Tourette's Syndrome
Georges Gilles de la Tourette 1857-1904

Georges Gilles de la Tourette
1857-1904

In 1885 Dr. Georges Gilles de la Tourette first described nine patients with the syndrome of multiple motor and vocal tics, a movement disorder that now bears his name.

Tourette syndrome (TS) is defined by multiple motor and vocal tics beginning before age 18 and lasting for more than one year. The first symptoms usually are involuntary movements (tics) of the face, arms, limbs or trunk. They may also involve the entire body, such as kicking or stamping. Many persons report what are described as premonitory urges — the urge to perform the activity before doing so. Often these movements can be delayed or suppressed for periods of time (like suppressing the need to scratch an itch or the need to sneeze). Other symptoms such as repetitive touching, intrusive thoughts, and compulsions can occur.

See more about Tourette's

There are also verbal tics, which may include grunting, throat clearing, shouting or barking. Despite widespread publicity due to their dramatic nature, coprolalia (the involuntary use of obscene words or socially inappropriate words and phrases) and copropraxia (obscene gestures) are uncommon in TS.

 

Echo phenomena are sometimes reported, and may include repeating words of others (echolalia), repeating ones own words (palilalia), and repeating the movements of others.

There is a waxing and waning phenomenon – the tics seem to get better and then worse, and individual tics may change over time, being replaced by others.

Associated conditions can include ADHD, impulsiveness, ODD (oppositional defiant disorder), OCD (obsessive compulsive disorder), and learning disabilities. Males are affected 3 to 4 times as often than females.

The Studies

 

The studies listed below are organized by date, with the most recent date first. Some of the full texts will need a password because they are kept in a locked file to protect their copyright. For educational purposes, we are allowed to share the password with you if you write to us.

If you are trying to find a particular author, see the Index below which lists all the primary authors alphabetically with their publication dates.

Author Index
  1. Comings 1990
  2. Cortese 2008
  3. Gerrard 1994
  4. Gorman 2006
  5. Kompoliti 2009
  6. Mantel 2004
  7. Sandyk 1992
  8. Wurtman 1992
  9. Young 2008
  10. Zou 2011
Zou 2011: Excitatory chemicals (e.g. MSG) in food & TS

Tourette syndrome and excitatory substances: is there a connection?  Zou LP1, Wang Y, Zhang LP, Zhao JB, Lu JF, Liu Q, Wang HY., Child’s Nervous System,  2011 May;27(5):793-802.

…  An increase in ephedrine type, testosterone, and stimulants may be related to the pathogenesis of TS. Unhealthy food possibly causes TS. The relationship between excitatory substances and TS needs to be explored with the goal of providing more information on diagnosing and treating TS.

MedLine || Full Text

Kompoliti 2009: use of alternative treatments for TS

Complementary and alternative medicine use in Gilles de la Tourette syndrome, Kompoliti K1, Fan W, Leurgans S.,    Movement Disorders, 2009 Oct 15;24(13):2015-9.

… Consecutive TS patients or their parent(s), seen in an academic movement disorder center, completed a questionnaire regarding their use of CAM (complementary and alternative medicine). One hundred TS patients or parents completed the questionnaire … Sixty four patients had used at least one CAM modality. CAM treatments used were prayer (28), vitamins (21), massage (19), dietary supplements (15), chiropractic manipulations (12), meditation (10), diet alterations (nine), yoga (nine), acupuncture (eight), hypnosis (seven), homeopathy (six), and EEG biofeedback (six). Fifty six percent of patients using CAM reported some improvement. Users paid out of pocket for 47% of treatments pursued, and 19% of these payers received partial reimbursement by third party payer. … Among CAM users, 80% initiated CAM without informing their doctor. CAM is commonly used in children and adults with TS, and often without the neurologist’s knowledge. Physicians should inquire about CAM to understand the spectrum of interventions that patients with TS use.

