Male1: Tonight we are going to discuss with Dr. Les Lanet, a psychiatrist movement disorders.
Male2: Hi I am Les Lanet, I am a physician specializing in child and adolescence occasionally, we are supervising that and also in adults occasionally and license to practice in New Jersey and New York.
We are going to talk about movement disorders, the most dramatic and famous one is Tourette Syndrome and it is most famous for one of its symptoms which I want to emphasize is not always present and not necessary to make the diagnosis, but it is the one that draws the most interest and fascination. The condition is Tourette Syndrome and the symptom that I am referring to is called Capillaria, that is the involuntary swearing, but what is involved with Tourette syndrome is multiple motor tics and vocal tics. The vocal tics do not have to be swearing, they do not have to be wordy, they can be little sounds like ugh! And motor ticks are stereotyped meaning, it is the same movement done over and over. It does not have to be one right after another, but you see the same twitch, the same shoulder shrug and it becomes part of who that person is that keep doing that.
Male1: What is the youngest you have seen or possibly has been diagnosed with Tourette’s type syndromes.
Male2: Well, tics are not uncommon in young children, but often they are transient. Often pediatricians will tell a family—do not worry about it, it will go away, and they are often right. Once a tic lasts for a year, it is generally lifelong and it is then a tic disorder. There is a condition called transient tic disorders, but they are by nature self limiting and disappear.
Male1: If the diagnosis of Tourette Syndrome is made, is there any treatments for it?
Male2: Yes, there is treatment and in this condition, there is a balance between the adverse effects of medicine and the benefit, so it depends on how severe the tics are. Some people’s tics, they live with it. It is a personal choice and it depends on how bad it is. Some tics are very socially embarrassing and that is a problem. Some tics cause pain because of the same muscle that is being used over and over again.
Male1: And in any phase in your practice, have you ever heard anybody getting help by behavior modification techniques.
Male2: I hear about it, but the more systematic studies do not support anything as actually being effective other than medicine and the medicines we have are not great for treating it. I mean, they can be very effective, but they all have—
Male1: Can Tourette’s get worse with time or better with time?
Male2: It can get worse. It can be either. There is a tendency for tics to get milder over time. If we look at people who are between ten and 20 versus 20 to 30 and each decade, we see the tics are a little milder with each decade, so that. There are also cases where the tics get worse.
Male1: Are there some kids who get a movement that looks like Tourette Syndrome, very close to it and is not Tourette Syndrome?
Male2: Well there are other movement disorders. Yes, well, some—I saw a youngster who played basketball for his high school and in my office, he would often jump up and touch the ceiling. Now what I am about to explain, most people do not know about, but you will know about it. That movement, that jumping up and touching the ceiling does not look like a typical tic. Now the way—however, this is a tic or a compulsion because you can do things that are compulsive. Just another quick example, the Tourette Syndrome Association had an educational video, it was years ago, I do not know if they still use it, but on that tape is a brother and sister with Tourette Syndrome and the boy is younger than the sister and at one point while they are being interviewed and while she is talking, she makes motions like this—towards her head, does not hit her, towards her shoulder and towards her waist.
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