How Tourette Syndrome Works

Thanks to that Friday dude. It's so good to be recording on a Friday. Beautiful. Ow, it's like eighty degrees. We have a window so we can see the beauty, or we can actually see the ugly building. The construction and the office is well underway. We've been inhaling volatile organic compounds all week. It's out of hand. Actually, it's everywhere I turned, their desk that shouldn't be there, and cube walls stacked up. Yeah, it's weird. I can't believe

we're not working at home through this whole thing. It's quite an idea, Bryant, is that a complaint? I don't want to come across his complaining. You're fine. I'm glad to have a job. We don't have a sponsor. It doesn't matter, Chuck. Yes, have you ever seen a Tourette's guy on YouTube? Uh? No, you haven't. He's this guy. He's a hefty guy with a glasses and a mustache and um, often a neck brace, and he has a foul mouth and anger problem. Uh. He's fond of using

Bob sagg It as an expletive. He goes Bob sag It. It's funny because Bob Saget is a very foul mouth. He is surprisingly that in itself is almost a curse word. Um he Uh. He's taken a lot of heat because he's very abusive towards his family members. Um I I can't imagine that. You haven't. He says just the craziest stuff. And also, uh, the stuff he's saying is is in response oftentimes to what like questions other people ask or whatever.

So really comes off as just a jerk. So I went on Snopes to find out if the guy actually has Turette's. He does. Actually he had, he was diagnosed with Tourette's, but his family admits on the Feeling Guilty page UM that, uh, he does have anger and alcohol issues that exacerbate things. Okay, so he may just be a jerk as well, It's possible, Yeah, but he has raised awareness. One could say of Turette's syndrome tourette syndrome. Tourette's going to be a problem throughout this whole podcast.

There is no s. It is Turette syndrome. Yeah, unless you're just calling it Turette's without the syndrome, then it has an apostrophe s. The reason why is because it belongs to a French physician, correct, Chuck kom Yes, his name was de la Tourette is how I'm going to pronounce it in my faux French. And he was a physician in France in the eighteen hundreds. And he did not Actually he was not the first person to UM

to report about Turette's. That was Jean Marc Gaspars. It yes, very nice, and he described the symptoms of a lady, a noble woman named Marquis de Dampia. I am impressed with you, chucking. She was elderly and she had it sounds like she had Turette's and uh, he described them

as a tick illness. And then later on is when Tourette himself published the Study of Nervous Affliction, when he tracted nine people in a French hospital, and then it officially became Tourette, right, it became the syndrome de Turette. That's right. We sound like we could collude at any moment um, so that that's where the the syndrome gets its name, right indeed. Uh. And since then, well, I guess since the nineteenth century to I'd say the mid

twentieth century, it was basically like holy cow, Tourette syndrome. Yeah. Uh. And then in the later twentieth century we started to get a slightly better handle on what was going on with Tourette sufferers. Um, but we still don't entirely know

what what's going on there. We we suspect that it has a genetic basis because um, they haven't tracted to the gene but they believe that there's a or they've noticed that parents with Tourette's have a fifty chance of passing on to their kids, which is pretty strongly in favor of genetics. Yeah, we also know and this. I found it very interesting. I didn't know this that you always have the onset of turette Tourette's, right, it's just

difficult before the age of eighteen. Yeah. Usually it starts around seven peaks from eight to twelve, and then the ticks start to decrease steadily after that. Boys get them more than girls. Yep. I think there are four times likely or three to four times likely to to have Tourette's girls are and you can have tourettess and not notice it too. Yeah. I did not have visible ticks. It's just in the gene is in your body. If it is indeed a gene. Let's let's stop beating around

the bush, shall we. Let let us talk about cop ro lalia. Very nice, thank you, right, that is what you were. What most people think of Tourette's is the old joke, O, hey, that guy's got Turette's. If somebody yells an obscenity, right, A vocal tick. It's a complex vocal tick, very complex. There's a simple vocal tick, which might be like a grunt or clearing your throat or

something like that. A complex vocal tick is is a symptom of Tourette syndrome, where you are stringing words together or even just saying a word would would be a complex vocal tick. But specifically with coper lalia copper lalia,

