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Question 70: I developed motor tics about a year ago went to a neurologist had the cat scan and was told it was either a motor tic that would go away or possibly tourettes. He gave me a web site to read and sent me on my way. Since then I have developed vocal tics and it sounds pretty classic through the year for tourettes, except everything I have read says it is not tourettes if the onset is not before the age of 21. Is this true and then what is it called if it starts at the age of 43y/o. Are there others that develop it at this age? C.M., WA, USA.

Hello C.M.

It is true that, to be diagnosed with Tourette, you must have symptoms develop before age 21 (actually, according to the newest criteria it is before age 18). The reason for this criterion is because Tourette involves a delayed (or stunted) maturation in particular parts of the brain -- as the individual grows and develops this delay becomes increasingly apparent as other children are able to put the "brakes" on various movements and noises better than (s)he can.

After early adulthood is reached, the brain has more or less finished maturing. If at that time a person is not experiencing tics, then those particular areas of the brain involved in motor movements must have matured the way they were supposed to.

This doesn't mean, though, that a person can NEVER experience tics or involuntary movements and noises after early adulthood is reached. What it DOES mean is that these involuntary movements and noises have come about for a different reason -- damage to those particular areas (for example through head trauma or illness). Even though the symptoms may look the same as Tourette on the surface, if they have a different cause (etiology) a different diagnosis should be made.

It would be important for you to review your childhood history carefully (perhaps with parents and siblings as well) to ensure that you never had tic symptoms when you were under age 18 -- if you did, then the diagnosis of Tourette may then apply (i.e., perhaps your symptoms are mild enough that they all but disappeared in adulthood, only to return now perhaps as a result of increased situational stress or life transition).

I would strongly urge that you continue to pursue this with your neurologist or, if you are unsatisfied with his response, a new neurologist. If the onset of these symptoms is NOT due to Tourette, it will be important to identify the cause of them. From what you describe the condition is becoming progressively more pronounced and may be a result of a condition that requires detection and treatment.

 

I hope this helps, and I wish you well in your exploration of this!

Dr. Dunc.

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