Why Are Muscle Relaxants Prescribed For Patients With Huntington Disease Tourette syndrome (TS): Symptoms, causes, and treatment

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Why Are Muscle Relaxants Prescribed For Patients With Huntington Disease

Tourette’s syndrome, also referred to as ‘Tourette syndrome,’ is a disorder that involves various physical tics and at least one vocal tic. A few people with Tourette’s unintentionally utter inappropriate or obscene words.A tic is an unusual movement or sound that a person has little or no control over. It may include eye blinking, coughing, throat clearing, sniffing, facial movements, head movements, or limb movements, or making unusual sounds.The tics are more common in people with obsessive-compulsive disorder (OCD), an autistic spectrum disorder (ASD), or attention deficit hyperactivity disorder (ADHD).According to the Tourette Association of America, 1 in every 160 children in the United States may have Tourette’s syndrome.The condition has been linked to damage or abnormalities in the basal ganglia of the brain.Here are some key points about Tourette’s syndrome:A person with Tourette’s syndrome will have physical and vocal tics lasting more than a year.It is a neurological disorder with symptoms that are made worse by stress.Treatment includes medication and behavioral therapy.Tourette’s does not have serious complications. However, it may be accompanied by other conditions, such as ADHD, and these can cause learning difficulties.Tourette’s is one of a range of tic disorders that can involve transient or chronic tics. The tic can emerge at any age. However, it most commonly appears between the ages of 6 and 18 years.During adolescence and early adulthood, the tics will normally become less severe. However, Tourette’s can become worse as the person moves into adulthood.For most people, the frequency and intensity of both minor and major tics tend to fluctuate. Tics may become more frequent and more intense when a person is facing physical, emotional, or mental stress.Most people with Tourette’s have normal intelligence and life expectancy.The hallmark sign of Tourette’s syndrome is a tic. This can range from barely noticeable to severe enough to make daily life challenging.A facial tic, such as eye blinking, may be the first sign. However, each person is different.A tic may be:Physical: Motor movements include blinking or jerking the head or another part of the body.Phonic: The person may utter sounds, such as grunts or squeaks, and words or phrases.There are two main classifications:Simple tic: This may involve moving just one muscle, or uttering a single sound. Movements are sudden, short lived, and often repetitive.Complex tic: The physical movements are more complex, and the phonic tics may include long phrases. Complex tics involve several muscle groups.People with Tourette’s have a combination of phonic and physical tics, which may be simple or complex.Simple physical ticsExamples of simple physical tics may include:eye blinkingeye dartinggrinding the teethhead jerkingneck twistingnose twitchingrolling the eyesrotating the shouldersshoulder shruggingsticking the tongue outSimple phonic ticsExamples of simple phonic tics may include:barking soundsblowingclearing the throatcoughinggruntinghiccuppingsniffingsqueakingyelling and screamingComplex physical ticsExamples of complex physical tics may include:copropraxia, or making obscene gesturesechopraxia, or miming the movements of other peopleflappinghead shakinghitting thingsjumping or hoppingkicking thingsshakingsmelling objectstouching oneself or othersComplex phonic ticsExamples of complex phonic tics include:varying one’s voice intonationecholalia, or repeating what other people saypaliphrasia, or saying the same phrase over and over againcoprolalia, which means uttering or shouting obscene words or phrasesAdvanced warningsMost people will experience unusual or uncomfortable sensations before the onset of a tic.Types of advanced warning include:a burning feeling in the eyes that is only alleviated by blinkingincreasing tension in the muscles that can only be alleviated by stretching or twitchinga dry throat that is only alleviated by grunting or clearing the throatitching in a limb or joint, where the only relief is achieved by twisting itSituations that may cause tics to worsen include:anxiety or stressfatigue, or tirednessillness, especially a streptococcal infectionexcitementa recent head injuryMedical News Today (MNT) asked the Tourette Association of America’s Medical Advisory Board what advice they would give to parents who think their child may have Tourette’s.They told us:“Tourette Syndrome is characterized by motor and vocal tics longer than 12 months. If this is the case, then start with a visit to the child’s primary care physician for an evaluation. Talk to him or her to see if the tics are causing pain or discomfort, bothering him or her, or affecting schoolwork or desired activities.”The Association provides resources and support for people with Tourette’s and for parents of children with the condition, including tools for parents and educators and information on how to find advocacy and support groups.The exact cause of Tourette’s syndrome is unknown. However, it appears to stem from an issue in the basal ganglia, the part of the brain that is responsible for involuntary movements, emotion, and learning.Experts believe that abnormalities in the basal ganglia may cause an imbalance in levels of brain neurotransmitters, which transfer messages from one cell to another. Abnormal neurotransmitter levels may disrupt normal brain function, resulting in tics.Parkinson’s disease, Huntington’s disease, and other neurologic conditions affect the basal ganglia.Tourette’s syndrome is believed to have a genetic link and to be hereditary. A person who has a close family member with a tic is more likely to have one, too.It also appears to be more common in infants who are born preterm.Another theory is that a childhood illness may trigger tics. Infection with group A streptococcal bacteria has been linked with symptoms of Tourette’s. It may be that the bacteria cause the immune system to produce antibodies that interact with brain tissue, and this brings about changes in the brain. This could have implications for treatment. However, more research is necessary.There is no current test for Tourette’s, so diagnosis depends on the signs, symptoms, and medical and family history.According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, the following criteria must be present for a diagnosis of Tourette’s:The person has two or more motor tics (such as blinking or shrugging the shoulders) and at least one vocal tic (such as humming, clearing the throat, or yelling out a word or phrase), although they might not always happen at the same time.The person has had tics for at least a year. The tics can occur many times a day (usually in bouts) nearly every day, or off and on.The person has tics that began before the age of 18 years.The person has symptoms that are not related to medication or