Movement Disorders

Case I - Kenny

1. What condition or conditions are being described in this case? Does this involve brain damage, a specific disease or disorder, or some other condition that maybe affecting the patient’s ability to move?

Tourette syndrome (TS), which falls on a spectrum of tic disorders, is defined as having both motor and verbal tics, for greater than one year. Tourettes will wax and wane, does not involve brain damage, and will not progress.

2. What brain areas may be involved? How should they function normally? What could be causing this dysfunction?

Tourettes is believed to be caused genetically, by areas of the brain developing abnormally, or by an imbalance of neurotransmitters. Areas of the brain that are thought to be involved include the frontal lobe, and the basal ganglia. Neurons in the basal ganglia inhibit or initiate action plans by processing the information they receive from the prefrontal cortex, sending it back to motor and sensory areas of the cortex through the thalamus.

3. How would the treatments recommended affect the brain? How might those effects relate to the symptoms?

For mild cases of TS, psychological therapy and education may be all that is needed. Learning to control certain impulse may be possible, but treatment is mostly focused on depression and social isolation. Educating the patient, family, educators, and friends is critical to Kenny living a happy life. Pharmacological treatment of TS is reserved for the more severe, debilitating symptoms. The efficacy of medication is symptom and patient dependant. Neuroleptics are a common choice, including; risperidone, haloperidol, and fluphenazine. These medications act on neurotransmitters such as dopamine. Antihypertensive medications can also be used to treat tics, adrenergic antagonists are commonly prescribed to steady hands, and also may help control impulses. Since co-morbidities such as ADHD, depression, and OCD are in high occurrence in these patients, Kenny may also be...