MedLine

Young 2008: Mercury in vaccines related to neurodevelopmental disorders

Thimerosal exposure in infants and neurodevelopmental disorders: an assessment of computerized medical records in the Vaccine Safety Datalink. Young HA, Geier DA, Geier MR., Journal of the Neurological Sciences, 2008 Aug 15;271(1-2):110-8. Epub 2008 May 15.

The study evaluated possible associations between neurodevelopmental disorders (NDs) and exposure to mercury (Hg) from Thimerosal-containing vaccines (TCVs) by examining the automated Vaccine Safety Datalink (VSD). . . . Exposures to Hg from TCVs were calculated by birth cohort for specific exposure windows from birth-7 months and birth-13 months of age. . . Consistent significantly increased rate ratios were observed for autism, autism spectrum disorders, tics, attention deficit disorder, and emotional disturbances with Hg exposure from TCVs. . .

MedLine || Full Text || Get Password

Cortese 2008: Iron connected to ADHD, TS, & restless legs

Attention-deficit/hyperactivity disorder, Tourette’s syndrome, and restless legs syndrome: The iron hypothesis Cortese S, Lecendreux M, Bernardina BD, Mouren MC, Sbarbati A, Konofal E., Med Hypotheses. 2008;70(6):1128-32. Epub 2007 Dec 27.

Preliminary but increasing evidence suggests that attention-deficit/hyperactivity disorder (ADHD), Tourette’s syndrome (TS), and restless legs syndrome (RLS) may be comorbid. . . . Iron deficiency might lead to ADHD, RLS and TS symptoms via its impact on the metabolism of dopamine and other catecholamines, which have been involved into the pathophysiology of ADHD, TS, and RLS. We speculate that the catecholaminergic systems are differently impacted in each of the three disorders, contributing to a different specific phenotypic expression of iron deficiency. MRI studies assessing brain iron levels in ADHD, TS, and childhood RLS, as well as genetic studies on the specific molecular pathways involved in iron deficiency, are greatly needed to confirm the iron hypothesis underlying ADHD, TS, and RLS. …

MedLine || Full Text || Get Password

Gorman 2006: Iron related to brain volume in TS

Ferritin levels and their association with regional brain volumes in Tourette’s syndrome. Gorman DA, Zhu H, Anderson GM, Davies M, Peterson BS., Am J Psychiatry. 2006 Jul;163(7):1264-72.

“. . . The authors measured peripheral iron indices in a large group of Tourette’s syndrome and comparison subjects and explored associations of ferritin levels with regional brain volumes. . . . Ferritin and serum iron were significantly lower in the Tourette’s syndrome subjects, although still within the normal range. . . . The lower peripheral ferritin and iron levels in persons with Tourette’s syndrome are consistent with findings in other movement disorders and suggest that lower iron availability may have a causal role in the pathophysiology of tic disorders. Lower iron stores may contribute to hypoplasia of the caudate and putamen, increasing vulnerability to developing tics or to having more severe tics. Lower iron stores may also contribute to smaller cortical volumes and consequently to reduced inhibitory control of tics.”

MedLine || Full Text

Mantel 2004: Supplements & alternative treatments in TS

Nutritional supplements and complementary/alternative medicine in Tourette syndrome, Mantel BJ1, Meyers A, Tran QY, Rogers S, Jacobson JS.,  Journal of Child Adolescent Psychopharmacology, 2004 Winter;14(4):582-9.

Of 115 respondents, 87.8% reported using 1 or more of 29 nutritional supplements to control symptoms. Many also reported using other CAM. Most supplement users reported an improvement in tics…. Given that most of our respondents were also using conventional medication, further study of the use of supplements and other CAM therapies by people with TS, the safety and efficacy of such therapies in this population, and possible interactions of such therapies with conventional treatment seems warranted.