I don't know, um. These these words aren't uttered often within a social or emotional context, meaning that you know, you're not there's it's quiet in the auditorium when the kid blurts it out, you know, um, and it's an obscenity there they blurt obscenities or reference to genitalia or um, bodily functions or sexual acts. Yeah, um, that right. The thing is, though, is UM. A lot of people who age uh and have copper lalia um learned to they learn tricks like they might mutter it a little more,

They might mask their mouth with their hands. Um, they might say just the first letter two of the word like, and that is enough for a lot of people who suffer suffered from this this affliction or have the symptom um. But in other cases it's so extreme that you can't say anything but that word that comes out. And what I've read is it's akin to wanting to um sneeze, but say sneezing is socially unacceptable. So you have to cough, but that doesn't satisfy the urge to sneeze, and eventually

you're gonna have to sneeze. Do you know what I would do? I would just turn around and look at the guy behind me every time. You're like, whoa dude? Right, Yeah, that's your deal. Well, apparently also there's a kind of um sub suffering of copper lalia where um people blurred out like racial and ethnic slurs in the company of

people who would take offense to that. But the researchers point out, although I'm not entirely certain that they have a true handle on this, they point out that this doesn't necessarily indicate, you know, the thoughts of a person who has copper Lawiyah. It's just this is what they're what's in their mind right then, or what they're saying

or what's coming out. Yeah, well that's uh. That is can be a symptom of turettes, but it's only in less than fifteen percent of sufferers, So the common thing that most people think of, it's actually very uncommon, right, And like you said, a lot of people have such mild symptoms you wouldn't even notice it. Like I could have Turette syndrome Chuck a very mild case and you

wouldn't know. I know. Well, they say stat wise one and a hundred people suffer from a mild form, which is a lot more than I would have thought, and about two hundred thousand Americans. It's just Americans have the most severe forms. So that's that's definitely a little more

common than you would think. And it is um pain cultural, but it's not found in equal amounts in every culture, which kind of undermines the genetic basis idea a little bit, because there's a lot more Turette sufferers in in UM the US than in Japan. Interesting, I wonder past something to do with our culture. We're a foul mouth culture. Maybe right, we're and we're very nervous. I think the Cold War did it to us well. And they do say that anxiety sometimes can increase the amount of tecks

and relaxation. That's one of the things I'll try and get you do is relax yourself with like breathing techniques, so that that could have some credibility. We'll get to that, Dr Clark, Thank you. Dr bryant Um. Whether or not it has a genetic basis, and by the way, if it does, will know for certain within five to ten years, because I'm gonna understand every single gene in the human genome within that time. I think it is very scary, all the ramifications. That's a podcast in itself. Yes it is.

Look for that one two thousand and eleven. Um whether or not it has a genetic basis, they have kind of and by they, I mean people who are involved intoret research have the government have no although they do some to the National Institutes of Health. Yeah. Yeah, Um, they've kind of narrowed down some regions of the brain that are likely candidates for, um, the underlying mechanism of Tourette syndrome. Right, Yeah, I thought this was a little weak.

