Tuesday, August 17, 1999
SAN JOSE MERCURY NEWS

Tourette’s Syndrome May Be Tied to Strep

Many little boys have a twitch here, a tic there, a flutter in the eyelid. Most of the time it’s benign and short-lived. But, occasionally, tics can become so persistent that they get in the way of a boy’s life. They can make him fearful of being teased, ashamed of being different and convinced he has something to hide. That’s when it’s time to see a specialist.

Tourette’s syndrome has long been misunderstood. Its best-known trait—coprolalia, the spontaneous outburst of foul language—appears in fewer than 20 percent of Touretters (as they sometimes call themselves). And though it often goes undiagnosed by general practitioners, psychiatrists say the diagnosis is really quite straightforward.

Tourette’s is a neurological disorder marked by tics and involuntary bursts of noise, experienced over a long period of time. In fact, recent studies suggest it may affect one in every 400 people—almost all of them male.

But the most astonishing news has been the finding that strep throat, a minor bacterial infection, may trigger Tourette’s in some children. Researchers at Johns Hopkins University in Baltimore, Md., made that connection after they observed that some patients with rheumatic fever (a possible complication of strep) went on to develop tics and other symptoms of obsessive-compulsive disorder.

Last year, the researchers published a study in the journal Neurology. Among other things, they suggested that the immune system’s response to strep could lead to an attack on the brain nerve cells in a subset of genetically predisposed children.

Nor is Tourette’s the only psychological illness implicated. The same bacteria and viruses that cause physical disease may also unleash a number of mental and emotional illnesses.

Though there is almost certainly a genetic component to Tourette’s, it appears that many children may inherit the gene without ever showing a single symptom of the illness. And for some, it appears that an environmental trigger, such as strep throat, is required to set it in motion.

Now, based on these findings, some doctors have begun giving penicillin to children with mild tic symptoms. The thinking is that this may prevent a recurrence of strep that could lead to a worsening of symptoms.

Even in a confirmed case, the symptoms of Tourette’s fluctuate, exacerbated by life’s stresses and strains. Caffeine—in coffee, tea, chocolate and soft drinks—makes tics worse. Ritalin and Dexadrine, stimulant medications commonly prescribed for attention deficit/hyperactivity disorder, may trigger symptoms, and doctors should be aware of this potential before writing a prescription. Many boys who develop Tourette’s first show symptoms of ADHD.

Allergies also place a physiological stress on the body, and it’s not uncommon for tics and outbursts to worsen during pollen season. The same is true of emotional stresses, both good and bad—from anxiety (say, around the first day of school) to the excitement of Christmas, holidays and birthdays.

And though it’s usually first observed when a child is 7 or 8, chances are it will get worse in adolescence.

“If you think of Tourette’s as an illness of stress and strain then it’s easy to see why it worsens in adolescence,” says Thomas L. Lowe, psychiatrist and director of the Tourette’s and Tic Disorders Clinic at the University of California-San Francisco.

Many times, symptoms die down in the early adult years. Though they may never disappear completely, such spontaneous reduction occurs in nearly half of all Tourette’s patients.

“We treat the disorder when the symptoms are significant enough to interfere with the child’s functioning,” explains Lowe. “In the teen years, someone with visible, audible tics can present quite a target in a group. It can affect his self-esteem. When we treat, it’s because of those kinds of interferences, not because one has to remove a symptom.”

Copyright 1999 San Jose Mercury News