ABSTRACT
The nervous system integrates and processes signals, orchestrating responses to environmental changes. Comprising central and peripheral structures, it coordinates sensory perception, motor control, cognition, and behavior. This complex network sustains homeostasis, enabling adaptation, learning, and memory. Its signaling pathways are essential for survival and effective interaction with the world. The dysfunctions in the nervous system can give rise to various disorders, one of which is Tourette’s Syndrome. Tourette's Syndrome is a neurodevelopmental disorder characterized by multiple motor tics and at least one vocal tic. Tourette syndrome affects about 1% of the population, with higher prevalence in children (0.3–1%). It is three to four times more common in males and often decreases in adulthood. Many cases go undiagnosed, especially mild ones. The worldwide prevalence of Tourette’s is 3–4% in children, among the other tic disorders.
INTRODUCTION
Tourette's Syndrome, named after Georges Gilles de la Tourette, a French neurologist, is a condition that affects the nervous system, causing individuals to produce tics. Tics are sudden, repetitive, and involuntary movements or sounds. Tics can be categorized as either motor tics (involving physical movements) or vocal tics (involving sounds). These tics range from simple, brief twitches to complex, coordinated actions. While this is often associated with childhood, its impact can even extend into adulthood, significantly affecting an individual's quality of life. In addition to tics, many individuals with this syndrome also experience other conditions, including Attention-Deficit/Hyperactivity Disorder (ADHD), Obsessive-Compulsive Disorder (OCD), anxiety, and depression. The disorder can significantly affect social, emotional, and educational development, leading to challenges such as social isolation, bullying, and academic difficulties.
CAUSES
Tourette’s Syndrome is a multifactorial condition, as it is a combination of genetic, neurobiological, and environmental factors. While the exact cause remains unknown, several factors play a key role in the disorder's onset:
- Genetic Factors: Studies have shown that the disorder tends to run in families, indicating a hereditary component.
- Neurobiological Factors: Dysfunction within the basal ganglia and its connections to other brain regions, such as the frontal cortex, contributes to the tics.
- Dopamine Dysfunction: Dopamine is a neurotransmitter that plays a crucial role in motor control, reward processing, and mood regulation. Imbalance in the dopamine levels, particularly an overactivity of dopamine, leads to the development of tics. This theory is supported by the effectiveness of certain dopamine-blocking medications which help reduce the frequency of tics.
- Infections: Particularly streptococcal throat infections, can lead to sudden onset or worsening of tics, a phenomenon known as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS).
- Stress, Anxiety, emotional excitement like public speaking, exams, heightened emotions, etc., can provoke tics.
- Environmental Sensory Overload: Overstimulation from loud noises, bright lights, or crowded spaces can trigger tics, particularly in individuals with sensory sensitivities.
SYMPTOMS
1. Onset of Tics in Childhood
Tics typically appear between the ages of 5 and 10, and they are often first noticed in the face, such as eye blinking or facial grimacing. The tics may flare up during periods of stress, excitement, or fatigue.
2. Waxing and Waning
Tics often fluctuate over time, with periods of exacerbation and remission. In some cases, tics may improve with age, while in others, they can continue into adulthood.
3. Comorbid Conditions
Such as ADHD, OCD, anxiety, or learning disabilities.
4. Social and Emotional Impact
The visible nature of tics can lead to social embarrassment, bullying, and isolation, therefore, individuals may experience anxiety or depression.
TYPES OF TICS
Tics are classified into two main categories
- Motor Tics : These are movements of the body.
- Simple Motor Tics : Brief & sudden movements, such as eye blinking, shoulder shrugging, or head jerking, etc.
- Complex Motor Tics : Coordinated sequences of movements, such as touching objects, facial grimacing, or jumping, etc.
-
Vocal Tics :
- Simple Vocal Tics : Brief sounds, such as throat clearing, sniffing, or grunting.
- Complex Vocal Tics: Words or phrases, such as echolalia (repeating others' words), palilalia (repeating one's own words), or coprolalia (involuntary swearing, which is relatively rare).
DIAGNOSIS
Diagnosing TS involves a comprehensive evaluation, including:
- Medical History & Physical Examination: A detailed history of the individual's symptoms, including the onset, frequency, and type of tics. It is important to rule out other causes of tics, such as medication side effects or other neurological disorders.
- CT scan, MRI of brain: To rule out any other condition.
- Neurological Examination: To assess motor function and reflexes.
- Diagnostic Criteria: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), provides specific criteria for diagnosing TS. Here the motor tics should be multiple along with one vocal tic. Tics should begin before the age of 18 years and should last for more than a year.
TREATMENT
There is no permanent cure for Tourette's Syndrome, but several treatment options can help manage symptoms:
- Behavioral Therapy:
- Comprehensive Behavioral Intervention for Tics (CBIT): A type of therapy that helps individuals become more aware of their tics and develop strategies to manage them.