I did too, and I didn't like the word pinpointed. Yeah, because I mean they picked the thalamus, the basil, ganglia, and the frontal cortex, and it's kind of like those are the three things that control like your motor functions. Are like, well, I must have something to do with that then, or you're from a cortex which is in charge of controlling the motor activity of speech, including speech. So it seems like I don't know, those are the obvious parts of the brain, right, Like nobody didn't even

real research. That's not true, of course, but you know, they're just like, it's probably this part of the brain. But like, we know enough about the brain. If someone were to have sat us down beforehand and said, pick out the three parts that may be responsible, I probably would have picked out those three. I would have said,

frontal cortex. Sure. Sure. Um. The problem is, Chuck, is not only do we not know that much about the brain, Humanity in general and science specifically doesn't have that great of a grasp on the brain. But and we'll say it again too, but um, it looks like the likeliest candidate is not necessarily a brain region. But uh, these brain regions working or malfunctioning in conjunction because of a an excess of the narrow transmitter dopamine misfiring transmitters. That's

always the case. And again, the reason why they think that this is possible is not because they have any hard scientific evidence that this is the case. They've just noticed that in Parkinson's patients, which are the opposite of

um Turette's patients in a lot of ways. Um, they move much more slowly, unsteadily um and their motor function seems to be impaired, it's decreased, and they've found that there is a lack of dopamine in Parkinson's pay and so they're like, well, then it's probably just means that there's an excess of you know, turette pace, because that's the universe. Is that cut and dry, right, That's what I think? Yeah, me too, But like we said, it's the brain, and it's just such a crap shoot when

you're dealing with the brain. Do you just don't know? They're doing their best? Though? Should we talk about symptoms? Yeah, let's while we already covered the obscenity bursting coupla very nice. He took the queue, and that is the rare symptom. More commonly, what you're gonna see is like eye blinking, throat clearing, shoulder shrugging. I knew a guy facial grimaces, that this friend of mine in high school had tourettes, and I didn't even know it until, you know, recently,

when I was researching. I was like, oh, that guy Andy had tourettes because he would go like uh like and like blank and turn his head and like make a little gutural sound like that. Well, yes, then he would have turetts because you said that he had a motor tick and a vocal tick, right, yes, So if he just had you know, the shoulder shrugging um or eye blinking or twitching just that, he would have had

a chronic motor tick disorder. Or if he just made the guttural sounds, he probably would have had chronic votal vocal motor tick. It's tough when you get out, isn't it. Yeah. Uh, well, since we're here, we might as well go ahead and say, and I didn't realize this either, that there are all

these very specific classifications. So if you if you're being diagnosed with turettes, they rule out a lot of other things first, and then once they've ruled out all the all the other stuff, they go, okay, have you what kind of ticks do you have? How often do you have them? When did you start getting them? Because it's

got to be before eighteen. You have to have multiple motor ticks and at least one vocal tick, and both of those have to happen within one year, and within that year you cannot go three months without a tick and still be diagnosed with turettes. I didn't know was that specific. I didn't either, but it's in all of It's based on observation obviously. Um. But if you have

something else, turette falls under a the umbrella movement disorders. Right. Um. So there's all these different kind of sister sibling disorders that that could be, uh, that could be diagnosed rather than turette. It's kind of like tourette is a milange of movement disorders or motor disorders. Very nice, Thank you very much for back to the French. Right exactly, So, Chuck, I jumped ahead a little bit, didn't I. Um, there are some other really interesting tidbits about Tourette's that I

was unaware of. Like, um, normally they start out higher up in the body and then as the patient ages, they the ticks move further down. Yeah. I thought that was interesting. So you might you might start out with um or shoulders shrugging or neck tensing or something like that. Right, And I should say, by the way, since this is in a video podcast, you can't see it, but every time Chuck or I describe some sort of tick, we try it out ourselves. It kind of feels it's almost involuntary,

it is. And then uh, from there, it can work its way down to the arms and hands, like clenching your fists, that kind of thing, and then eventually down to your feet, so you might stomp your feet really loud, or you might have an a hitch in your giddy up as they say. Who says that, the Tourette researchers Walter Brennan Old Westerns. And then ultimately chucky can move into the respiratory and alimentary systems. So a tick can manifest as a hiccup or whistling or belching or throat

