Tourette’s syndrome is characterised by involuntary tics, repetitive movements and vocalisations and can lead to significant disturbance when engaging in daily activities.
Clinical neurofeedback is based on the concept of the neuroplasticity and the mechanism ofaction is operant conditioning. Clinical neurofeedback has been found to be effective in improving brain function.
Clinical hypnotherapy is said to deal with the unconscious processes of the mind and can be used to help treat a variety of disorders. In this case study, with a client diagnosed with Tourette’s syndrome, intervention included a combination of clinical neurofeedback and hypnotherapy.
This combination of interventions led to a significant improvement in the client’s condition over time. Future studies might make more use of psychological testing to understand client’s progress and also include long term follow up
Hiro sharing session about the Tourette Syndrome on the Lite FM breakfast show - 19th February 2019.
Hiro discussed about the prevalence and awareness about Tourette Syndrome.
We also discussed about the treatment option etc.
If you missed the show, welcome to read some tips below:
8 Ways to Deal with Ticcing in Public
Medical ID Card/Bracelet
When you were a kid, your mother might have carried one of those “I have Tourette” cards. Some stranger would make a rude remark, or you’d be having a visible/audible tic in the grocery store, and mom would flash the card. It might have helped you both in some situations. If your tics are quite severe, one of these cards in your wallet is probably still a good idea, just in case someone seriously misinterprets your movements or sounds. It’s not for flashing at random strangers, though (and you might prefer a Medic-Alert style bracelet or pendant for more difficult situations).
For your public outings, we suggest seven more methods for coping with tics that won’t stay in the closet when you’re out and about:
Don’t isolate yourself
It’s tempting, especially if you get nasty remarks and curious looks, but you’ve got as much right to enjoy public spaces and places as anyone else. In totally public venues like the local library, the swimming pool, the shopping mall, or the sidewalk, don’t worry about doing anything special. These places belong to everyone, and that includes you. Some “public” places are a bit different, because other people come to them with certain expectations: upscale restaurants, the opera, that sort of thing. For these rare exceptions, see below.
Bring something attention-absorbing
When your mind is totally focussed, your tics tend to recede. Waiting around in a public place might cause tics to come to the forefront Always carry a book of really hard crosswords, number puzzles, a hand-held computer game, needlework, sketchbook, an iPod with the ultimate party mix, or something similarly engrossing, and let yourself really get absorbed by it. Not only are you less likely to tic, but you won’t even sense it if you do, and you won’t observe any stares from other patrons either.
Bring a friend
If you’re enjoying their company and they’re enjoying yours, it will put strangers around you at ease. They may notice your tics, but they’ll also notice that you’re obviously a normal guy or gal with friends who like you. It’s an automatic icebreaker.
Be prepared
Think about your current tics, and how you might minimize both your own discomfort and others’ potential reaction. For a spitting tic, bring a handkerchief so you can be discreet about it. If you’re sniffing loudly, try a bit of Vick’s VapoRub or similar strong-smelling ointment under your nose — it will change the sensation, quite possibly short circuiting the tic for a while. If you have complex tics that slow you up, allow extra time to get into and out of events. If you find that you’re better relaxed after an hour at the gym or yoga class, schedule your life accordingly. And so on…
Prepare others
For events where the noise level might not be high enough to camouflage vocal tics, contact the venue in advance to see if they can suggest a solution. Perhaps a private box can be arranged (and if it’s a disability accommodation, there really shouldn’t be any extra cost to you…). Many movie theatres now have “VIP Seating” for people who like to talk and canoodle during movies, and “Cry Rooms” for people who want to bring babies. These facilities can be helpful for you too.
Frame your response
If someone goes out of his way to be rude, use your judgement, but don’t be shy about defending your rights. You can reply directly with an explanation, complain to the management of the venue, or take your business elsewhere. The only thing you shouldn’t do is take it personally. You can’t control your tics, but you can raise the level of the dialog, and, just maybe, add to someone’s knowledge.
Seek opportunities
Look for places where you can really let go: if you’re a (young?) rocker, head for loud clubs, rock concerts, that sort of thing. Other activities to explore include running, skiing, swing dancing, swimming, bicycling—all provide wonderful energy outlets.
J.Y
developed motor tics about 3 years ago (at the age of 9). At age 11, she
developed vocal tics. It was so apparent that people/friends started to ask her
why she made those barking sound. We started researching and found/came across
on the website, Hiro Koo, who provides clinical hypnosis &
neurofeedback therapy. On 13 Sept 2017 after an initial assessment on her brain
waves, her condition improved after 3 sessions but it was not stable. Some good
days, some bad days. J.Y completed 20 sessions of neurofeedback therapies. On 5
March 2018, Hiro did another assessment on her (qEEG Brain Mapping). This assessment
gave a more detailed report on J.Y’s brain waves. From this report, Hiro
was able to zoom in on problem areas & commenced new protocol according to
the assessment. After 10 sessions, we see vast improvement in J.Y’s condition.
