How will leaving the EU now affect the NHS?

Last week it was revealed that Britain is leaving the EU after the controversial referendum. Having been busy revising for my a-level examinations which are now thankfully over, I had not taken much consideration into what effects Brexit could have. Having researched into the multitude of consequences it is clear that the NHS is a main issue that leaving the EU will effect.

The potential impact on the NHS is still unknown. Although it is almost certain that the NHS will not be receiving significant extra funding, despite promises that Brexit will mean saving £350 million a week. Nigel Farage admitted the promise was inaccurate himself. In reality the NHS could face less funding due to the economic uncertainty that leaving the EU has posed. Indeed 135,000 EU migrants are employed by the NHS, and now Britain is leaving the EU they may choose to exit as well. Will the UK be able to cope with fewer doctors and nurses and even longer waiting times? Sir Bruce Keogh has said that, “If you are a European doctor or nurse you might not feel too welcome at the moment,” hence it is, “really important we make them feel welcome.”

Diagram from the guardian showing who the NHS employs. http://static.guim.co.uk/ni/1390829680973/NHS_staff_graphic.pdf
Diagram from the guardian showing who the NHS employs. http://static.guim.co.uk/ni/1390829680973/NHS_staff_graphic.pdf

It is apparent that the EU sustains the NHS in various ways. Dr Mark Porter, BMA chief claims that “Anyone who attacks the contribution to this country of people from around the world, attacks us all. They attack many of us personally, but they attack every one of us, because the health service we love would not exist without their contribution.” However, Brexit did predict that migration could have meant a 4.25 million population increase by 2030, which would have hastened demand for services such as A&E by 46%. This supports the argument still that we have a blurred vision for our health prospects.

Some argue that Brexit will now make it easier for the UK government to make changes to those employed in the NHS. Nevertheless, having been a member of the EU, Britain had to abide to principles such as the European Working Time Directive which warrants that employees are not overworked. Without rights and rules enforced upon Britain, will workers still be offered fair working hours, rights, maternity and paternity leave? In addition, Britain now has no influence over the European Medicines Agency, a key organisation which regulates the approval of the uses of different drugs.

So overall, leaving the EU is going to impact our health service significantly. It could potentially bring more money into the NHS, but conversely could spell the end of the NHS. The referendum has definitely imposed an unknown future onto the NHS; we can only hope that our future health care is sustainable with a new Brexit government leading.

The Generalisation of the term “diabetes”

Often I hear a news report or read a magazine article on diabetes and unfortunately the majority of the time the author will fail to distinguish between type 1 and 2 diabetes.

The latest offenders are the World Health Organisation (WHO), publishing a major report on how the number of adults with diabetes has “almost quadrupled since 1980 to 422 million adults.” They claim factors driving the rise include “overweight and obesity.” The report completely merges type 1 and 2 diabetes together; hence those uneducated about diabetes would assume that both types are due to an individual’s unhealthy diet or lifestyle.

Report published by the WHO; can be accessed via http://www.who.int/diabetes/global-report/en/
Report published by the WHO; can be accessed via http://www.who.int/diabetes/global-report/en/

There is a clear difference between type 1 and 2 and it would not be difficult to explain so that the public do not stereotype those with diabetes as “overweight” or “obese.” In a previous blog entry I explained how my sister has type 1 diabetes. Type 1 is an autoimmune condition, whereby the body’s pancreas cannot produce the hormone insulin to maintain blood glucose levels. Whereas type 2, which is more common, is predominantly due to individuals eating unhealthy and leading an inactive lifestyle.

The WHO are right in publishing the report to make the public aware of the complications of being overweight, however they should have separated data on type 1 and 2 diabetes because they are effectively two different conditions. They may be diagnosed in the same way but the treatment and causes are completely different.

The report was interesting as I discovered that 2.2 million additional deaths were caused by higher-than-optima blood glucose levels as well as finding that the Eastern Mediterranean region actually has the highest estimate of prevalence of adults with diabetes; whereas Europe has a much lower estimate. Hence, it seems low and middle income countries are now experiencing a burden of type 2 diabetes. In the BBC article about the WHO report they declare that “Diabetes itself is the eighth biggest killer in the world, accounting for 1.5 million deaths each year.” Indeed, this is an astonishing statistic; however it completely generalises type 1 and type 2 diabetes when evidently much less people experience fatal consequences with type 1.