clearing or something like that. So it makes the cycle over time. It doesn't necessarily, but it can. And once it starts moving, brother, it's tough to bring back to its original position. Yeah, what what happens is there's an urge. They all um suffers disc this build up. They feel it's like building up in their body, like this urge to do it, and then that that is satisfied by the tick, whatever that tick is. And sometimes you can,

you know, learn to control that a little bit. But they say that you're just kind of putting up the uh, the wall, which will be broken at some point, so your tick will be even worse later on in the day. It's like, if you're in a business meeting and you're holding it back and holding it back, you might get out of the business meeting and have like a really bad tick or something, which is you know, I guess it's good if you can control it, but you gotta

know when to let it loose to well. Yeah, and I imagine that that kind of comes with living with Tourette, Like you realize, Okay, I'm gonna have a really big tick after this business meeting, but if I can hold it during the meeting, then I'm probably better off. Or you know, if you're alone, I'm sure you just let the ticks fly right. Um. And also I was reading about a uh The New York Times has a lot of question and answer blogs about Turette syndrome, really interesting stuff.

One guy said that he uses um his Turette's as a jerk meter or a jerk sensor, so like he's found that people who people react very differently, but they can kind of be lumped into two categories. One people who can look past it and be friends with you and the other category are people who just can't. And apparently people who are um not down with turettes are kind of uh sure, I mean in what way other than the fact that they're kind of jerks for not

being understanding. I think that's enough, don't you. I mean, this is something that I don't I don't even know that you could say Turette syndrome is misunderstood and are I think the greatest misunderstanding is thinking that all Turette sufferers have copper lalia. But other than that, I mean, it's not like this is some hidden mystery that that everyone walking the planet had hasn't hurt about just because it's so fascinating and it doesn't have any um attendant

like physical problems associated with it. It's completely based on brain function, you know. And although there's not like you know, uh, you're not wheelchair bound when you have Tourette syndrome. There are other um, I guess, behavioral problems or disorders that usually accompany or can very frequently right, Yeah, O C obsessive compulsive disorder and a d h D, which is

adult attention deficit hyperactivity disorder. Yes, thank you for filling in the blanks there, um, and they're they're not always linked, but UM, a lot of times they are like a child. If if you've been diagnosed with Tourettes and you're a kid, many times will be diagnosed with O c D or

a d h D afterward. And um, not only that, but sometimes you can have disorders as a result of Tourette's, like a sleeping disorder or learn disorder because of the Turette's and they they I know that of Tourette's suffers have a d h D, which is a pretty strong link. But I also wonder if some of it has to do with misdiagnosis. The one that UM I kind of bought into was the O c D UM Tourette link. Yeah, you're twenty times more likely to have O c D

or symptoms of O c D if you have Tourette's. Yeah, and pretty high parents um who have O c D are have a higher likelihood of having kids with Tourette syndrome. So there's a there's a little something there, something linking them or something something. Uh So, Josh, let's say one of us has turette and we want to try and rein it in some what can we do? Do you mean treatments? What what are my options? Well? I think

probably the gentlest um option is behavior modification. Behavioral therapy, yeah, Josh, And habit reversal therapy is one of the behavioral therapy, so we'll use a lot of times. It's got five components, but the main key there is the competing response. So if you feel a tick coming on, uh, and oftentimes you'll do the competing response is sort of linked to

what your ticket is. So if you have like a a shoulder thing and you feel a tick coming on, you will like really relax your shoulders or roll your shoulders and like roll your neck around or something to try and like fight back the tick. Right, you want to use the same muscles to create the opposite movement though, Right, it's kind of like when your earbug chords are kind of bent, right, you have to bend them back the other way for a while to get back to the middle.

