Gilles de la Tourette's syndrome, a rare and fascinating movement disorder, has often been poorly understood and misdiagnosed by physicians. In reviewing the literature it becomes apparent that much of the diagnostic confusion may be attributed to the fact that Gilles de la Tourette himself failed to differentiate the syndrome which bears his name from other obscure disorders described in his time. Also, Tourette's original paper has been frequently misquoted.
On the basis of our experience with 34 patients who have been intensively studied over a period of 6 years, diagnostic criteria for the diagnosis of Tourette's syndrome have been set forth. The symptoms have been found, to start between the ages of 2 and 13, usually in the form of simple involuntary tic-like movements. Involuntary noises, often described as barks, grunts, or hisses, were also common initial symptoms. In the course of time the symptoms insidiously change. They will wax and wane in intensity and new symptoms will replace old ones. Movements usually progress from simple to multiple and may often become complicated, appearing purposeful, but remaining entirely involuntary. Although sounds or words appear eventually in all patients, coprolalia is not a necessary component of the syndrome and was present in only slightly more than half of our patients. Contrary to many statements in the literature there is no mental deterioration.
In order to aid the physician in diagnosing this rare syndrome, a review of other movement disorders which may enter into the differential diagnosis has been undertaken. The basic characteristics, associated symptoms and findings, courses without treatment, and types of movements seen in these various disorders are discussed and also summarized in a table.
It is hoped that this will enable physicians to diagnose the syndrome earlier in its course and more frequently since effective treatment with haloperidol is now possible.
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