Tourette Syndrome - Description

Page Contents

• Other Names
• ICD-9
• Description
• Genetics
• Prognosis
• Prevalence
• Helpful Articles

Other Names

TS and Tourette disorder

ICD-9

307.23, Tourette syndrome

Click Tourette ICD9 ( 79 KB) for more detail and for coding of associated conditions. If you are coding for a child with tics and you are not yet sure it is Tourette syndrome (TS), use 307.2. Although TS is a neurological disorder associated with basal ganglia dysfunction, many insurance companies mistakenly interpret TS exclusively as a psychiatric disorder and may initially deny reimbursement to non-psychiatrists. See Tourette syndrome insurance information.

Description

Tourette syndrome (TS) is a childhood-onset neurological condition characterized by chronicity (lasting over a year) and the presence of both motor and phonic (vocal) tics, although not necessarily at the same time. These features distinguish TS from three other types of tic disorders: tic disorder, unspecified, transient tic disorder, and chronic motor or vocal tic disorder. Motor tics may be simple (brief and involving an isolated muscle group, such as an eye blink) or complex (more purposeful in appearance, involving sustained postures or multiple muscle groups in coordination or sequence such as jumping and twirling). Phonic tics may also be simple or complex. Simple phonic tics involve meaningless sudden noises such as sniffing or grunting; complex tics are more language-based, such as echolalia (repetition of vocalizations made by another person) or coprolalia. The latter is the utterance of socially inappropriate language and is rare, despite its frequent presence in characterizations of people with TS in the popular media.

By adolescence, most people with TS can describe an uncomfortable physical sensation or urge that precedes a tic. Although most individuals with TS are able to suppress their tics temporarily, the urges usually persist and are so intolerable that tics are ultimately expressed. Stress, anxiety, excitement, and fatigue may increase tic frequency.

Most people diagnosed with TS will also have one or more non-tic-associated conditions, including attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), anxiety, learning problems, sleep disorders, depression, and anger dysregulation. Onset of the signs and symptoms of these co-morbid conditions can precede, co-occur with, or follow the onset of tics. These conditions usually pose greater risk to the neuro-developmental, psycho-social, and behavioral well-being of the child than do the tics. Adverse consequences of TS on self-esteem, academic performance, and social flexibility are common and can be profound.

Genetics

The cause of TS is poorly understood, although both genetic and environmental factors influence variations in the expression of the signs and symptoms of tics and associated conditions. See Tourette syndrome mechanisms for more information. Males are 3-4 times more likely than females to have TS.

Prognosis

Tics are likely to decrease somewhat or even resolve in late adolesence. [Zinner: 2000] [Zinner: 2004] [Bagheri: 1999] For more information, see Clinical course and prognosis of Tourette syndrome. Associated conditions such as ADHD and OCD are likely to be lifelong, although symptoms will vary with developmental stages.

Prevalence

Because TS often occurs in families with milder tic disorders and obsessive compulsive disorders, and because many mild cases of TS probably go undiagnosed, it is difficult to know the exact prevalence. Estimates vary, but up to 1% of school children may have TS. [Freeman: 1997]

Helpful Articles

PubMed search on Tourette syndrome: review articles over

Zinner, SH.
Tourette syndrome - much more than tics; First of two parts, Moving beyond misconceptions to diagnosis.
Contemporary Pediatrics. 2004;21(8):22-36. / Full Text
First of a two part article; diagnosis of TS and associated questions are covered in this first section.

Bagheri, MM, Kerbeshian, J, and Burd, L.
Recognition and management of Tourette's syndrome and tic disorders.
American Family Physician. 1999;59(8):2263-2272, 2274.
Excellent medical information regarding TS for the medical home.

Dooley JM.
Tic disorders in childhood.
Semin Pediatr Neurol. 2006;13(4):231-42. PubMed abstract

Tourette syndrome association.
TS: Basic Information.
Tourette syndrome association; (1997) http://www.tsa-usa.org/Medical/whatists.html.
Comprehensive source of family-focused information

McMahon WM, Filloux FM, Ashworth JC, Jensen J.
Movement disorders in children and adolescents.
Neurol Clin. 2002;20(4):1101-24, vii-viii. PubMed abstract

Tourette Syndrome Module Authors

The authors listed above are responsible for the overall Tourette Syndrome Module. Authors contributing to individual pages in the module are listed on those pages.

Page Bibliography

Bagheri, MM, Kerbeshian, J, and Burd, L.
Recognition and management of Tourette's syndrome and tic disorders.
American Family Physician. 1999;59(8):2263-2272, 2274.
Excellent medical information regarding TS for the medical home.

Freeman, Roger D.
Diagnosis and management of Tourette Syndrome: Practical aspects.
Medscape from WebMD; (1997) http://www.medscape.com/viewarticle/431108.

Zinner SH.
Tourette disorder.
Pediatr Rev. 2000;21(11):372-83. PubMed abstract
An excellent summary with excellent information to guide medication usage.

Zinner, SH.
Tourette syndrome - much more than tics; First of two parts, Moving beyond misconceptions to diagnosis.
Contemporary Pediatrics. 2004;21(8):22-36. / Full Text
First of a two part article; diagnosis of TS and associated questions are covered in this first section.