It's just like that. Yeah, I can't believe me to think that. Thanks for that, Chucky. What I don't understand though, is it I mean, it makes sense in one way, but if you're always going to be doing that competing response, what's the difference. Now, The point is that you're not always doing the competing response, just like your earbug cord is not going to always be twisted the other. You're just working it out from being twisted one way for

so long, so eventually eventually able to eradicate the ticks. Okay, Yeah, I thought it was just to keep from doing the ticket, and I think, well, what's the difference. You know, I think that it's to eventually get to the point where

you're not having those ticks any longer. Um. There's also regular, straight up, good old cognitive behavioral therapy, which mainly focuses on UM relaxation techniques, UM, identifying and dealing with stressors because, like you said, UM Tourette's syndrome is often set off by UH emotions, stress right, UM, and drugs. There's drugs. Drugs.

You want to this These are tough, man, This is dicey, and I think that these are generally UM reserve for people with UH Tourette syndrome that really interferes with their daily life. Yeah, if you can't get it through behavior modification and it's more than a nuisance, then you might want to look into something like an antipsychotic Josh, Yeah, like pema's eyed or hell a parrot al or something. Yeah,

these are rough. Well, that's a deal. That's why doctors don't throw you on these meds if you have turetts like immediately, because they can bring along some side effects like men growing breasts, men growing breast, drooling, restlessness, sexual dysfunction, and seizures. Yeah. So in a lot of ways, the cure can be worse than the disease when you're using

anti psychotics, tight turetts and UM. Since it occurs in conjunction with a d h D or O c D, a lot of times the doctor will just piggyback the turette treatment onto treatment of a d h D or O c D. Right, So, if you have O c D and Tourette syndrome UM, you're probably going to be prescribed to ssr I like Zoloft or prozac or something the p and then like riddling or something to treat

a d h D may help alleviate the Tourette syndrome too. Yeah, but Josh, if all these don't work, then you've got a really really debilitating case of turettes and none of this stuff works. There is an experimental surgery taking place called deep brain stimulation where they connect electrodes two wires from a small battery pack in your chest. So it's sort of like a pacemaker for the brain, there's a good way to describe it. Yeah. And it prevents its

supposedly prevents against the misfiring of neurons. Yeah, it blocks, it blocks the firing of the neurons. That crazy. And they're they're not using this widely now because it's really experimental at this point, but they do use it for Parkinson's. That's gonna be one of those treatments that in fifty or a hundred years looks just ridiculously primitive and barbaric. You know, I can't believe they suck up wires and

block firing of neurons patient akers in the brain. Should we talk about famous people because I know we mentioned in uh, I think in our CD podcast about Mammad abdul Rolf who was the basketball player? Yeah? Yeah, was that him? Yeah? I think it was like Chris somebody, Chris Jackson. He changed his name? Is me paying attention? I thought his name was Cassius Clay uh. And I think we got email saying no, he didn't have O C. D head turettes or the other way around. But I

think he's diagnosed with both in conjunction. I might be wrong. You're probably right, Chut dan Ackerroyd, I had no idea. Yeah, one of the Blues brothers, uh, Pete Bennett, who apparently was on Big Brother, which apparently is a TV show. I have not heard of this. I haven't either. James Boswell, he's a writer. Jim eisen Reich, he's a major League baseball player. I think for the Cardinals. Maybe we'll find out.

And who else is a little guy named like the tinker on the piano named Mozart possibly possibly that's that that that might be uh false, they don't know for sure. And then a few other people. I haven't heard of goalkeeper for man you Tim Howard, Yeah, I'm more of an Arsenal guy. Really, Yeah, figures and sent me it's just Arsenal. That's like coming to American be Liken Yankees, right. But no, I think if you're a man, you fan, that's that that you would go to Europe and be like,

oh man, you fan. See. I thought Arsenal was like the biggest no they're both pretty big. But it doesn't matter either way. If you don't really play soccer and you're an American and you call it soccer and you're an Arsenal fan or making air quotes, you're a jackass. If you walk in here with an arsenal sweater or something like that, would not maybe a scarf. Those things are saucy checked. There's one last thing we talked about, copra copri la, yes, copper lay um. There's also copper praxia,