other drugs they may be taking, or due to having another medical condition (such as seizures, Huntington disease, or postviral encephalitis).Other conditions that could produce similar symptoms include:allergies, if there is coughing and sniffingdystonia, a neurological condition that includes involuntary movements and prolonged muscle contraction, leading to twisting body motions, abnormal posture, and tremorrestless leg syndrome, if movements affect the legsproblems with vision, if the patient blinks a lotBlood tests, skin tests, eye tests, and imaging tests can help rule out these and other medical conditions.Treatment normally involves medication and non-pharmacological treatments. In rare cases, surgery may be an option.Medication may include antihypertensives, muscle relaxants, or neuroleptics.AntihypertensivesAntihypertensives are normally used to control high blood pressure or hypertension. However, they may help patients with mild to moderate symptoms of Tourette’s, possibly by regulating neurotransmitter levels. One example is Clonidine. Side effects include diarrhea or constipation, dry mouth, headaches, dizziness, and fatigue.Muscle relaxantsMuscle relaxants help control physical tics by treating spasticity, which is when muscles become too stiff. Examples include baclofen and clonazepam. Side effects include drowsiness and dizziness. Patients taking muscle relaxants should not consume alcohol, and they may not be able to drive or use heavy machinery.NeurolepticsNeuroleptics block the effects of dopamine in the brain. They may be taken orally or by injection. They can treat moderate to severe symptoms. Some slow-release neuroleptics are injected only once every 2 to 6 weeks.Adverse effects may include drowsiness, blurred vision, dry mouth, low libido, shaking, spasms, twitches, and weight gain. Some neuroleptics have more adverse effects than others.If side effects are becoming a problem, the patients should tell their doctor. There may be other neuroleptics they could take.Non-pharmacological treatmentsBehavioral therapy is commonly used to help people with Tourette’s. It can help change the patient’s behavior patterns.Studies have found that comprehensive behavioral intervention for tics (CBIT), a kind of cognitive behavioral therapy (CBT), may help children and adults with Tourette’s syndrome. Therapy aims to treat symptoms by reversing habits.Habit reversal is based on the idea that:patients are unaware of their ticsthe purpose of tics is to alleviate uncomfortable sensations before they occurThe therapist helps the patient monitor the pattern and frequency of their tics. Any sensations that are triggering the tics are also identified.Once the patient is aware of the tic, they can develop an alternative and less noticeable way of relieving the uncomfortable sensations that are stirring. This is called a competing response.For example, if an unpleasant sensation in the throat makes the person feel the need to grunt or clear their throat, they can learn to relieve the sensation by taking a series of deep breaths instead.A study published in 2015 found that the kind of CBT used to reduce chronic tics in people with Tourette’s syndrome can also change the way their brains work.Another study published in 2015 found that a brain chemical known as GABA may help treat tics in people with Tourette’s syndrome.Habit reversal therapy often includes relaxation therapy. Stress or anxiety may make tics more severe and more frequent. Deep breathing and visualization may help relieve anxiety, often resulting in fewer and less severe tics.Are there any alternative therapies?According to an older study, self-hypnosis, may be effective. A number of dietary factors, such as a higher intake of vitamin B or vitamin D, may also have benefits, according to anecdotal evidence. However, these have not been supported by research.The Tourette Association Medical Advisory Board told MNT:“There is no evidence at present for the use of any alternative therapies for the treatment of Tourette. Simply put, these have not been studied yet for Tourette.”However, exercise and a balanced diet can help reduce stress and enhance a sense of wellbeing, which may help reduce the severity and frequency of tics.SurgerySurgery is usually only considered for adult patients with severe symptoms who have not responded well to other treatments.Limbic leucotomyA limbic leucotomy is when an electric current or pulse of radiation is used to burn away a small part of the limbic system. This system responsible for some emotions, behavior and memory. A limbic leucotomy may resolve the problem partially or fully.Deep brain stimulation (DBS)With DBS, electrodes are implanted permanently into parts of the brain known to be linked to Tourette’s. They are connected to small generators that are implanted inside the body. An electronic pulse passes from the generator to the electrodes, stimulating different parts of the brain. This may help control the symptoms of Tourette’s.The long-term effects of DBS have not yet been proven.Activities that may help to manage tics include engaging in competitive sports, playing an enjoyable computer game, or reading an interesting book. However, overexcitement can be a trigger for some people, so some activities can have the opposite effect.Many people learn how to control the tics when at work or school, for example. However, suppressing tics may increase tension, until the tic can be expressed.Over time, the types, frequency, and severity of tics may change. Tics tend to be most severe during the teenage years. However, they often improve during early adulthood.Tourette syndrome does not affect a person’s intelligence. However, learning difficulties can result if the person also has ADHD, OCD, or ASD.A child with or without these additional conditions may also experience bullying at school, which can make schooling harder both socially and academically.Schools can help by educating students about the condition, so that they can better understand a classmate who happens to have Tourette’s.The basal ganglia are also involved in habit learning, so people with Tourette’s may have problems with learning through habit. This may affect skills such as writing, reading, or arithmetic.A child with Tourette syndrome may need additional educational help.Tourette’s syndrome is a disorder that involves at least one vocal tic, and various physical tics. The condition can emerge at any age. However, it usually begins between the ages of 6 and 18 years.The exact cause of Tourette’s syndrome is unknown. However, it seems to stem from a problem in the basal ganglia. This part of the brain is responsible for involuntary movements, emotion, and learning.Treatment usually includes medication and non-pharmacological treatments. Rarely, surgery may also be an option.Competitive sports, playing an enjoyable computer game, or reading an interesting book may all help to manage the condition. However, it is important to note that overexcitement can also be a trigger for some people.

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