MedLine || Full Text || Get Password

Gerrard 1994: Case studies on tics related to foods

Neuropharmacological evaluation of movement disorders that are adverse reactions to specific foods. Gerrard JW, Richardson JS, Donat J, International Journal of Neuroscience 1994 May;76(1-2):61-9

Three cases are reported of patients who had episodic movement disorders triggered by foods or components of the diet. In the first patient, the movement consisted of shaking the head from side to side that was triggered by milk and a number of other foods. In the second patient, the movement consisted of a repeated shrugging of the shoulders that was triggered by egg and coffee. In the third, the movement consisted of rhythmic contractions of the arms and legs that were triggered by aspartame. … These observations suggest that, in susceptible individuals, foods can trigger movement disorders through an action on dopamine and other neurotransmitter pathways in the brain.

MedLine

Wurtman 1992: Effects of food on the brain

Effects of foods on the brain. Possible implications for understanding and treating Tourette syndrome. Wurtman RJ. Adv Neurol. 1992;58:293-301.

Review. Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge 02139.

Sandyk 1992: Review of tryptophan use in CNS disorders

L-tryptophan in neuropsychiatric disorders: a review, Sandyk R, The Inernational Journal of Neuroscience, 1992 Nov-Dec;67(1-4):127-44.

Animal data indicate that serotonin (5-HT) is a major neurotransmitter involved in the control of numerous central nervous system functions including mood, aggression, pain, anxiety, sleep, memory, eating behavior, addictive behavior, temperature control, endocrine regulation, and motor behavior. Moreover, there is evidence that abnormalities of 5-HT functions are related to the pathophysiology of diverse neurological conditions including Parkinson’s disease, tardive dyskinesia, akathisia, dystonia, Huntington’s disease, familial tremor, restless legs syndrome, myoclonus, Gilles de la Tourette’s syndrome, multiple sclerosis, sleep disorders, and dementia. The psychiatric disorders of schizophrenia, mania, depression, aggressive and self-injurious behavior, obsessive compulsive disorder, seasonal affective disorder, substance abuse, hypersexuality, anxiety disorders, bulimia, childhood hyperactivity, and behavioral disorders in geriatric patients have been linked to impaired central 5-HT functions.

Tryptophan, the natural amino acid precursor in 5-HT biosynthesis, increases 5-HT synthesis in the brain and, therefore, may stimulate 5-HT release and function. Since it is a natural constituent of the diet, tryptophan should have low toxicity and produce few side effects. Based on these advantages, dietary tryptophan supplementation has been used in the management of neuropsychiatric disorders with variable success. This review summarizes current clinical use of tryptophan supplementation in neuropsychiatric disorders.

MedLine 

Comings 1990: Tryptophan in ADHD and TS and families
Blood serotonin and tryptophan in Tourette syndrome, Comings DE, American Journal of Medical Genetics, 1990 Aug;36(4):418-30.

Blood serotonin and tryptophan levels were studied in 1,440 individuals. These included patients with Tourette syndrome (TS), attention deficit hyperactivity disorder (ADHA), or ADHD with a family history of TS (ADHD 2 degrees TS); relatives (parents, sibs) of these patients; other patients with TS-like disorders; and controls. … The low blood serotonin and tryptophan levels in TS are consistent with the wide range of behavioral disorders seen in TS and suggest tryptophan oxygenase as a possible candidate gene.

MedLine

The Diet Connection

Through our Facebook groups, the members have been reporting Tourette’s symptoms and diagnosis far more often in recent years.  While we do not know the reason for this, we are pleased to hear from many of the parents that the Feingold diet consistently improves or controls Tourette’s Syndrome. We are still waiting for somebody to do the research to show WHY this happens.


Sheila Rogers of the Association for Comprehensive NeuroTherapy has collected an enormous amount of information about triggers for TS and how to deal with them in her book, Natural Treatments for Tics and Tourette’s: A Patient and Family Guide.

Natural Treatments for Tics & Tourette's by Sheila Rogers

Click to go to Amazon.com

 

More ... about the research

As for research in the MedLine, there have been some intriguing studies … Zeisel in 1986, said “Diet clearly influences neurotransmission” in his discussion of tryptophan, tyrosine, choline, and food additives. There have been numerous studies “around the edges” without actually studying the effect of diet on TS.

