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- [Voiceover] So you may have heard of Tourette's or Tourette Syndrome before, and it's possible that when you think about Tourette's, you might picture what's been kinda popularized in TV shows and movies, which is that people with Tourette's have these kind of verbal outbursts. And while this is possible in someone with Tourette's, this popularized image of Tourette's is actually not all that common. So if this isn't exactly what Tourette's is always like, then what is Tourette's? Tourette's is a disorder that causes the person to make sudden, really brief, unwanted movements and sounds. And just before these unwanted movements or sounds occur, the person actually feels this urge to make them. Kinda like that feeling you get when you have an itch that you really wanna scratch. Or like that feeling we get just before we're about to sneeze. And just like itching and sneezing, right after doing these things, the person feels a sense of relief. So an example of an unusual or unwanted movement could be something like unnecessary blinking or facial expressions, or maybe shrugging the shoulders or kicking. And an unusual unwanted sound could be something like grunting or repeating words, or maybe swearing. And there's actually a word to describe these movements and sounds. They're called "tics." So Tourette's is actually a particular type of tic disorders. There are a few different types of tic disorders, and what makes Tourette's different from the other types is that someone with Tourette's has both of these types of tics. So the movements and the sounds. They might not occur together at exactly the same time, but the person does occasionally have both movement and sound tics. And something that's really unique to Tourette's and helps set it apart from other movement disorders is that many people are able to find ways to suppress their tics. So in other words, with effort, they're able to kind of push away that urge to engage in a tic behavior. But often they'll need to release the urge in another way, maybe by performing a different movement or sound that is more appropriate while they're in public, maybe like blinking or shrugging the shoulders. Or, maybe they'll need to release the urge later on by actually engaging in the tic, but this time in privacy. So you might have been able to guess from the examples that we put down here, these examples of possible tics, that Tourette's can look pretty different between different people. And that's definitely the case. Tourette's is actually a spectrum disorder, which means that someone with Tourette's can fall anywhere along a spectrum that ranges from mild to severe, where mild would mean that the person's tics, the unwanted movements and sounds that they make, aren't really noticeable and don't really impact their life. So maybe every so often they blink unnecessarily or clear their throat, something that you might not even notice. And on the severe end of the spectrum, the tics that the person has would be really debilitating. So maybe their tics involve really noticeable head-jerking or saying obscene words. These sorts of tics could really impact the person's day to day life, especially if they occur frequently. So Tourette's is a disorder that crops up in childhood, usually around the age of about six to seven years old. And while we haven't completely figured out what causes Tourette's, we do have some clues about the cause. So, for example, we know that a lot of people with Tourette's have parents who also have Tourette's. And we also know that boys are about three times more likely to be affected than girls. So both of these things suggest that there's probably a genetic cause involved, something going on in the genes that are being passed down from the parents to their kids. And we also have a clue about where in the brain we think things might be going awry. So we know that in the brains of people with Tourette's, there's a particular neural circuit that doesn't quite function properly. So bear with me here, this is a bit of a complex name, but we'll go through it in a sec. So the cortico-striatal-thalamic-cortico circuit is what's not quite functioning properly. So "cortico" here stands for the cortex of the brain, and "striatal" stands for striatum, which is part of the basal ganglia here. And "thalamic" stands for thalamus. So these structures normally chat to each other to coordinate our movements. So in someone with Tourette's where this circuit isn't able to function properly, that might explain why movements can't really be prevented like they normally would be and the person ends up with tics. So even though we think we might know what's going on in the brains of people with Tourette's, we don't currently have a way to actually see this. We don't have a brain scan or a blood test to look for and diagnose Tourette's. So instead, Tourette's is diagnosed by looking for the movement and vocal tics in children that we suspect might have the disorder. Now, once we determine that someone does indeed have Tourette's, what do we do to treat it? Well, it turns out that for a lot of people with Tourette's, the disorder is on the mild end of the spectrum here and the tics often actually disappear or at least improve significantly once the child reaches adulthood. So for these people, we don't usually really need any medications to manage the Tourette's, and instead one of the main things that we usually do is something called Habit Reversal Therapy. Remember how we mentioned that people with Tourette's can often find a way to suppress their tics? With Habit Reversal Training, the idea here is to help the child learn to recognize those urges that happen just before a tic is about to occur, and then try to help them find a new habit that they can use to help relieve that urge without performing the tic. So maybe their tic is kicking. And when they start to feel that urge that would normally be relieved by kicking, we get them to itch their nose instead, and try to relieve the urge through this movement. So even though we're kinda trading one example of a tic for another, itching the nose is much more subtle and something that the person can probably do in public to relieve the urge they feel before a tic comes on. Now, for some people, they're on the far end of the spectrum. So their Tourette's is more severe, and it does impact their daily living. So when this is the case, we might need something more than Habit Reversal Training to manage the tics. Now when someone has an involuntary sound that they make, or maybe a movement that just happens to be in a really specific part of the body, one way that we might be able to deal with this is by going directly to the problematic body part. So maybe if it's a movement, let's say that it's a hand jerk, we could try to stop that from occurring by preventing the messages that neurons send to that particular muscle to tell it to move. And funny enough, we can actually do this with Botox. So when we inject Botox into the hand here that jerks during a tic, that blocks some of the signals coming from the neurons that send messages to the hand to make it active. So after the injection of Botox, the hand can't really be as active anymore for a few months until the Botox wears off. So the tic may not be as noticeable, or it may not even occur. Now, sometimes the tics may not be so localized. They might be more widespread. So we might need something that acts in a little bit more of a widespread way than Botox does. So when this is the case, rather than going to the muscles involved in the tics, we might need to head back up to the source, the brain, and try something that will reduce these movements in a more global way. And it turns out that we have these particular medications called antidopaminergic medications that we can use. So dopaminergic here is referring to dopamine, a chemical that neurons can use to initiate movements in muscles. So these antidopaminergic medications they prevent dopamine in the brain from activating the muscles so much. So all these extra movements don't really get initiated, and the person's tics hopefully get decreased or go away. And it turns out that quite a few kids with Tourette's also have other disorders that co-occur with their Tourette's. Disorders like attention deficit hyperactivity disorder, or also known as ADHD, and obsessive compulsive disorder, also known as OCD. So for kids with Tourette's that also have one of these other disorders, they may need to go on a medication or have some sort of therapy to help them manage these disorders as well as their Tourette's.