artery, and then attach one end of a bypass graft to a point above the blockage and the other end to a point below it. The blood supply is then diverted through the graft, around the blockage, to bypass the diseased section of the artery. The diseased artery is left in place.
Celiac Artery Compression Syndrome
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The main symptoms are chronic abdominal pain that has lasted several months, abdominal pain after eating, weight loss, and sometimes an abdominal bruit, or the sound made by blood flowing through an obstruction.
Compression syndrome could be the cause of persistent abdominal pain that has not been treated successfully. This condition is generally not life threatening but is debilitating. It is recommended that a person with the symptoms has a consultation with a vascular surgeon familiar with the disorder.
If you have had abdominal pain for months, especially after eating, and have not treated it successfully, consider consulting with a vascular surgeon about the possibility celiac compression syndrome might be the cause of your problem.
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