Surgical And Non-Surgical Treatments For Tourette Syndrome
Is surgery an option in the treatment of tic?
Surgery has been tried for severe cases of Tourette's for quite some time. Exactly what type of surgery should be done and what part of the brain should be operated on has not really been defined yet. A more recent technique, more recent surgical technique, is so called deep brain stimulation where an electrode is permanently implanted into the brain and stimulates part of the brain by delivering a weak electrical current. There have been some reports of success by using this technique, again in people who have been so severely impacted by their tics that they can't live a normal life or anything close to it, have failed medications and there aren't other nonsurgical therapies that are available to the person. In that circumstance where it is so severe and medications have not been successful, deep brain stimulation would be reasonable to consider. But I have to emphasize that this is a very small minority of people with tic or Tourette Syndrome.
What surgical operations are used to treat people with Tourette syndrome?
What role does exercise play in the treatment of Tourette syndrome?
Exercise is not going to play a central role in addressing or trying to alleviate tick, but as with any neurological diagnosis, routine exercise I think is an important component of maintaining good health, reducing stress which in turn may help reduce tick frequency and severity.
What is 'habit reversal therapy'?
Well, this would be redirecting this internal urge that people have into something that is less disruptive. For example, one of my patients has a very prominent vocal tic which emerges more during the night time hours. Wakes the whole household and I have referred her to a psychologist to try to channel that need to tic, that sensory feeling with the resultant vocalization which is quite loud into something else. Something that is more acceptable that is not going to wake up everybody when they are sleeping at night. And this can be done successfully in some people. But not everyone is going to have a positive outcome with this kind of therapy.
How is hypnosis used to treat people with Tourette syndrome?
Relaxation techniques, in general, may be of some limited benefit to people with tic. As noted previously, tic can come out during moments of stress and learning to cope with stress in a different way through relaxation techniques of self-hypnosis or by using bio-feedback therapy can help to quiet down their background of stress and thereby alleviate tics. So that could be helpful with people with mild tics or as an adjunct to medication.
How is marijuana used in the treatment of Tourette syndrome?
Well exactly how Marijuana may improve Tourette's is not worked out yet. We don't really know the pharmacology of how tics occur in the first place and how Marijuana may alter that is not understood. Marijuana is similar to normally occurring brain chemicals called canabanoids, which do play some role in these brain structures called the basal ganglia. So the active ingredients when one either smokes or ingests Marijuana are mimicking some of the affects of naturally occurring brain chemicals. Perhaps the affect of Marijuana is simply by a sedating quality, calming a person and as a consequence reducing tics. There may be more to it than that, we just don't know. There haven't really been any well-organized formal studies on how Marijuana affects tics in general.
How is botulism injection therapy used to treat Tourette syndrome?
Botulinum toxin, or one brand is Botox®, can be very helpful for some types of very localized tick; for example, people with repetitive eye-blinking, or repetitive eye-closure, can be quite successfully treated by injection with Botulinum toxin. Or, if somebody else has a very predictable smaller movement, a movement of their face, or a movement of a limb, if you can target the muscle that's contracting repetitively for that tick - and get a needle there safely - it could conceivably be treated with some success by injection with Botulinum toxin, or Botox®. Now, that doesn't necessarily remove that sensory phenomenon that precedes the motor tick, so the person could be left with that need to move, and a less ability to do so, which could be unpleasant for some people. But, in my experience, where I've treated the repetitive eye-closure/blinking, it's worked quite well. It's a pretty simple procedure to do, and with very little risk.
What is 'tetrabenazine' and how is it used to treat Tourette syndrome?
Tetrabenazine is available in Europe and also in Canada but it is not presently available in the United States. Tetrabenazine is believed to have a pharmacological action of inhibiting the release of dopamine instead of blocking dopamine on the receiving side it reduces the release of dopamine. There have been studies done that shows it can be quite effective for some people with TICK. One of the concerns about the side effects can be depression but the experience to date is that people with TICK haven't had big problems with depression when using Tetrabenazine in the confines of a clinical trial. The medication is under investigation in bringing it to the FDA currently to see if it can be approved in the United States for involuntary movements.
How can a nicotine patch treat Tourette syndrome?
Nicotine may modulate some of these brain chemicals, these neurotransmitters, including things like dopamine, and it's been observed in the past that nicotine can have a favorable impact on reducing tics. Nicotine patches or nicotine supplements in some other fashion, had not really emerged as a mainline for second or third choice therapy for reducing tic, but it may be of some benefit in some selected cases.