Estimates of the prevalence of diabetes in adults within different regions of the world (as of 2016)
Estimates of the prevalence of diabetes in adults within different regions of the world 

1 in 3 people are now overweight and this is obviously the major cause for type 2 diabetes which needs to be prevented. Treatment for type 2 diabetes is much simpler than type 1; focusing on 3 major areas- diet, weight and physical activity. What’s more, type 2 diabetes can actually be prevented, whereas type 1 cannot be. If type 2 could be prevented in the first place the NHS would have to fund less treatment for the complications it causes such as strokes, kidney failure, blindness, etc. More funding could then go into researching for a cure for type 1 diabetes and improving the quality of those with this type of the condition, for example ensuring that all diabetics have the choice whether to use an insulin pen or insulin pump, particularly diabetic children.

The effect of type 2 diabetes is becoming an ever increasing burden on our NHS and the health of the world population. We need to act in order to prevent it dominating our future health and generations to come. I often feel it is unfair that type 2 diabetes is always the focus of our concern; indeed it affects many more people than type 1 but the majority of type 2 sufferers could have prevented such diagnosis in the first place. In conclusion, type 2 diabetes needs to be dealt with and controlled, but we must not forget about the need for a cure for type 1 diabetes to improve the quality of lives of those suffering from it.

Why we should look to Cuba to improve our Healthcare System…

Cuba’s healthcare system has been in revolution ever since the 1950s when the infant mortality rate was more than 80 per 1000 births, whereas now it has been reduced to only 5. This is lower than the USA itself and Cuba’s life expectancy is nearly identical to the USA with the average being 78 years; one of the highest in the world. Yet Cuba only spends $431 per head per year in contrast to the USA which spends $8,553. How do they do it? The answer is simple; prevention instead of a cure.

Various graphs comparing the success of Cuba's healthcare system compared to the USA and Latin America
Various graphs comparing the success of Cuba’s healthcare system compared to the USA and Latin America

With its small population of 11 million, Cuba has a multitude of 90,000 doctors to support it. With more than 8 for every 1000 people, this is significantly more than the UK which has 2.7 per 1000. This volume of doctors is the key to the prevention model which ensures that every patient is visited at home annually, and those with chronic conditions have more frequent visits. Data from home visits is combined to put patients into categories according to their “risk”; measured on a scale of 1 to 4.This allows the doctor to assess whether an annual visit is sufficient, or if more regular visits are required. So there is a clear aim to stop the public getting ill in the first place which is completely logical. All house calls result in addressing problems with follow-up appointments; this applies even for the failure of preventing an unwanted pregnancy.

Vaccination rates are the highest in the world, their literacy rate is 99% and health education is compulsory in all schools. However, there are disadvantages to this system; the public have no choice and no alternative with private health care. Physicians do receive benefits such as housing and food subsides, but their pay is low- $20 per month. Although they get free education and their role is respected, personal wealth is unattainable. Cuba still remains an extremely poor country in other aspects with very basic infrastructure and sanitation. Nevertheless, the advantages of their healthcare system should be an example to countries around the world.

Cuban healthcare
Cuban healthcare

Due to the success of their healthcare and the extension of the Cuban life, the country now has an ageing population equivalent to the UK. Hence, new problems such as obesity, heart disease and cancer are rising. Ironically the “Cubans live like the poor, and die like the rich,” in that their lifestyle is within a poor nation yet they die from the same diseases as many from a rich nation such as the UK. Indeed, the Cuban government is tackling this with new investments for education on the importance of diet and exercise and the effects of smoking and alcohol.

Should we look to Cuba to solve the NHS problem?
Should we look to Cuba to solve the NHS problem?

In conclusion, Cuba would be one of the most successful countries if it was not a less economically developed country. This presents how prosperous the UK, US or any other more economically developed country could become if the same measures were applied. Everyone could have an increased quality of life in health and wealth. To start we need to train more doctors and ensure that everyone is vaccinated to prevent conditions and people getting ill in the first place. With the NHS system being close to failure, maybe we need to consider Cuba before it’s too late?

