Brain Based Therapy and Tourette's Syndrome


Tourette's syndrome or TS for short is a one of a group of conditions known as movement disorders. As a group, movement disorders are characterized by uncontrollable involuntary movements. We have all seen someone who has struggled with things like tremors. Tremors like Tourette's syndrome, are also a movement disorder. Unlike tremors, the movement disorder associated with Tourette's Syndrome manifest as twitches of the muscles. A unique feature of the Tourette's movement disorder is a "vocal tic". Tourette's syndrome is a genetic disorder and because of this, the involuntary movements of Tourette's usually start in childhood. Recent research in this disorder has uncoformed some of the underlying causes of Tourette's Syndrome and offer a potential avenue for treatment. The part of the brain associated with most movement disorders is called the basal ganglia. The classic movement disorder associated with malfunction of the basal ganglia is Parkinson's Disease. Although Tourette's Syndrome and Parkinson's Disease are both associated with problems in the basal ganglia, the fundamental defects in the basal ganglia are quite different in these two conditions. For example in Parkinson's Disease, certain cells and sections of the basal ganglia degenerate and die off. Unlike Parkinson's Disease, the basal ganglia in children with TS does not typically degenerate, but rather goes out of balance. This difference, degeneration as occurs in Parkinson's Disease versus imbalance which is more common in TS, may explain why, in general, patients with Parkinson's diseases usually get worse with age and why most Tourette's symptoms get better and lessen over time.

Some exciting research that has been recently published suggests that part of the basal ganglia has spikes of excessive activity in patients with Tourette's Syndrome. This excessive electrical activity in the brain, produces the involuntary tics and twitches seen in Tourette's patients. The more conscious, upper part of the brain, functions to suppress this abnormally increased activity in the lower parts of the brain at the basal ganglia. Researchers believe that this top down suppression of over activity may explain why the tics of Tourette's Syndrome usually occurs when the child is at rest and rarely are seen with conscious physical activity. The researchers believe that this top down suppression of the over activity is the brain's way of compensating for and historically reducing the symptoms of Tourette's Syndrome. So as the child's brain ages, the brain can compensate for the abnormal activity responsible for the tics of Tourette's Syndrome.

The question becomes what, if anything can be done to either

1. directly suppress the abnormal electrical hyperactivity in the basal ganglia that is associated with the symptoms of Tourette's Syndrome or
2. Enhance the higher parts of the brain that compensate for the abnormally elevated electrical activity and suppress it?

Various researchers have used either deep brain or vagal nerve stimulation to reset the electrical activity in the brain and to suppress the symptoms of Tourette's Syndrome in patients who failed to respond to any other type of therapy. Unfortunately these brain stimulation techniques are invasive and carry great risk. However other researchers in Germany demonstrated that non-invasive brain stimulation might be possible through simple electrical stimulation of the vagus nerve on the outer aspect of the ear. This means that the abnormal electrical activity in the brain that produces many of the symptoms of Tourette's Syndrome may be reduced or modulated by a mild external electrical stimulus delivered to the skin around the outer ear. Furthermore, techniques of chiropractic neurology may offer methods that may enhance the top down suppression of this abnormal electrical spike activity. These techniques are essentially brain exercises that have the potential to enhance the upper brain's natural ability to suppress the hyperactivity of the lower parts of the brain that are responsible for many of the symptoms of Tourette's syndrome.