The first symptoms of Tourette Syndrome (TS) usually are involuntary movements (tics) of the face, arms, limbs or trunk. These tics are frequent, repetitive and rapid. The most common first symptom is a facial tic (eye blink, nose twitch, grimace), and is replaced or added to by other tics of the neck, trunk, and limbs.
For a person to be diagnosed with TS pursuant to DSM-5 criteria, they must:
- have both multiple motor tics (for example, blinking or shrugging the shoulders) and vocal tics (for example, humming, clearing the throat, or yelling out a word or phrase), although they might not always happen at the same time.
- have had tics for at least a year. The tics can occur many times a day (usually in bouts) nearly every day, or off and on.
- have tics that begin before they are 18 years of age.
- have symptoms that are not due to taking medicine or other drugs or due to having another medical condition (for example, seizures, Huntington disease, or postviral encephalitis).
These involuntary (outside the patient’s control) tics may also be complex, involving the entire body, such as kicking and stamping. Many persons report what are described as premonitory urges — the urge that comes before a tic. Other symptoms such as touching, repetitive thoughts and movements and compulsions can occur.
Vocal tics may occur with the movements, and can include grunting, throat clearing, shouting and barking. Vocal tics may also be expressed as coprolalia (the involuntary use of obscene words or socially inappropriate words and phrases) or copropraxia (obscene gestures). Despite widespread publicity, coprolalia/copropraxia is uncommon with tic disorders.
Echo Phenomena (Echo Speech or Echolalia)
These types of tics are also reported, although less frequently. These may include repeating word of others (echolalia), repeating ones own words (palilalia), and repeating movements of others. Neither coprolalia/copropraxia or echolalia is necessary for the diagnosis of Tourette syndrome. However, for a confirmed diagnosis of TS both involuntary movements and vocalizations must be present.
Co-occurring conditions can include ADHD/ADD, impulsivity, and obsessive compulsive behavior. There is usually a family history of tics, Tourette Syndrome, and/or ADHD, and/or OCD. Tourette Syndrome and other tic disorders occur in all ethnic groups.