Tourette syndrome is a disorder that involves sudden repetitive movements (motor tics) or unwanted sounds (vocal tics) that can not be easily controlled. For example, repeated blinking of eyes, shrugging of shoulders, blurting out unusual sounds or offensive words . These may significantly interfere with communication, daily functioning and quality of life. Tics typically show up between ages 2 and 15, more in males than females. The exact cause of T S is not  known. It is likely caused by a combination of genetic  and environmental factors. Neurotrasmitters, including dopamine and serotonin, might play a role.

There is no specific test that can diagnose TS. Blood tests and MRI imaging of brain may be normal. There is no cure for Tourette syndrome. However, neuroleptic medications to help control tics may be added (meds which block or lessen dopamine, botox injections, ADHD meds, central adrenergic inhibitors, antidepressants, anti seizure). Other  therapies, like cognitive behavior therapy (CBT), psychotherapy and deep brain stimulation have also been tried.

Case Study

In September 2021, a 13 year old male child visited our clinic, complaining of vocal tics ( repeated grunting, tongue clicking) and motor tics (blinking and rolling of eyes, grimacing, shoulder shrugging, head and limb jerking, sticking out of the tongue), since last 3 years. He also developed epilepsy 1 month back. He was also a hyperactive child.

According to the neurologist, he was a classic case of Tourette syndrome. He was prescribed western medicines to control tics and seizures, but the parents refused. They tried homeopathy to control them but that did not help.

At our clinic, treatment was started with basic PNST protocol on head, face and Jing-well points; followed by traditional classical acupuncture for liver wind due to hyperactive liver yang.

Treatment Plan

1. PNST- Basic PNST protocol on side, Top and back of head, face and jing-well pints of hands.  

Basic PNST treatment – Side of Head

Basic PNST Treatment - Top of Head

Basic PNST Treatment - Back of Head

Basic PNST Treatment - Face

Jing Well Points

2. Body acupuncture- DU.20, Yintang, Liv.14, Ren.12, Ren.4, LI.4, HT.7, Pc.6, TW.5, LI.11, ST36, SP.6, LIv.3

3. Acupuncture points added according to symptoms:-

(a) Vocal tics:- Ren.23, extra point 0.5 cun lateral to Ren.23, St.9, ST.10

(b) Head jerks- GB.20, TW.16, SI.16

(c) Facial tics:- ST.5, ST.6, ST.7

(d) Eye blinking- UB.2, Taiyang

(e) Ear points- Pen laser was used on ear shenmen, sympathetic, kidney and liver

Treatment Frequency:

His treatment was started daily for 4 weeks and as his symptoms improved, it was reduced to thrice a week and then gradually reduced to twice a week. The treatment continued for a year. Now that all the symptoms have subsided, the frequency of treatment is reduced to once a week and will gradually be stopped.

Discussion

This case is noteworthy as we do not have any treatment for Tourette Syndrome in any system of medicine. It is the first case of TS, that I have treated in my life. I chose to start with PNST as the mode of therapy, as the symptoms indicated a lot of imbalance in the autonomic nervous system. Basic PNST helps in balancing ANS. Rest of the classical acupuncture points helped in controlling tics and seizures.

Before treatment his tics were the main problem. They were severe and noticeable socially. He was very self conscious about them. They would get in his way to move around, to talk or to lead a normal life, physically or socially. After treatment, he is leading a normal tic free life, much calmer, focuses well on school work and interact with others. A systematic review and meta-analysis conducted in 2016 regarding the effects of Acupuncture on TS patients concluded that acupuncture does reduce the tic severity in TS and is more efficacious than Haloperidol. This correlates with our results.