Trigeminal Neuralgia

Earlier this year I wrote a post about Temporomandibular Disorder (TMD); jaw joint dysfunction, which my mother suffers from. She has recently visited a specialist who has recognized that this condition is a consequence of trigeminal neuralgia. By looking into my mother’s medical history, the disorder is likely to have been caused after she had surgery to remove her wisdom tooth, in which her jaw was opened too far.

What is Trigeminal Neuralgia?

It is described to be a sharp, shooting facial pain which can last from a few seconds to around 2 minutes. Commonly it only affects one side of the face, in my mother’s case it is her left side. These attacks can happen up to hundreds of times a day, although most people experience it daily or weekly. This pain can improve or disappear, however with my mother the condition has developed into a more continuous throbbing ache, along with random sharp attacks. My mother is normally triggered when she over exerts herself, is exposed to cold wind or harsh weather. In other people a simple movement of the face or head can sometimes activate the pain.

The Trigeminal Nerve
Figure 1: The Trigeminal Nerve

What is the Trigeminal nerve?

The compression of this nerve which is the largest inside the skull is the main cause of Trigeminal Neuralgia. There are actually two sets of the nerve in both the left and right side of the face. Figure 1 shows how extensive the Trigeminal nerve is; it lengthens into smaller branches such as the Mandibular branch which sends sensory information from the skin to the lower jaw, teeth and gums. Typically either the Mandibular branch or the Maxillary branch (upper jaw) is affected. The exact cause of the condition remains unknown; however 95% of cases seem to be caused when pressure is caused by an artery or vein compressing the Trigeminal nerve. In this way the pressure causes the myelin sheath which protects the outer layer of a neuron to wear away which causes the uncontrollable pain signals to occur. However, accepting this as a cause in contradictory as it does not explain why sufferers experience pain periodically with times when there are no symptoms.

The various parts of the face that can be affected if the Trigeminal nerve is disturbed
Figure 2: The various parts of the face that can be affected if the Trigeminal nerve is disturbed

How is the condition treated?

Painkillers such as paracetamol are ineffective at treating this condition therefore anticonvulsant medication is usually prescribed. The only current type of this medication licensed for such treatment is called Carbamazepain. Unfortunately although the initial effect of this medication is effective, in the long-term it becomes more ineffective. In addition it has various side effects such as double vision, memory problems and allergic skin reactions. Hence, patients are normally referred for further treatment. In serious cases when medication is inadequate surgery may be necessary. Procedures may involve injection, for example glycerol injections into the Gasserian ganglion (where the 3 branches of the trigeminal nerve come together); this works by intentionally injuring the nerve so that it disrupts the pain signals travelling along it. This type of surgery has various complications such as numbness to part of or the entire side of the face. Indeed, the treatment will only cause the pain to be relieved for up to a few years so the consequences have to be considered before such treatment.

My mother has been referred to a specialist who will hopefully be able to assign an appropriate treatment for her condition. Living with the pain can be extremely difficult for her and sometimes her quality of life is affected considerably. In the meantime she tries to avoid doing activities that trigger her symptoms as it is important to live a normal life. If you experience persistent facial pain and find that normal painkillers do not suffice, you may want to consult your GP to see if Trigeminal Neuralgia is a potential cause. For more information on the condition visit: http://www.tna.org.uk/; the Trigeminal Neuralgia Association for the UK.

Coeliac Disease

Following from my post about food intolerance’s, I have received my blood test results. I have been diagnosed with coeliac disease which causes inflammation in the lining of the small intestine. My results will be confirmed at a follow-up appointment but from now on I cannot eat gluten or wheat food products. Although it has been distressing to find that I have limitations to my diet, I am relieved that I know the cause of my problem and hopefully my symptoms will calm down as I change my food intake.

Wheat and gluten excluded from my diet
Wheat and gluten have to be excluded from my diet

Interestingly, coeliac disease is not a food allergy or intolerance. It is in fact an autoimmune disease. Since my sister has type 1 diabetes, another autoimmune disease, it is not surprising that I have one too; if a close family member has such a disease there is a 1 in 10 chance of developing one. My diagnosis means that my body actually makes antibodies against gluten. Therefore, my small intestine identifies gluten as harmful; responding in the same way as it would to pathogens. It reacts with the gluten leading to the development of inflammation in the lining of the intestine. The villi that line the small intestine become flattened due to this inflammation. Villi normally help food and nutrients to be digested and so with coeliac disease you do not properly digest your food. This is why I have had limited weight gain, abdominal pains and tiredness; the main symptoms of the disease. The average time from the first symptoms to diagnosis of coeliac disease is 13 years in the UK; this means I could have been living with it for nearly my whole life.

