Tourette Syndrome

Tourette Syndrome (TS) is a complex neurobehavioral disorder characterized by multiple motor tics, as well as vocalizations, which wax and wane. The motor tics involve specific muscle groups and can change from one part of the body to another. The vocalizations, or phonic tics, may involve grunting, sniffing, coughing, snorting, throat-clearing or other sounds.

The tics occur many times a day, nearly every day, or intermittently for more than a year. Many people believe that these tics and vocalizations are involuntary. However, many patients are able to exercise some control over these behaviors.

Studies indicate that more than 19 percent of children in regular education classes have tics and more than 23 percent of children in special education classes have tics. More than 7 percent of children in special education classes have Tourette Syndrome.

Successful treatment without medication

Commonly, Tourette Syndrome and its accompanying tics are treated with medications such as neuroleptics (tranquilizers), antidepressants and stimulants. The side effects of many of these medications can be significant and potentially life-threatening and often the patients discontinue them on their own.

Self-hypnosis (SH) has been used successfully to treat patients with TS. It can be used either as a primary treatment, without the use of medication, or as an adjunctive therapy in addition to medication. When used as an adjunct, medication can often be decreased or even discontinued.

Note: Although clinical hypnosis can be effective in the treatment of tics, it is not designed to treat other conditions that can be associated with TS, such as: Obsessive-compulsive behavior, attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), learning disabilities, immaturity, emotional lability, anxiety, self-injurious behavior, and personality disorders.

Tics and habits (without Tourette Syndrome)

Many children experience tics that last for a few weeks or a few months and often go away on their own. These patients do not have Tourette Syndrome, which is characterized by multiple motor tics and vocalizations that last more than one year.

[In a rare condition called PANDAS (pediatric autoimmune neuropsychiatric disorders associated with Streptococcal infections), tics are precipitated by a streptococcal infection such as a strep throat. You need not worry about your child getting PANDAS after a typical strep throat. It is mentioned here for the sake of completeness.]

Cough tic , or habit cough, is not uncommon in children. Typically, the patient develops throat-clearing behavior as a result of post-nasal drip associated with the common cold. Because the throat-clearing is comforting, the patient continues the behavior after the cold is gone. The patient forces a dry (unproductive) cough during the day, but the cough is absent while the child is asleep . Some parents report that the cough keeps the patient up at night, but on closer questioning, they realize that the cough is gone while the patient is actually asleep.

Often these patients have unsuccessfully tried medications. They have undergone tests such as chest x-ray or CT scan. They have seen subspecialists including ear, nose and throat (ENT) doctors and pulmonary (lung) specialists, and they have been told that there is nothing wrong.

Read the IHS Abstract (PDF): Treatment Of Tics In Tourette Syndrome With Training In Self-Hypnosis

Treatment

Usually, Dr. Lazarus first meets alone with the parents. Then, he sends an introductory letter to the patient ; the letter sets the tone and expectation for a positive outcome with the patient.

At the first visit, Dr. Lazarus gets to know the child, emphasizes that he will help the patient help him/herself, and assigns homework. The homework is designed for the patient to think about the tic in a different way.

At subsequent visits, the child watches a video of a boy who overcomes his cough tic through self-hypnosis; he is clearly empowered and happy during and after the treatment. The video offers the reassurance of knowing that other kids have this problem, too, and gives children a sense of hope.

Results: 17 of 20 patients had dramatic improvement after two or three visits with Dr. Lazarus. Not surprisingly, success is directly related to motivation and compliance. When patients are motivated, this technique works quite well.

Nicholas' story
“We flew to Cleveland because Nicholas had reached the end of his rope. Our pediatrician had treated him with allergy medicines and a nebulizer before diagnosing him with Tourette Syndrome. Then, a neurologist at a renowned hospital recommended that he take an anti-psychotic medication for his tics.

“His father and I decided this was not a road we wanted to travel, and we began to look for alternative methods of treatment. Fortunately, our research led us to Dr. Lazarus. We flew to Cleveland in search of an answer.

“Our son's first appointment went well and he was excited to return a month later. At his second appointment, he learned techniques to help himself to get better. He practiced his techniques daily. As his tics faded away, his self-confidence grew, his self-esteem improved, his performance at school improved and his spirit returned.

“Dr. Lazarus empowered our son with a tremendous gift that he will carry with him everywhere. We cannot begin to express our gratitude for the time and confidence he has given to our son.” -- mother of 12-year-old Nicholas

Michael's story
“I can't tell you the impact that Dr. Lazarus has had on our family. Our son, Michael , has always been a straight-A student, and he got kicked out of school for disturbing other people with a cough tic. It really disturbed him that he was disturbing others.

Dr. Lazarus had such an impact. Our son doesn't have any tics anymore. We are in the process of relocating to another city, but Dr. Lazarus is still our pediatrician regardless of where we live. If he asked me to come to the west coast on a red-eye to help support him, I'd do it. That's how much he means to us.” --Father of 8-year-old Michael

Caroline's story
“When a neurologist diagnosed Caroline with Tourette Syndrome, I went home and I started reading books and freaked out. As a parent, you think the worst. There was not a whole lot out there to help us figure out what to do about this, and I wasn't big on medication. When my daughter was ready and said, ‘The kids are making fun of me- I want this to stop,' we called Dr. Lazarus. In two or three sessions, she was tic free-until we told her we were going to have another baby, and then she started all over again. But that's a different story. We had a couple of tics then, too!

“My point is that Caroline's life has been enhanced by this. And it's a non-medication way to treat your child. The upside is vast and the downside is, I think, nonexistent.” -- Mother of 6 1/2-year-old Caroline

Steven's story
“My son is a real smart student and real sensitive, and the pain that we had to see him go through was terrible. What Dr. Lazarus did with him was just amazing, and my wife and I are both very thankful. We feel like we're friends forever. We are just very happy.” --Father of 10-year-old Steven

Brooke's story
“When we first discovered Brooke's tic, she would describe it as a flinch. In the beginning it was very strong, almost seizure-like. But we didn't want to jump to put our child on medication. Our pediatrician had heard Dr. Lazarus speak, and we thought it was certainly worth the trip, so we went to see him. Brooke loved him immediately and responded to him real well.

“It definitely has to be something the child wants to do. She picked one tic that bothered her the most and discussed it with him. They dealt with it. Most of her other tics have subsided. Instead of seeing a tic ten times a day, I see it once maybe every two weeks. It has really subsided, and she knows how to control it, and it's a great feeling.” --Mother of 6-year-old Brooke

Dr. Lazarus on tics:
“There is something about treating patients with Tourette Syndrome which is particularly rewarding for me. Tics are socially embarrassing, humiliating and unacceptable. Often these children feel frustrated, angry, sad and hopeless. Helping them is the most rewarding thing I do because patients feel relief from the pain of humiliation, are accepted by others and are often able to decrease and even discontinue their medication(s). This is extremely empowering for children and adolescents and boosts their self-confidence and self-esteem.”

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