People who curse a lot might have this

BY GEORGE NAVA TRUE II

PHILIPPINE President Rodrigo Roa Duterte has a habit of cursing in his speeches. To drive home his point and elicit laughter, he often sprinkles his talks with insults aimed at different people, like government officials, human rights groups, United Nations officials, and journalists.

While not everyone finds that funny, some people can’t help but act like Duterte without intending to do so. These people are suffering from a neurological disorder known as Tourette syndrome (TS).

TS is named after Dr. George Gilles de la Tourette, a French neurologist and intern of the influential French neurologist Jean-Martin Charcot, the director of the Salpêtrière Hospital. He started working with Charcot in 1884 and served as the latter’s student and house physician. Tourette was described as intelligent but he had a short temper. 

In spite of this, the intern managed to advance his career with Charcot’s help. He studied and lectured in psychotherapy, hysteria, and hypnosis. In 1885, Tourette first observed TS in an 86-year-old woman and published an account of nine patients with “convulsive tic disorder” that year. 

Sudden movements of Tourette syndrome

People with TS have tics (sudden movements or sounds) that are done repeatedly. Patients can’t stop doing these things just as they can’t control hiccups. The condition is often associated with coprolalia or the utterance of obscene words and derogatory remarks. This is also seen in deaf patients who swear with sign language.

While coprolalia can be embarrassing, the person doing this has no control over what he is saying. Nor do his remarks reflect his thoughts or opinions. Often patients are portrayed by media as always shouting, swearing, or constantly repeating the words of other people (echolalia), but the US Centers for Disease Control and Prevention (CDC) said these symptoms are rare and not required for a diagnosis of TS.

The CDC said about 1% of school-age children and adolescents have TS, while coprolalia occurs in a few cases. Early symptoms appear in childhood, often between the ages of 3 and 9 years. More males than females are affected, but many cases are undiagnosed.

Types of tics in Tourette syndrome

TS usually occurs with other problems like:

* Anxiety

* Attention deficit hyperactivity disorder (ADHD)

* Depression

* Obsessive-compulsive disorder (OCD)

Tics can be motor or vocal. Motor tics are often the first symptoms of TS. They refer to body movements like blinking, shrugging the shoulders, or jerking an arm. Vocal tics, on the other hand, are sounds that a person makes like humming, clearing the throat, or shouting a word or phrase.

Simple tics involve a few body parts like squinting or sniffing. In complex tics, several body parts are used. Examples are bobbing the head jerking an arm, and jumping up.

The types of tics and how often they occur differ in people and change over time. They get worse when the patient is stressed or excited and improve when the person is calm or doing something. Family members may have different symptoms.

The US National Institute of Neurological Disorders and Stroke (NINDS) said tics usually decrease during adolescence and early adulthood and may disappear entirely. However, some patients continue to experience tics into adulthood and these can become worse.

Tourette syndrome can be inherited

The exact cause of TS is unknown, but it is believed to be an inherited genetic condition that can be passed on from parents to children. A paper published in the Journal of Psychosomatic Research said that problems in the brain may be responsible for the condition.  

The NINDS said there is no cure for TS. But in most cases, the CDC said no treatment is needed unless the tics interfere with everyday life. Often, all that patients have to do is to avoid worrying or excitement. They should remain calm and focused on their activities.

If tics cause pain, injury, or interfere with school or work, medicines and behavioral treatments may help. Also, the NINDS recommends the following:

* Educate the community about TS to help others understand the symptoms, reduce teasing patients, and relieve stress. People with TS need a lot of support to lessen the symptoms of the disease.

* Since patients usually have other conditions like ADHD and OCD, they require different treatments based on symptoms. Treating these conditions can help reduce tics. For the best treatment plan, patients, parents, and health care providers should work together.

* Medications can also reduce tics and the symptoms of other conditions, but not all patients will respond well to this. Also, not all drugs for tics have been approved by the US Food and Drug Administration.  

Different treatments for different patients

Other recommendations from the CDC are:

* Try different medicines and doses until you find the best treatment

* Choose the medicine with the least side effects

* Be wary of side effects and report them to the doctor. These include weight gain, stiff muscles, tiredness, restlessness, and social withdrawal

While Tourette’s discovery of TS has helped many people understand the disease, things didn’t work out well for the famed neurologist. In 1893, he was shot in the neck by a former patient. Although he recovered and continued working, Tourette became severely depressed and his mental health declined. He was sent to a psychiatric hospital in Switzerland where he died on May 22, 1904, at the age of 46.  

***

National Press Club and Philippine Dental Association awardee George N. True II has written two bestsellers based on his popular column that has been running for almost 40 years. For questions about health, email geogenavatrue@yahoo.com./PN