The impact of coeliac disease on the lining of the small intestine
The impact of Coeliac disease on the lining of the small intestine

My blood test for coeliac disease was obviously positive as there was a high percentage of the antibody that occurs in the disease in my blood. My follow-up appointment may include a biopsy where a small sample of tissue is taken from the lining of the intestine in order to examine the typical changes that coeliac disease causes. This is carried out by using an endoscope which is a thin flexible tube that is passed down the oesophagus, through the stomach and then to the small intestine. In addition, I may have to have further tests to see how poor absorption of food has affected me, such as blood tests for iron or protein levels.

Endoscopy is used to confirm coeliac disease
Endoscopy is used to confirm Coeliac disease

The main treatment for the disease is a gluten free diet. The symptoms should then go within a few weeks. Wheat, barley and rye are the main foods that contain gluten. This means breads, pasta, cakes, pastries and most cereals are out of the question. Nevertheless, potatoes, rice, maize, corn, fruit, dairy products and vegetables are all allowed. The main disadvantage with Coeliac disease is eating out. Processed foods, fast foods and ready-meals almost always contain gluten. Care has to be taken with foods such as french fries in McDonald’s; although they do not contain gluten, they are likely to be contaminated with the various other foods containing gluten that the restaurant is cooking.

Image of the small intestine before and after coeliac disease
Image of the small intestine before and after Coeliac disease

To avoid all symptoms and complications I will have to avoid gluten for life as even small amounts can sensitize the gut. Furthermore, I may have to take vitamin supplements for the first 6 months to replace deficiencies while my gut is returning to normal.

Coeliac disease means I now have an increased risk of developing other conditions such as the thinning of the bones (osteoporosis). Commonly people think that consuming small amounts of gluten will not matter. In reality only a small amount can cause symptoms to return.

The disease affects 1 in 100 people in the UK, with anyone at any age being impacted. If you think you may be Coeliac you should see your doctor. A gluten free diet should not be attempted before diagnosis as if you go on this diet before the blood test then it may give negative results. Hopefully I will be able to live free from the symptoms of Coeliac disease if I avoid gluten! For more information visit: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/celiac-disease/Pages/facts.aspx

Temporomandibular Disorder (TMD)

My mother has lately been diagnosed with TMD also known as jaw joint dysfunction or myofascial pain disorder. This is a group of conditions that result in joint pain which can stop the correct movement of the jaw. 1 in 6 people are affected by the condition, and 30% of adults will experience TMD at some point in their lives.

Diagram showing the jaw joint
Diagram showing the jaw joint

Grinding her teeth was the main cause of my mother’s TMD; this happens normally when you’re asleep meaning the jaw muscles are overworked so there is unnecessary pressure on the jaw joint. Nevertheless the disorder can be caused by stress, uneven bite, specific diseases or wear and tear of the jaw joint. TMD is not usually serious and the symptoms typically last a few months before improving. However, this can have a significant impact on someone’s quality of life and it may develop into a more severe dysfunction.

My mother had been experiencing more severe symptoms of the condition for around a year before being diagnosed. She was suffering from painful migraines and serious neckache. However other symptoms include clicking or popping as you chew food, muscle pain around the jaw, earache, backache and difficulty opening the mouth.

Milder versions of TMD can be treated by making simple lifestyle changes such as eating soft food, holding a warm/cold flannel on the jaw several times a day, doing jaw-stretching exercises or massaging the jaw muscles. However my mother had previously tried such techniques and had no success. Hence, she has now been prescribed with a mouth guard. This fits over your teeth to stop grinding, especially at night. So far she has found her jaw to be less painful as clenching has been reduced.

