What is the historical evolution of the understanding of Tourette syndrome (TS) and other tic disorders?

Updated: May 30, 2019
  • Author: William C Robertson, Jr, MD; Chief Editor: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP  more...
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Answer

TS was originally considered a rare psychogenic condition but is now thought to be a relatively common genetic disorder. It remains misunderstood by the lay public, and many people are still unaware that cursing tics (coprolalia) affect only a minority of patients (8%).

One of the first descriptions of tics appeared in 1825, when the French physician Jean Itard described 10 people with repetitive tics, including complex movements and inappropriate words. [8] Subsequently Charcot assigned his resident, George Gilles de la Tourette, to report on several patients treated at the Salpêtrière Hospital for repetitive behaviors. The goal was to define an illness distinct from hysteria and chorea.

In Tourette's 1885 paper, Study of a Nervous Affliction, he concluded that these patients suffered from a new clinical condition: "convulsive tic disorder." [9, 8] Tourette and Charcot thought it was untreatable, chronic, progressive, and hereditary. Although Charcot persisted in his efforts to distinguish "Gilles de la Tourette's tic disease" from other illnesses, his contemporaries generally did not agree.

Over the next century, little progress was made with respect to pathogenesis. A popular theory was that tics resulted from a brain lesion or lesions similar to those seen with rheumatic chorea or encephalitis lethargica. Another commonly proposed idea was that repetitive tics were caused by emotional and psychiatric factors and therefore would be best treated by Freud's psychoanalytic method.

In the United States, the view that TS was a rare, bizarre psychological disorder prevailed for much of the 20th century. In the 1970s, Drs Arthur and Elaine Shapiro, with Bill and Eleanor Pearl of the fledgling Tourette Syndrome Association (TSA), used the efficacy of haloperidol and other clinical data to support the conclusion that TS was a relatively common neurological disorder and not a mental or emotional problem.


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