Thus, studies have been done on neurotransmitter levels and TS, and Tryptophan levels and TS. Studies have been done showing that salicylates affect both tryptophan levels and neurotransmitter changes. We know that TS and ADHD are connected, and TS and autism are connected – and diet affects both of them. Both TS and ADHD have been related to low serotonin levels in the family, and salicylate has been shown to have an effect on serotonin.

Many doctors believe that TS is the inability to screen out random firing of neurons (nerve cells). We know from research that some food dyes increase random neuron firing and cause nerve cell membrane changes. Dr. Lau (2006) showed that when a food dye is combined with another additive (MSG or aspartame) the nerve cells suffer much more damage than when they are subjected to just one additive. We believe that any chemical that has been found to damage nerve cells should be avoided by people with TS.

Most of these studies, however, have not been intentionally connected to the problem of TS, and nobody has yet pulled them together to see what all that might mean for TS treatment. This brings us back to the first sentence – parents consistently report that the Feingold diet helps improve symptoms, sometimes quickly and sometimes slowly, but we certainly believe that avoiding the additives (and possibly the salicylates) can be an important piece of the puzzle.

Hayden's story

 

Summer, 2007:

Hayden

Hayden

My son, Hayden, had mild symptoms of a tic disorder starting at a very young age. He would stutter for short periods of time or make little sounds or movements. His tics were the “transient” variety, and not of major concern.

By age eleven he developed a noticeable tic that involved the shaking of his head in rapid patterns of two to three shakes accompanied by a variety of small, vocal tics. The head shaking was persistent, severe and increased in frequency over a period of weeks. I noticed the head shaking was at its worst when he ate artificially flavored, brightly dyed foods.

When a pediatric neurologist diagnosed my son with Tourette Syndrome, I immediately thought of the Feingold Association because of something I had researched years before. I quickly concluded that removing the synthetic chemicals from food and toiletry items might help my son, and posed far less risk than medications.

My son began eating only Feingold-acceptable brands of foods and using only Feingold-acceptable toiletry items with astounding results. In a mere 72 hours we saw his head shaking subside. Over a period of only thirty days, all tics virtually disappeared.

Hayden has been on the Feingold diet for several months now. If he consumes unacceptable foods on any given day, by nightfall we see little tics developing, primarily vocal. He is aware of his symptoms and their relationship to his eating habits. Once a tic starts he enthusiastically returns to good eating habits and always with fast results. Tics are typically reduced to a non-noticeable level or eliminated by the following day.

I checked with my son about using his story, and in keeping with his general outlook, he said “Sure! Use my name and my picture if it will help other people!” He is just a sweetheart.


 

2010 update:

Hayden turned 14 in October and is doing great!

Occasionally, I get to know families with a child diagnosed with Tourette’s who turned immediately to drugs, which were instantly offered to Hayden upon diagnosis. Honestly, I hear horror stories and for most of the children the drugs severely worsened tics, impacted moods and caused changes in appetite (some increases, some decreases).

We continue to be thankful for starting Feingold within a week of Hayden’s diagnosis of Tourette’s Syndrome. Looking back to summer of 2007, had we gone any other route, he might well be in horrible shape right now, rather than virtually tic-free.

I cannot recommend strongly or passionately enough that parents explore environmental/diet chemical reduction prior to exploring drugs for their children. Though having tics disappear within 72 hours of being on the Feingold diet, as was the outcome with Hayden, might present an unrealistic hope for some, I cannot help believing it is a realistic hope for many. The bright dyes in candies, frostings, frozen treats, breakfast foods, fruit snacks, soft drinks and hundreds of other dietary items are triggers for my son’s tics. Avoiding all those blue, green, orange, red, yellow, and purple dye-laced foods is now a daily habit for our entire family. We all feel better!

Editor’s Note: From member reports, it seems that some children respond quickly with improvement in tics within a week or so. Other children respond slowly, over a period of six months or more. These parents generally kept using the diet because other symptoms had improved. There has been no research directly considering the use of the Feingold (or any other) diet for Tourette’s Syndrome, but there has been research showing that the artificial colorings trigger an increase in random neuron firing in the brain.