My mother's mouth guard
My mother’s mouth guard

For very severe cases, surgery may be necessary to resolve TMD. One treatment is called arthrocentesis which involves inserting needles into the affected joint. The needle injects a sterile solution to wash out the joint- removing any extra scar tissue while increasing mobility. In rarer cases, open joint surgery is required to fix an abnormality within the joint. Very few people are recommended to have complete joint replacement as it can have significant side effects.

If you think you are suffering from TMD try making some simple life changes as suggested. If your symptoms do not improve consult your doctor or dentist.

Food Allergies and Intolerances

Food allergies cause a reaction in the body’s immune system causing various effects on different organs. Hence, a food allergy can be severe or life-threatening and so a certain type of food cannot be consumed at all. Whereas with food intolerance, the body can cope with small amounts of a type of food without a reaction and there are ways in which this intolerance can be prevented.

Milk, gluten, nuts and eggs are common foods that induce reactions, however effectively any food has the potential to cause an adverse effect. It is estimated that between 1 to 2% of people in the UK have a food allergy, although 30% “believe” that they are allergic or intolerant to certain types of food. Therefore, it is important that sufferers who “believe” they have intolerance seek advice from their doctor before changing their diet.

Food intolerance can be caused by: enzyme absence; meaning food cannot be digested, irritable bowel syndrome, food poisoning, food additive sensitivity, stress or celiac disease. Such symptoms that may develop include abdominal pains, bloating, constipation, diarrhoea, fatigue, headaches, stomach cramps and weight loss.

% of population with intolerance to certain food groups
% of population with intolerance to certain food groups

 

Over the past few months I have come to realise that I may be intolerant to certain types of food. Over a year ago I went to Ecuador on an aid-working expedition where I contracted gastroenteritis; an infection of the gut. Possible complications of the disease include lactose intolerance as the gut lining can be damaged leading to a lack of the chemical enzyme lactase which is required to digest lactose. Thus, recently I have been drinking soya milk instead of regular milk and my symptoms seemed to have calmed slightly. Nevertheless I have visited my doctor where I had a blood test to see if I have any allergies, and I will get the results back soon to see if my self-diagnosis is correct.

Map presenting lactose intolerance globally
Map presenting lactose intolerance globally

 

So why do not all people develop allergies? As a baby the body becomes tolerant to a multitude of proteins that it encounters in the first stages of its life. Such mechanisms it undergoes are still unknown, hence research would be able to reveal if the timing of introducing foods is important in order for normal tolerance to function. Most childhood allergies disappear after 12-24 months, however why this is, is unclear. There is limited knowledge as well with why allergic diseases develop, though existing diseases such as asthma may influence them.

In conclusion, if after eating a particular food you have a reaction ensure you visit your doctor as soon as possible to see if you have an intolerance or allergy. Keeping a food diary can also help if you have unexplained constipation or stomach cramps in order to identify a trigger food. If you wish to know more about this aspect of nutrition visit: https://www.nutrition.org.uk/nutritionscience.html.

Improving the NHS

Last week I attended the British Youth Council (BYC) convention in London as a member of the Kent Youth County Council. Conventions are held around 3 times a year by this charity which aims to involve young people to make a difference to decisions being made nationally.

The BYC has recently collaborated with NHS England by launching a Youth Forum which intends to give a voice to the next generation who will use the NHS and to improve the future of public health in England. Their main aims are:

  • To improve communication between young people and clinicians.
  • Raise awareness of mental health issues
  • Destigmatise sexual health services in order to improve the sexual health of young people

Their current campaign involves tweeting images and tweets with the hashtag “DearNHS” so that the decision makers in the NHS are aware of how young people feel the service can be improved.

While at the convention, we were split into groups and had to devise our own tweet. It was beneficial to discuss the various ways in which the NHS could be improved, and the process enhanced my critical thinking and made me more mindful of new ideas that could be successful. For example, someone suggested having a “teen” ward, since in hospitals there is either a children’s or adult’s ward. Indeed, many of the facilities available in a children’s ward may not be relevant for teenagers, equally an adult’s ward may not be appropriate. In order to advance the quality of life at hospitals we should really consider creating a ward for teenagers to safeguard their mental and physical well-being.