- Habit reversal training (HRT): It involves increasing awareness of tics and teaching strategies to replace them with more socially acceptable behaviors.
- Medications: Medications may be prescribed to help control tics, including:
- Dopamine-blocking agents
- Alpha-2 adrenergic agonists
- Antidepressants
- Deep Brain Stimulation: It is advised in severe TS where the patient doesn't respond to medication, deep brain stimulation (DBS) can be considered. DBS involves implanting electrodes in the brain to regulate abnormal neural activity.
AYURVEDIC OVERVIEW
In ayurveda, there is no direct correlation of Tourette’s syndrome, but it can be understood as the disease developed due to the vitiation of the vata dosha. Our nervous system is regulated by vata dosha. The imbalanced vata dosha also involves our Manovaha srotas. The factors like Alpa Satva (low mental strength), Bhaya (fear), chronic stress, bad dietary choices can act as a trigger and lead to the manifestation of tourette’s in childhood. The aggravated Vata dosha can lead to the over-stimulation of the nervous system, causing the involuntary movements called tics.
When the Manovaha Srotas gets vitiated due to vata dosha, it can result in increased anxiety, impulsivity, and emotional instability. This also heightens restlessness, further intensifying the severity and frequency of tics.
There are various Panchakarma procedures and medications which are beneficial for managing Tourette's syndrome. Procedures like shirodhara (pouring medicated oil on head), shiropichu (a cotton pad dipped in medicated oil is placed on head), shirobasti (a pool of medicated oil is made over head) etc. are advised to balance the vata dosha. Medicines like Balaarishtam, Dhanwantharam Gulika, Kalyanak Ghrita, Sidharthak Ghrita, Vachadi Ghrita, Saraswatarisht, etc. are advised.
AYURVEDIC HERBS BENEFICIAL IN TOURETTE’S SYNDROME
1. Ashwagandha / Withania somnifera
Ashwagandha has Katu (bitter), Tikta (pungent), and Kashaya (astringent) tastes, along with Snigdha (nourishing) yet Laghu (light) qualities and Ushna Veerya (heating potency). It helps balance Vata and Kapha doshas, alleviating stress, fatigue, and inflammation while enhancing vitality and endurance. Its neuroprotective effects may benefit Tourette’s syndrome by regulating neurotransmitters and reducing stress-induced tics. Additionally, it helps reduce inflammation and strengthen immunity.
2. Tagara / Valeriana wallichii
Tagara is a well-known herb for addressing sleep-related issues. Being a rich source of melatonin, it is commonly used alongside other formulations to regulate the circadian rhythm. By modulating neurotransmitters that facilitate communication between brain neurons, it induces a calming effect on the mind. This action helps suppress excessive neural activity, thereby promoting restful sleep. It is beneficial for soothing the central nervous system, enhancing cognitive functions, and improving mental clarity. Classical texts highlight its therapeutic use in conditions such as Bhuta (psychiatric disorders), Mada (intoxication), and Apasmara (epilepsy).
3. Brahmi / Bacopa monnieri
Brahmi is highly regarded for its ability to enhance cognitive function, memory, and intelligence. It helps in balancing Vata and Pitta doshas. The herb has Tikta (bitter) and Kashaya (astringent) tastes, Laghu (light) attributes, a Sheeta veerya (cooling potency), and undergoes Madhura vipaka (sweet metabolic conversion after digestion). Known for its Medhya prabhava (brain-boosting effects), Brahmi is a natural source of melatonin, aiding in relaxation. It calms the nervous system and blood vessels, thereby reducing blood pressure. Traditionally classified as a "Vayasthapana" herb, it promotes longevity and well-being, while its "Unmada Vinashini" properties make it beneficial in managing psychiatric disorders.
4. Shankhpushpi / Convolvulus pluricaulis
Shankhpushpi helps in balancing Pitta and Kapha doshas. It holds a unique prabhava (special effect) of being "Medhya," which signifies its role in boosting intelligence and memory. Traditionally, it has been utilized in treating neurological imbalances. As a neuroprotective herb, it is recognized as "Manasarogahrut" (beneficial for mental disorders), "Unmada" (effective in psychiatric conditions), and "Apasmara" (useful in epilepsy). Also, it is known as "Smritiprada," which enhances memory, and has Rasayanic properties that contribute to overall health and longevity.
