Source [size=9px]San Antonio Express News[/size]
Tic suppression, as well as tic re direction are ways to control tics often used by some people with Tourette Syndrome to reduce the impact of their disorder in certain situations. A study, part of which will take place in San Antonio, Texas, to examine this idea is being funded by the National Institutes of Mental Health (NIMH) in the U.S.
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San Antonio expert joins study into brain affliction
[size=9px]Web Posted: 11/26/2005 12:00 AM CST
Express-News Staff Writer [/size]
Throughout high school, Walter Smith couldn't control the neurological tics that twisted his face and caused him to blurt out odd sounds at inappropriate moments.
Nor could he control the merciless teasing of schoolmates who would ridicule him and mimic his vocal tics during classes.
But Smith did know how to control his fists.
"The only means I had back then was I was a big guy and I could fight them off," said Smith, who ended up at an alternative campus after breaking a taunting classmate's nose. "That was all I knew. Nobody else would do anything and I would just beat them up."
The 43-year-old San Antonio businessman suffered a torturous childhood because of Tourette syndrome, an uncommon and poorly understood neurological condition that is brought on by a chemical imbalance in the brain.
People with Tourette can display a wide spectrum of muscle tics, from eye blinks and facial twists to jerks of the head, arms or legs.
More severe forms include vocal tics ? involuntary outbursts of odd noises and sometimes profanity.
The best that doctors have been able to do is prescribe drugs, an assortment of which are more typically used to control psychotic behavior, depression and convulsions. They don't cure Tourette, and some say the side effects of the drugs are worse than the disease itself.
Now a San Antonio psychologist is part of a consortium that has $6 million in federal funds to test a new treatment approach.
It is a behavioral therapy that aims to help people with Tourette learn how to recognize the onset of their tics and diminish them through isometric exercises or breathing techniques.
Alan Peterson, a psychologist from Wilford Hall Medical Center and the University of Texas Health Science Center, helped test the therapy over 20 years, building on an existing approach called habit reversal that is used with people who have single body tics or less complex behavioral issues.
"I wondered if a type of treatment that worked with one tic would work for someone with multiple tics," Peterson said.
He also took cues from Tourette patients themselves who talked about how they could control vocal tics in certain situations.
One man, Peterson said, would whistle at work to keep from cursing and making barking sounds. In church, the same man cleared his throat when he felt a tic coming on.
"Most people, if you ask them, are able to control it in certain situations," Peterson said.
Tourette is marked by an overabundance of the brain chemical dopamine in an area of the brain that regulates motor movements. It tends to run in families and is more common in boys than girls.
Tics typically begin in childhood and can change over time, involving different muscles.
Estimates are that 100,000 Americans have Tourette and many more may have a milder form of the disorder.
The health science center is one of six universities in the country to form a consortium with the Tourette Syndrome Association to secure grants from the National Institute of Mental Health for the controlled study.
San Antonio will be one of three locations enrolling people ages 16 and older.
"A lot of the scientific community had a lot of skepticism about whether this type of treatment would really work," Peterson said. "So it took 20 years to gain enough acceptance to get a major grant."
Peterson will enroll about 40 people in the local trial. Altogether the study will seek 120 adults; half will get standard psychosocial support and half will get weekly sessions teaching them to recognize cues that precede tics and to substitute other behaviors, such as tensing muscles or taking deep breaths.
"It's probably no different than you being aware that you are blinking or breathing," Peterson said. "It is involuntary, but if you become aware you notice it and, if you try, you can change it."
People interested in learning more about the study can call coordinator Christin Pasker at (210) 292-7882.
Tourette patients, though, have said restraining the tics comes with consequences.
"If I wanted to hold it in I could, but what happens when you do that is it comes out with even with more force later on that day," said Brad Cohen, a teacher and author who came to San Antonio last week promoting his book, "Front of the Class," which details his personal experience with Tourette.
Smith agreed. Now a husband and father who built several successful small businesses, he takes several medicines to keep his tics under control.
"You can feel it and you can hold it back, but it puts you under a tremendous amount of stress," he said.
Still, any effort to control the disorder without drugs is a positive step, Smith said. "I would sure be willing to try."
Small studies have suggested the behavioral therapy could be a way to control Tourette tics without the sedating medications now in use, Peterson said. This will be the first large clinical trial testing it.
Patients will be followed for about six months, and researchers will measure whether they can maintain control of their tics with the behavioral techniques.
"My best guess is this is not a cure for Tourette," he said. "It's not likely to eliminate all tics for most people, but we believe it will be an effective treatment in reducing tics, and we hope the gains are maintained over time."