Diagnosing Tourette Disorder
Tourette disorder is a chronic disorder of the nervous system that starts in childhood and causes involuntary motor and vocal tics—sudden twitches, movements, or vocal sounds that occur repeatedly. Common motor tics include eye blinking, shoulder shrugging, and facial grimacing. Vocal tics may include throat clearing, coughing, and sniffing.
In people with Tourette disorder, tics start before age 18, happen daily, and range from mild to severe. Some people with the condition feel an overwhelming urge to perform the tic and can sometimes resist it, whereas others may not be aware of tics, even while they’re happening. Tics can temporarily occur less frequently when a person is concentrating or distracted, and they may occur more often during times of stress or tension. Triggers may include excitement, anxiety, or physical sensations, such as a tight collar that triggers a neck tic.
The exact cause of Tourette disorder is unknown, but experts believe that genetics plays a role. Tourette disorder is more likely to affect men than women and can run in families. It’s also common for people with Tourette disorder to have other conditions, such as anxiety, obsessive-compulsive disorder, or attention deficit hyperactivity disorder, which may be the main focus of treatment. If symptoms of Tourette disorder are interfering with a child or adolescent’s school, work, or social life, our experts can help.
Medical and Psychiatric Evaluation
NYU Langone doctors obtain an in-depth psychiatric and medical history and perform an examination when evaluating a person for Tourette disorder. While doing so, they look for the presence of involuntary tics.
To get a clear picture of how tics affect a child or adolescent in everyday life, our psychiatrists and neurologists often talk to people close to the child—usually family members and teachers who frequently interact with him or her and can provide insight into tic triggers. These interviews can take place in person, over the phone, or through written reports and questionnaires.
A diagnosis of Tourette disorder is made when the person has two or more motor tics and at least one vocal tic—even if these do not happen at the same time. Tics must persist for more than one year. During the evaluation, the doctor also looks for signs of other conditions that are associated with Tourette disorder and can occur at the same time, such as obsessive-compulsive disorder, attention deficit hyperactivity disorder, and learning problems.
The doctors at NYU Langone review and discuss the results of the evaluation with the family, the child, and, when appropriate, school personnel. Our neurologists and psychiatrists work in concert to determine an accurate diagnosis and to develop the best care plan for children and adolescents with Tourette disorder.
Because other psychiatric disorders or certain medications can cause symptoms that mimic those of Tourette disorder, a thorough evaluation is needed to ensure an accurate diagnosis. This may at times include diagnostic tests that provide doctors with a detailed look at the brain, enabling them to identify any other sources of the symptoms.
CT scans produce detailed images of tissues and internal organs based on several X-rays taken from different viewpoints. This imaging test allows the doctor to look for any structural abnormalities in the brain that may be indicative of conditions, such as epilepsy, that can cause symptoms similar to those associated with Tourette disorder.
MRI machines use magnetic waves and computers to create two- or three-dimensional pictures of the brain. This allows NYU Langone specialists to better view the brain and rule out conditions such as traumatic brain injury.
A doctor may order an electroencephalogram (EEG) to rule out other conditions that can cause tics, such as dystonia, encephalitis, or Huntington’s disease. An EEG measures electrical activity in the brain and can tell the doctor if the nervous system is not working properly.
Experts at NYU Langone use the information from these medical evaluations and imaging tests to develop a personalized plan to manage tics and other symptoms of Tourette disorder and to improve quality of life.