Her tics reduced dramatically (in just 6 weeks) and her condition was more
stable.
Remark: Our client's information will be kept strictly confidential
all the time. All reviews and photos have been acknowledged and
provided by past and current clients of Hypnosis Integrative Hub
(Clinical Hypnotherapist Hiro Koo). Clients names have been changed to
protect their identity.
It is my honour to be one of the Tourette Syndrome (TS) expert panels together with renowned psychiatrist Ass. Prof Dr Amer at the Astro Ria PM live today. I am glad to promote the Tourette Syndrome awareness with other specialists and hope more will come. It is indeed an exciting experience to share about the concept of clinical hypnotherapy, EEG biofeedback and psychotherapy method in managing the TS symptoms.
The Application and Efficacy of Combined Neurofeedback Therapy and Imagery Training in Adolescents With Tourette Syndrome
Two patients, aged respectively 14 and 16 years, had been treated with haloperidol and tiapride; however, this medication was ineffective and accompanied by intolerable side effects.
In this study, the patients completed 80 sessions of neurofeedback treatment followed by imagery training. The patients were assessed with behavior rating scales both before and after the treatment as well as during follow-up examinations to evaluate the effect of the combined therapy.
Patients showed significant improvement in motor tic and vocal tic symptoms, exemplified by a reduction in the frequency and intensity of tics, indicating that neurofeedback, together with imagery training, has a positive therapeutic effect on adolescent patients with medication-refractory Tourette syndrome.
Newmindcentre.com: We provide both services (Clinical Neurofeedback and Imagery Training) to help for Tics Disorder and Tourette Syndrome. Text us via 0167154419 if you are interested.
Most of the time, some sounds like throat cleaning sound, sniffing, or grunting sound will come out involuntarily by my son's mouth. He is a patient who suffered from Tics disorder (Tourette Syndrome and ADHD). People around my son felt annoyed with his noisy sound. It affected his daily life and he feels ashamed of it. He even get bullied by his friends in school.
To get rid of it, my son visited neurologists and ate medicines. However, it only can be controlled at the very beginning and it seems that his body started to resist it with some side effects. I even went to temples and visited monk before. He lived with this condition and suffered for 2 years until I follow Hiro Koo's brain training, finally I saw hope.
After following the training session with Hiro Koo, his vocal tics reduced significantly, he have better self-control even without finding any distraction. Besides, My son regained his confidence and he have better mood every day. I was amazed by this technique as it is a very effective training to control my son's vocal tics.
The advantage of this brain training technique is that this is a natural approach without any pain and side effect. I definitely will recommend to people who suffered for similar issues.
Remark:
Our client's information will be kept strictly confidential all the
time. All reviews and photos have been acknowledged and provided by
past and current clients of Hypnosis Integrative Hub (Clinical Hypnotherapist Hiro Koo). Clients names have been changed to protect their identity.
Tourette Syndrome (TS) is difficult for some teachers to understand because every student has different symptoms, which can change, wax, and wane. Some teachers may not be well informed about strategies and techniques for recognizing the needs of students with TS, or the most effective teaching approach. Besides the tics, many common co-occurring conditions can be impairing, such as Attention Deficit/Hyperactivity Disorder (ADHD), handwriting difficulties, sensory integration or sensory processing disorders, obsessive-compulsive behaviors, and social skills deficits.
RECOGNIZING THE SIGNS IN SCHOOL SETTINGS
Educators and families should be aware of signs that may point to underlying symptoms of the common conditions that co-occur with TS. It is important to recognize the signs so that the additional support in school can be provided for students with Tourette Syndrome or other Tic Disorders. The following are common indications that additional support may be necessary:
Difficulty attending or staying at school
• A collaborative and positive working relationship with the school can assist in an honest discussion to determine why this may be occurring and then developing a proactive/positive plan to help.
Behavior issues at home or school
• Focusing on when, where, and why behaviors are occurring will decrease the chance of making assumptions and punishing the child. The Tourette Association provides several resources geared toward addressing challenging behaviors at school and strategies for these difficulties. Significant reluctance to completing work in school and/or homework
• This could be a sign that the child has difficulties in the following areas: handwriting difficulties, problems with memory, processing delays, or difficulties with organization. It may also be due to fatigue, which can increase tics and symptoms of other disorders and make focusing more difficult. A meeting with appropriate school staff (such as the teacher, counselor, or others working with your child) to discuss why this is occurring can be helpful. An initial evaluation, or re-evaluation may be necessary to determine if specific skills deficits are the reason for this.
