Tourette’s Syndrome of Childhood and OCD
Minor manifestations of Tourette’s syndrome of childhood are so common as to be considered a normal stage of development. Many children when over tired or stressed will blink or grimace and minor vocal tics as they are called – throat clearing, coughing or grunting – are similarly common in some older children. As the brain cannot be expected to grow and develop in perfect harmony it is to be expected that minor signs such as these can be produced particularly when it is having a hard time. Generally as the areas of the brain that generate these often worrying symptoms catch up in terms of development the motor escapes cease. However, it is not uncommon to see minor facial tics often on the left side of the face of worried parents and I have seen many an eminent lecturer tic before and during delivering a lecture. Next time you are watching the television look out for minor facial tics and involuntary movement of the limbs of the game show presenter.
Again minor obsessive traits are often a feature of normal development. Parents and some professionals become concerned when a child lines up their cars or adopts a routine that must be followed at bedtime. While the right side of the brain is growing and developing order and routine is often necessary in order to help the right side of the brain to be able to cope. The reason why, is that the right side of the brain is the ‘approach/withdrawal’ side of the brain and it is this right prefrontal cortex that has to decide if a new situation is safe or possibly presents a danger. If the right side of the brain is struggling then the avoidance of new and possibly threatening situations is preferred and the child adopts routines thus avoiding change. It is therefore very important when assessing young children to differentiate between routines/minor ritualistic behaviour patterns and signs of potential obsessive traits.
To date I have yet to see a child that has Tourette’s syndrome in isolation. Every child that has attended the clinic supposedly with Tourette’s syndrome has in fact other signs/symptoms of developmental delay. Attention deficit, attention deficit with hyperactivity, obsessive compulsive traits and dyspraxia go hand in hand with motor escapes. Only when it is appreciated that all these so-called conditions are nothing but symptoms of developmental delay and symptoms that will always appear in comorbidity, can the underlying cause be uncovered and appropriate treatment put in place.
Whereas dyslexia tends to be a left brain based problem, Tourette’s syndrome, OCD, ADD, ADHD, phobias, anxiety and autism are symptoms of a right prefrontal cortex that is struggling to develop. It is a very interesting fact that the bulk of the second-wave of brain cells which principally develop some 4 months after birth end up in the right prefrontal cortex and in those areas of brain that have been implicated as being the sites of developmental delay symptoms. For instance, the right anterior cingulate gyrus is where a great many of the von Economo neurons (one of the second-wave brain cells) migrate to and it is this area that has been cited as being the area which when under functioning is the cause of the symptoms associated with ADD, ADHD and Tourette’s.
Dorsal Ant. Cingulate
• Cognitively demanding tasks
• Has increased activity in anxiety, phobic states & OCD
• Reduced levels of activity found in ADHD
Ant. Cingulate / F Pole / Infraorbital Areas
• Guiding attention (ADD) error correction
• Control of autonomics
• Non-mimetic facial expressions
So what are Tourette’s and OCD in reality? They are I believe symptoms that appear in comorbidity with dyspraxia, attention deficit and attention deficit with hyperactivity. They are symptoms that always appear in various combinations and are a manifestation of developmental delay. Developmental delay as the name would imply is a slowing or delay in the maturation of the brain in general but more specifically in the development, migration and synaptogenesis of the second-wave of brain cells that includes the von Economo neurons.
Calcium Binding Calretinin cells
In 2001 Hof et al described a previously unknown group of pyramidal (motor) neurons restricted to the anterior cingulate cortex of humans. The precise function of these cells is not known but it has been suggested that they may play an important role in the control of the autonomic nervous system (controlling digestion, heart rate and the fight-or-flight response, etc.) and/or be projection neurons to motor centres involved in the production of facial expression and vocalisation. It has been suggested that immaturity of the anterior cingulate gyrus or unparalleled development with other areas of the brain might provide the underlying cause of certain tic disorders.
Various theories have been put forward to date including a genetic predisposition and this may well prove to be true. However, as the majority of geneticists involved in this area of research are looking for genes specific to disorders that I believe do not exist, to date no clear evidence is to be found. Perhaps if the geneticists looked for the genes that control the development of the second-wave cells and looked to the control of these genes by the epigenome an answer might be found.
In a recent study of developmental delay we found the most striking figures occurred with a family history of developmental delays but also with the Ventouse assisted delivery and foetal distress without birth interventions. It has been suggested that such stressors might prevent the epigenome from switching on the genes that control the postnatal development of the brain and hence the developmental delay that ensues.
Can developmental delay be treated? I believe the answer is a very positive yes. If we accept that Tourette’s syndrome of childhood is no more than a symptom of developmental delay and we can relate the symptoms to specific areas of brain then I believe a great deal can be done to treat this very distressing condition.
The holistic approach:
1. Make the brain generally healthier by providing a diet as free as possible from bad e-numbers, artificial sweeteners and excessive processed carbohydrates.
2. Reduce bad fat and supplement with essential fatty acids.
3. Provide specific physical exercises that will afferentate (stimulate) areas of the central nervous system.
4. Provide computer generated programs to stimulate very specific areas of the brain.
Unfortunately, getting the right balance of foods is not as easy as you might think particularly when so many children with DDS are fussy eaters or sugar junkies. Also, we have to consider hydration, sleep and exercise – both specific and general.
For more information on diet see The Brain Food Plan written in collaboration with Carina Norris the nutritionist and author of numerous books including You Are What You Eat: the meal planner that will change your life and the academic brains behind Channel 4′s Turn Back Your Body Clock.
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