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Neurology - Parkinson's

Houston, Texas

The Cullen Building at Baylor College of Medicine.
Department of Neurology
not shown on screen

Tourette Syndrome Center
and Childhood Movement Disorders Clinic

Directed by Joseph Jankovic, M.D., professor of neurology, the Tourette Syndrome Center is committed to providing the most expert and compassionate care for patients with TS. The clinical staff includes skilled neurologists and specialists in movement disorders, neuropsychologists, clinical psychologists, therapists, and educational specialists. These professionals provide comprehensive evaluation and treatment services specifically designed to address the unique needs of each patient.

The TSC is also committed to conducting research into the cause and treatment of TS and other childhood movement disorders, and patients are invited to participate in a broad range of clinical trials. TSC also provides a setting for the training of clinician-scientists and for educational programs directed to scientists, physicians, allied health professionals, patients and their families, and the community at large. Finally, the TSC partners with the national and local Tourette Syndrome Association and provides advocacy for patients with TS.

The TSC, located on the 18th floor of Smith Tower, is a joint project between Baylor College of Medicine, The Methodist Hospital, and the Learning Support Center at Texas Children's Hospital.

Clinical services provided by the TSC

  • Medical and neurological evaluation and treatment
  • Psychological assessment
  • Individual, group, and family psychotherapy
  • Neuropsychological and educational testing
  • Academic planning, intervention, and advocacy
  • Parent support and training
  • Social skills training

What is Tourette Syndrome?

Tourette syndrome (TS) is a neurological disorder characterized by motor and vocal tics. Tics are abrupt, rapid, brief, repetitive behaviors that may resemble aspects of normal behavior, except in their intensity, frequency, and timing. Examples of common motor tics include eye blinking, eye deviation, facial grimacing, neck popping, head jerking, and shoulder shrugging. Tics may also cause noise or sound as air is forced through the nose and throat (“vocal” or “phonic” tics). Sniffing, coughing, grunting, guttural maneuvers, inhaling, shrieking, sniffing, and squealing are among the most common phonic tics. Some tics are described as “complex” and may involve the integration of learned, sequenced movements (e.g. touching, tapping, jumping, gestures) or complex vocalizations (e.g. repeating a syllable, word, or phrase). An example of a complex vocal tic is shouting of profanities or obsenities, so called coprolalia, but this is actually present in less than a third of all patients. TS is often accompanied by obsessive-compulsive disorder, attention deficit-hyperactivity disorder, poor impulse control, and other behavioral problems.

TS typically begins in childhood and can vary between patients, with symptoms ranging from mild to disabling. Also, people with TS often find that their own symptoms fluctuate in severity and frequency over the course of their childhood. Tics can often be suppressed for periods of time, but this may cause discomfort and fatigue. Many patients “grow out of it” and are free of tics by their late teens or early twenties.

What causes Tourette Syndrome?

TS is thought to be due to an abnormally functioning basal ganglia, the portion of the brain deep inside the cerebral hemispheres that is most responsible for controlling the body’s movement. Some studies suggest that abnormal regulation of the neurotransmitter dopamine reduces the ability of the basal ganglia to inhibit behavior. Unfortunately, the symptoms of many patients are wrongly attributed to “habits”, “allergies”, “asthma”, “dermatitis”, “hyperactivity”, “nervousness” or many other conditions. While the exact cause is unknown, TS appears to be genetically inherited in the majority of patients, although the way in which it is inherited is complex and may not be obvious.

What is ADHD?

Attention deficit-hyperactivity disorder (ADHD) is characterized by the three primary symptoms of hyperactivity, impulsivity, and inattention. There are three general “types” of ADHD. While some patients with ADHD are predominantly hyperactive and impulsive (e.g. can’t sit still, always fidget, interrupt others, blurt things out or make inappropriate comments, difficulty awaiting turn), others are predominantly inattentive (e.g. forgetful, make careless mistakes, have difficulty staying focused, difficulty following instructions or finishing things, are reluctant to do things that require mental effort, daydream), and some have a combination of the two types. Despite increased social awareness, these behaviors are often attributed to “lack of motivation”, “not trying hard enough”, or “poor parenting”. If not properly treated, symptoms of ADHD can significantly interfere with a patient’s academic/occupational, social, and emotional functioning.

What is OCD?

Simply put, obsessive-compulsive disorder (OCD) is characterized by the presence of obsessions, compulsions, or both. Obsessions are intense, intrusive, repetitive thoughts such as concerns about evenness and neatness, unfounded or irrational fears (e.g. becoming ill, hurting someone/self, causing a flood or other catastrophe), perverse sexual thoughts, excessive concern about a body part, excessive concern with morality, intrusive words, phrases, music, or images. Compulsions are meaningless and/or irrational rituals such as checking, counting, cleaning, washing, touching, smelling, hoarding, and repeating. People with OCD often feel that something terrible will happen if they do not perform their compulsions. These symptoms can cause significant distress and often interfere with a patient’s focus, concentration, and efficiency.

How is Tourette Syndrome treated?

Currently, there is no known cure for TS, but many safe and effective treatments are available to improve tics and co-morbid the symptoms. It is essential that the selection of the therapy is individualized and targeted to the most troublesome symptom. Therefore, a comprehensive evaluation is important, as symptoms associated with ADHD, OCD, or other behavioral difficulties may be more problematic than the tics. Tics usually improve with drugs that block or deplete dopamine or injections with botulinum toxin. Central stimulants, atomoxetine, and drugs that act on the adrenaline system are useful in the treatment of ADHD, impulse control and other behavioral symptoms. Serotonin receptor blocking drugs and other medications are often effective in treating symptoms of OCD. In addition, tutoring, psychotherapy, behavioral therapies, and other interventions may be helpful in addressing academic, emotional, social, and behavioral problems that arise as a result of the impact of TS, OCD, and ADHD on patients’ daily lives.

What are Childhood Movement Disorders?

Tics associated with TS are among the most common childhood movement disorder, but there are other involuntary movements such as tremors, chorea, athetosis, dystonia, myoclonus, and paroxysmal dyskinesias that occur in children. Each requires early recognition, full assessment and evaluation, and specialized treatment approach.

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