HERBAL REMEDIES FOR TOURETTE’S SYNDROME BY PLANET AYURVEDA
Planet Ayurveda provides a combination of ayurvedic herbs for the management of Tourette's Syndrome. The medicines beneficial in Tourette's Syndrome are Neurogenie capsules, Medhya Churna, Neuroplan syrup, Brahmi Ghrit, and Stress Support Capsules. All the Planet Ayurveda medicines are 100 % natural, vegetarian, additive free, chemical & preservative free and without any side effects. With Ayurvedic intervention, Tourette's Syndrome can be managed efficiently and thus, increasing the quality of life.
PRODUCT DESCRIPTION
1. Neurogenie Capsules
These capsules are prepared from the standardised extract of the ashwagandha (Withania somnifera) and brahmi (Bacopa monneri). Ashwagandha helps in reducing stress, improving memory, boosting focus, and protecting brain cells from the oxidative stress. Brahmi enhances memory, increases concentration, supports learning, and promotes mental clarity. Both these herbs together help in improving brain function, reducing anxiety, and support complete brain health.
DOSAGE: 1 capsule twice a day
2. Medhya Churna
This churna is formulated using standardized extracts of potent Ayurvedic herbs, including Vacha (Acorus calamus), Ashwagandha (Withania somnifera), Ajmoda (Carum roxburghianum), Shweta Jeerak (Cuminum cyminum), Krishna Jeerak (Carum carvi), Sunthi (Zingiber officinale), Maricha (Piper nigrum), Pippali (Piper longum), Patha (Cissampelos pareira), Shankhpushpi (Convolvulus pluricaulis), and Brahmi (Bacopa monnieri). The main ingredient Vacha in this churna is known for its medhya prabhav (special action on intellect), which helps in enhancing memory and cognitive function. This churna maintains the balance of both Kapha and Pitta doshas, promoting mental clarity, boosting memory, reducing anxiety, and improving confidence.
DOSAGE: ¼ tsp twice a day with warm milk and scrub over the tongue too
3. Neuroplan Syrup
This syrup is prepared using the standardised extract derived from the various intellect improving herbs like Brahmi (Bacopa monneri), Mandukaparni (Centella asiatica), Shankhpushpi (Convolvulus pluricaulis), Jyotishmati (Celastrus paniculatus), Ashwagandha (Withania somnifera), Bhojpatra (Betula utilis), Yashtimadhu (Glycorrhiza glabra) and Trikatu (Three bitters). This syrup is sweetened with natural organic honey. Brahmi, Mandukaparni, and Shankhpushpi support cognitive function, reduce stress, and enhance neurotransmitter activity, potentially improving focus and reducing tics. Jyotishmati and Ashwagandha aid in calming the nervous system, reducing anxiety, and promoting emotional stability. Bhojpatra and Yashtimadhu have neuroprotective and anti-inflammatory properties that may support brain health, while Trikatu enhances absorption of these herbs. This syrup helps in regulating nervous system imbalances, reduces involuntary movements, and supports mental well-being in individuals with Tourette’s.
DOSAGE: 2 tsp twice a day
4. Brahmi Ghrit
This ghrita is prepared using the pure cow’s ghee and the standardised extract of the herbs like Brahmi (Bacopa monneri), Vacha (Acorus calamus), Kutha (Saussurea lappa), and Shankhpushi (Convolvulus pluricaulis). These herbs possess neuroprotective and calming properties that help regulate excessive nerve impulses, potentially reducing motor and vocal tics. Brahmi and Shankhpushpi enhance cognitive function, focus, and memory, while Vacha supports nervous system stability. Also, this Ghrita helps in balancing Vata Dosha, which is often linked to Tourette’s syndrome.
DOSAGE: 1 tsp twice a day with warm water
5. Stress Support Capsules
These capsules are formulated using standardized extracts of Ashwagandha (Withania somnifera), Tagara (Valeriana wallichii), and Brahmi (Bacopa monnieri). These herbs naturally support the regulation of neurotransmitters and are rich in melatonin, which aids in relaxing the nervous system, improving sleep patterns, and reducing stress-related symptoms. In Tourette’s Syndrome, these capsules help by stabilizing excessive nerve activity, minimizing involuntary movements (tics), and promoting mental calmness. These properties also help in managing emotional imbalances, anxiety, and hyperactivity, making them beneficial for overall neurological well-being.
DOSAGE: 1 capsule twice a day
CONCLUSION
Tourette's Syndrome is a complex neurodevelopmental disorder with significant social and emotional implications. Though its exact cause remains unclear, research points to a combination of genetic, neurobiological, and environmental factors. Understanding the nature of tics and their triggers is essential for managing the condition effectively. Conventional treatment options, including behavioral therapy, and medications can help reduce tic severity and improve quality of life. In addition, Ayurvedic remedies offer a complementary approach to managing Tourette’s, particularly in terms of stress management and brain health. A holistic approach that combines both conventional and alternative therapies may offer the most effective means of managing Tourette’s Syndrome and improving the lives of those affected.
