Bizarre disease identified

A 20 year old young boy was brought to the department of Neurology, GGH, Guntur with
complaints of right foot automatically bending itself when he was walking. Dr Sundarachary Dr
Veeramma examined the patient and found that the patient had a variety of problems. His mother
told that the boy would try to touch and flirt with women unabashed. He also repeatedly washes
his hands and his slippers with an obsession of cleanliness. Dr Bindu, neurology post graduate
explained that the patient has a rare disorder called Tourette syndrome.

Patients exhibit compulsive tics-sniffing, snorting, involuntary vocalization. The problem begins
in childhood, in boys three times more often than in girls. Some patients display repetitive and
annoying motor behavior, such as jumping, squatting, or turning in a circle. Other common types
of repetitive behavior include the touching of other persons and repeating one's own words and
the words or movements of others. Explosive and involuntary cursing and the compulsive
utterance of obscenities.

The course of the illness is unpredictable. In half of adolescents the tics subside spontaneously
by early adulthood and those that persist become milder with time. Others undergo long
remissions only to have tics recur, but in other patients the motor disorder persists throughout
life.

Poor control of temper, impulsiveness, self-injurious behavior, and certain sociopathic traits are
seen in some but by no means all affected children.

As to causation, little is known. The disease is unrelated to social class or to psychiatric illness;
there is no consistent association with infection, trauma, or other disease.

Treatment

Clonidine and guanfacine have been useful in several studies. The neuroleptics haloperidol,
pimozide, sulpiride, and tiapride have proved to be effective therapeutic agents but should be
used only in severely affected patients.

- Courtesy Adams Text Book of Neurology.