Dropping grades
• It is common for students with tics and co-occurring conditions to receive good grades in elementary school and then experience a decline in the grades in middle and high school. An updated education evaluation/assessment will assist in determining if hidden symptoms may be responsible and assist in identifying appropriate supports.
Increase in tics, anxiety, and obsessive compulsive behaviors
• This may be an indication that a meeting with school staff is needed to discuss any changes that may be increasing anxiety. Discussions should include difficulties with peers and specific teachers or support personnel.
Difficulty socializing with peers
• Screen for social language deficits, as they are common difficulties for students with TS that can severely impact peer interactions and friendships. The use of social stories may not be effective because students with TS often know what to do and say, but are inconsistently able to perform as they know they should and are sometimes capable of doing. Loss of interest in preferred activities
• Consider the environment to determine if there is something or someone increasing anxiety. It may also be due to some obsessive-compulsive behaviors related to attempts to achieve perfection.
Tourette syndrome (TS), also known as Tourette’s Disorder, is a neurodevelopmental disorder characterized by multiple motor tics and at least one vocal tic present for greater than one year. Among the neurodevelopmental disorders in the DSM-5, TS is the most complex of the spectrum of tic disorders, which includes:
Tourette’s disorder
Persistent motor or vocal tic disorder: one or more motor or vocal tics have been present for greater than one year
Provisional tic disorder: motor and/or vocal tics have been present for less than a year.
Psychiatric disorders, such as obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD) frequently co-occur in TS. Tic symptoms typically begin in early childhood, peak before puberty, and attenuate later in adolescence.
Symptoms and phenomenology
Tics are rapid, repetitive, non-rhythmic movements or vocalizations. Motor and vocal tics are divided into two classes: simple and complex. Simple motor tics are brief movements involving one muscle group. Simple vocal tics are characterized by simple sounds.
Simple motor tics include eye blinks, facial grimaces, head and neck jerks, and shoulder shrugs. Briefly sustained postures (e.g., blepharospasm, oculogyric movements, and sustained mouth opening) can also be classified as simple motor tics.
Simple vocal tics include coughing, sniffing, throat clearing, grunting, and squeaking.
Complex motor tics are more purposeful or orchestrated patterns of movement; complex vocal tics are longer, more orchestrated patterns of speech.
Examples of complex motor tics are turning while walking, echopraxia (imitating gestures) and copropraxia (obscene gestures).
Complex vocal tics include repeated words or phrases, echolalia (repeating another person's words or phrases) and coprolalia (uttering obscenities). Although coprolalia can cause considerable social distress, it is infrequent, and occurs in only approximately 10% of patients.
A distinguishing characteristic of tics are the sensations that may precede the movement or sound, termed premonitory sensations or "urges." Sometimes patients can localize these feelings to particular parts of the body from which the tic emerged.
Even if not localizable, patients often describe a feeling of inner discomfort, using words such as a “build up of tension," or describe an unexplainable urge or impulse to perform the tic. Most patients experience an intensification of these sensations or urges when they suppress their tics.
Patients also often describe a strong need to repeat the tic until it feels "just right". After performing the tic, a sense of relief is experienced, although sometimes brief.
Descriptions of these sensations may be difficult for younger patients to express, but there is a quantitative, pictorial rating scale of these urges that can be used with children.
Epidemiology
TS is reported worldwide, with prevalence from 0.3% to 0.9%. It affects boys 3 to 4 times more frequently than girls.The vast majority of individuals with TS have behavioral and/or emotional symptoms or disorders; only 12% across all ages are reported to have only tics without other associated conditions.
From a worldwide dataset, ADHD is the most common comorbid psychiatric disorder, and accounts for about 55% of the behavioral findings. Other disorders, such as mood and anxiety disorders and learning disorders, are also frequently present.
Etiology
The cause of TS remains unknown, although evidence from genetic studies suggests that TS is inherited. Genetic factors seem to be the most important etiology, given significant familial aggregation and supporting twin studies.
Monozygotic twin studies show 53% concordance for TS and 77% for persistent (chronic) motor tics, whereas dizygotic twins show 8% and 23% concordance, respectively.
Environmental factors, including perinatal insults, sex-hormone exposure during brain development, and psychosocial stressors, are also thought to contribute, and thus the overall expression of TS is thought to be multifactorial.
Diagnosis
Diagnosis is made by a comprehensive clinical history from reliable sources, most often parents. Currently there is no identifiable biological marker for a TS diagnosis. A thorough, detailed history focusing on onset, time course, phenomenology such as urges or sensations, exacerbating and ameliorating factors, family history, and comorbid symptoms is essential. A general medical and neurological exam is indicated.