the the involuntary use of obscene gestures like this. I had that in traffic at times. Yeah, yeah, you do, but yours is voluntary. That's a big difference. There's also echolalia m right right, oh boy exactly. That's when you repeat things that someone says, I guess yeah. And then lastly, there's an echo prexia, which is um me doing I'm stroking my goatee as Chuck does too, except you don't have a good phantom gotee. Okay, so you mimic someone's motion,

bodily motions? Interesting, Yeah, well do you have it? That's turette? Is that it? And anything else? Oh? Medical marijuana is a study a field of research right now for treatment of it, and all the potheads are like, yeah, man, it works really well treatment turette, and all the scientists are like, we don't know. Do you see me yelling out words, bro exactly. The jury is definitely still out on medical marijuana and any of its uses, but we're

looking into it. So that's definitely it. That's that's it for now. If you want to learn more about Tourette syndrome, you can type that in that's t O U r E t t E syndrome. And there's a really cool picture of a turette suffer. It's a multiple exposure picture of a turette suffer undergoing a series of ticks. It's pretty neat. You can type that into the handy search bart how stuff first dot com, which of course means it's time for listener mail, the return of listener mail.

It's been a while. Yeah, it's been a little while. We've been so long winded lately. There hadn't been a room. Carry has been like enough, she's listening. Uh, So I'm gonna call this one, uh Patriot offsets. This is from Robin Cincinnati, Rob K and he I'll just summarize the beginning. He was a little he's a little put off by the whole carbon offset thing because he's like, how can you be an environmentalist and support this, Like it basically means you're free to do whatever you want as once

you buy these offsets. He was put off in the same way by the Catholic Church who sold indulgences to offset the sins the wealthy. We got a lot of email about this, apparently that you know, I said something about a karma off setter, and they said indulgences are kind of like that. So he's he was put off

by that, and they were very popular. So he says, in the spirit of the carbon offset, Josh and Chuck, I am now creating the patriot offset because I have noticed once or twice in the blogs that you two get a few people were a bit close minded and question your patriotism. Yeah, that happens from time to time. Yeah, they think we're it's not gonna ask me if I served in the military. Very mockingly, Oh really you should, said, yeah. Howard stern Away says it is in Vietnam when he

was here. He tells these big, long stories about it. I have I have fifteen years in the army with three deployments so far. For the simple price of a shout out on the podcast, I'm willing to give each of you a year of my army time and let's say three months of peacekeeping deployment in Kosovo. Aw, you guys had a blast, trust me, he says in Kosovo. So next time anyone calls you a hippie or anything like that, just tell them that you bought your service

to your country and you were true Americans. And that is from Rob. So we now have served a year in the army. So do we get a year each or a year combined? Were we in the same platoon, same unit? What did we do any like search and destroying missions? We need to come up with this stuff. I think we were definitely probably bunk mates because I remember that one night went out. Well, not in the

same bunk, bunks are on top of each other. I just remember being on that top bunk of that night when you beat me with the bar of soap in the towel along with you're asking for it, squealer. You shouldn't screw things up for the rest of the platoon. I had to wipe down the latrines because of you. Yeah, sorry, pile, Well I got it in the end with the soap. You certainly did. Wow, Chuck, that one was fraught with

all of it was super clean though. And also did you know that in the Civil War, wealthy people could pay people to stand in uh for their conscription? Oh really doesn't surprise me, which we just kind of did with no money changing hands. It's basically legal. So shout out to Rob. Yeah, big shout out to Rob. Thank you for the military service for us. UM. If you want to give Chuck or I anything we love free stuff, you can send an email to us describing it and

possibly offering something. Uh. To stuff podcast at how stuff works dot com for more on this and thousands of other topics. Is it how stuff works dot com. Want more how stuff works, check out our blogs on the house. Stuff works dot com home page. Brought to you by the reinvented two thousand twelve camera. It's ready, are you