Male2: …now just looking at that, you cannot tell whether that is a compulsive act as it is—the typical tic is a quick movement of a small part of the body, a twitch, an eye blink, but a compulsion involves some harm of ways and in other words, like hand washing compulsions are done because I am afraid that I am going to contaminate people. I have germs on me and I have to wash my hands a hundred times a day, two thousand times a day or whatever. I am doing that for a purpose.
The young student who jumped up and touched the ceiling, I asked him, why he was doing it. Now, if he told me he was doing this because his mother was going to die if he did not—that would have been a compulsion. He was doing it because it was a pleasure.
Another young lady who noticed a cabinet in my office opened, she went over and closed it because she told me that she does this all the time at home, it drives her family crazy. She keeps doing this. She would close doors and closet doors. I also asked her what would happen if she did not do it and she said, she liked it. She was glad when she would find a door open—so there, that was a tic. It is what we call a complex tic. It is not that typical twitch, so some behaviors can be compulsions. There are also other neurologic conditions that are not tics. I mentioned that tics are stereotyped. A writhing movement that could be more fluid and found to be always the same when it could be something called chorea, so there are neurologic movement disorders. There are behaviors that are—such as compulsions, so they are not all tics.
Male1: Can stress make Tourette Syndrome worse?
Male2: That is a great question. Yes, it can make it worse transiently, while you are under stress. It does not make the disorder worse.
Male1: It makes the symptoms worse for that moment.
Male2: For that particular period of time. The Tourette Syndrome Association has support groups, so there is a collection of people with Tourette Syndrome. They often go home and their tics are much worse. They get stereo—but it worse for a while.
Male1: Any truth that strep plays in some of these movement disorders?
Male2: Yes, it is a very interesting finding. The strep organism has a protein coat that has some similarities to human tissue and the formation of antibodies to beta hemolytic strep organism. Those antibodies potentially can attack one’s own tissues. This is why pediatricians are aggressive about treating strep throat because we do not really want that person to develop an antivirus. You can get rheumatic heart disease—Sydenham’s chorea is a neurologic condition. You can get a kidney problem—glomerular nephritis and now we know that it also can at least make worse or perhaps cause anorexia, it suddenly can make worse Tourette Syndrome. We see people after perhaps with sore throats, and this is looked at and we have some more science to this. There is an increase in antibody titers and various indicators of the antibody response that are correlated with the streptococcal infection and an increase in tics.
Obsessive compulsive disorder is common with Tourette Syndrome and will also sometimes see after strep infections an increase in compulsive symptoms. Not all obsessive compulsive disorders are related to this and not all tic disorders are related to this strep condition. Some people have heard it, it goes by an acronym—PANDIS—Pediatric Autoimmune Neurologic--
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