When eliciting history from the parent and patient, inquiry regarding onset of tics is important, as they typically begin in early childhood, followed by a waxing and waning course. Often tics worsen in late childhood prior to puberty.
Although tics tend to wax and wane, with one tic replacing another, sometimes tics can present abruptly or in acute bursts. Explosive, acute onset over 24 to 48 hours, particularly of OCD symptoms, may be suggestive of infectious or autoimmune etiology.
Potential day-to-day exacerbating factors, such as medications (stimulants in some patients, including caffeine and over-the-counter decongestants or cold remedies), fatigue, boredom, and stressors should be noted.
Tic symptoms may be difficult to disentangle from other common childhood symptoms of allergies or cough-variant asthma. Inquiry regarding seasonal patterns, and presence of other allergy-associated symptoms such as rhinitis and post-nasal drip, can be helpful in the differential diagnostic process.
Additionally, at times it may be difficult to differentiate complex motor tics from compulsions, as OCD symptoms frequently co-occur in children with TS. Repetitive behaviors preceded by urges or sensations are more likely to be complex tics, whereas repetitive behaviors that are preceded by a cognition, often a worry, are more likely to be compulsions.
At newmindcentre.com, we provide help by using intervention such as:
1) EEG biofeedback training for Tics and Tourette Syndrome
2) Habit Reversal Therapy combined with Clinical Hypnotherapy
We are one of the international contacts of Tourette Association of America. We provide information and support to families in Malaysia.
For information on the latest treatment options, please visit the Tourette Association of America's treatment page or contact us via email: [email protected]
Brain scan of a child with Tourette's. Yellow indicates an area with less white matter than in the same brain region in kids who don't have the disorder. The scans also revealed areas in the brains of kids with Tourette's that have more gray matter than in children without the condition. Credit: Washington University School of Medicine
Using MRIs, researchers at Washington University School of Medicine in St. Louis have identified areas in the brains of children with Tourette's syndrome that appear markedly different from the same areas in the brains of children who don't have the neuropsychiatric disorder.
Tourette's syndrome is defined by tics—involuntary, repetitive movements and vocalizations. Scientists estimate that the condition affects roughly one to 10 kids out of every 1,000 children.
"In this study, we found changes primarily in brain regions connected to sensation and sensory processing,"said co-principal investigator Kevin Black, MD, a professor of psychiatry.
Differences in those brain regions make sense, Black said, because many people with Tourette's explain that their tics occur mainly as a response to unusual sensations. The feeling that a part of the body doesn't seem right, for example, prompts an involuntary sigh, vocalization, cough or twitch.
"Just as you or I might cough or sneeze due to a cold, a person with Tourette's frequently will have a feeling that something is wrong, and the tic makes it feel better," Black said. "A young man who frequently clears his throat may report that doing so is a reaction to a tickle or some other unusual sensation in his throat. Or a young woman will move her shoulder when it feels strange, and the movement, which is a tic, will make the shoulder feel better."
In the largest study of its kind, the researchers conducted MRI scans at four US sites to study the brains of 103 children with Tourette's and compared them with scans of another 103 kids of the same age and sex but without the disorder. The scans of the children with Tourette's revealed significantly more gray matter in the thalamus, the hypothalamus and the midbrain than in those without the disorder.
The gray matter is where the brain processes information. It's made up mainly of cells such as neurons, glial cells and dendrites, as well as axons that extend from neurons to carry signals.
In kids with Tourette's, the researchers also found less white matter around the orbital prefrontal cortex, just above the eyes, and in the medial prefrontal cortex, also near the front, than in kids without the condition.
White matter acts like the brain's wiring. It consists of axons that—unlike the axons in gray matter—are coated with myelin and transmit signals to the gray matter. Less white matter could mean less efficient transmission of sensations, whereas extra gray matter could mean nerve cells are sending extra signals.
Black said it's not possible to know yet whether the extra gray matter is transmitting information that somehow contributes to tics or whether reduced amounts of white matter elsewhere in the brains of kids with Tourette's may somehow influence the movements and vocalizations that characterize the disorder. But he said that discovering these changes in the brain could give scientists new targets to better understand and treat Tourette's.
"This doesn't tell us what happened to make the brain look this way," Black explained. "Are there missing cells in certain places, or are the cells just smaller? And are these regions changing as the brain tries to resist tics? Or are the differences we observed contributing to problems with tics? We simply don't know the answers yet."
Black said the researchers will aim to replicate these findings in additional patients and determine if and how the brain regions they identified may contribute to Tourette's syndrome, with a goal of developing more effective therapies.
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