Mental health needs to be prioritised within the NHS
Mental health needs to be prioritised within the NHS

Our tweet was “Can you reduce the stigma around mental health so young people can access services more comfortably and quickly?” This certainly is a key issue especially as 1 in 3 people suffer from a mental disorder and it links into one of the forum’s main aims. People with mental health problems already experience discrimination and prejudice every day; they should not then be put off using mental health services because of such stigma. People certainly need to know the real facts about mental health, with many myths and stereotypes dominating people’s attitudes and behaviour.  Those with mental health disabilities do contribute to society; we need to give them the dignity and respect we give to all other members of society.

1 in 3 people suffer a mental disorder
1 in 3 people suffer a mental disorder

Hence, the convention was extremely awe-inspiring and has motivated me to take action on improvements within the NHS. I have joined our mental health interest group at the council which focuses on creating resources for youth organisations to provide information about mental health services.

If you want to have your say about how the NHS could be improved tweet with the hashtag “DearNHS,” or to find out more about campaigns that the British Youth Council is promoting go to http://www.byc.org.uk/about-us.aspx#.Vm25n0qLSUk.

The Consequences of Cholera

Cholera, a deadly, life-threatening disease that affects 3 to 5 million people worldwide. I previously did not know how widespread and lethal this disease was, but after reading a detailed article in this month’s Biological Sciences Review magazine I found out exactly how the toxin causes such devastating effects.

Having had the cholera vaccine in order to travel to the Dominican Republic and Ecuador, I did not realise the consequences that cholera could have. It is actually endemic in various parts of Asia and is responsible for 100,000 to 120,000 deaths annually. Essentially it is an infection of the small intestine by the bacterium Vibrio cholera which thrives in contaminated water. Hence, the disease occurs in areas of poor sanitation, particularly after natural disasters or war.

There is excessive transport of chloride ions and water into the small intestine as a result of the toxin being released. This leads to severe diarrhoea causing rapid dehydration. In 50% of cases, if untreated, it can cause death in just a few hours. Fortunately, there are new therapies to counteract dehydration by delivering a mixture of sugars and salts dissolved in water. Sufferers can therefore revive their immune system and recover. Nevertheless, the majority of people do not have access to such treatments as Figure 1 shows 70% of all cases occur in Southeastern Asia, Northern and Central Africa. The territory size on this map indicates the proportion of all cholera cases in that country. The United Kingdom (top centre) and United States (top left) are almost unnoticeable. Hence, most people infected are likely to live in poor conditions and so are likely to die if they become severely dehydrated.

Figure 1: territory size is in proportion to the number of cholera cases reported
Figure 1: Territory size is in proportion to the number of cholera cases reported

Indeed, there are no drugs currently which can specifically block the cholera toxin, and so even in economically advanced countries, recovery is only ensued by oral-rehydration therapy. Nevertheless there are a multitude of clinical trials being carried out in cholera-affected areas. To find out about specific clinical trials visit: http://www.nhs.uk/Conditions/Cholera/Pages/Clinical-trial.aspx?&Condition=Cholera&pn=1&CT=0&Rec=0 .

In conclusion, always check to see if you are travelling to a cholera-affected area to ensure you take the necessary precautions. A cholera vaccine is administered as a drink and it lasts for 2 years. While in the affected area you should also avoid ice cream and any ice in drinks, ensure you drink bottled water, avoid uncooked food unless you have washed it yourself and avoid seafood. While making sure that your health is protected from cholera, we also need to support those who are disadvantaged from such privileges. The most recent severe outbreak of cholera was in South Sudan and charity MSF has so far treated 46,900 people. They do this by simply replacing the fluids and salts the patient has lost having developed cholera treatment kits to provide rapid assistance. The MSF has managed to limit the case fatality in South Sudan to less than 1%. Working in Angola, Cameroon, Haiti, India, just to name a few more countries; the charity is hugely responsible to providing a future where cholera can be controlled and contained. Their website includes an interactive guide to how they treat cholera (http://www.msf.org.uk/cholera,) and you can also donate online.

Cholera is just one of the few diseases that effects less economically developed countries around the world. It is important to remember in the midst of wars and natural disasters, how such diseases can thrive and spread so quickly affecting millions who are deprived from medical facilities that we take for granted each day.

Biological Sciences Review, Volume 28, November 2015

Tourette’s Syndrome

While I was working at my local pharmacy a customer came in to collect their prescription and I noticed they were making abnormal physical movements; jerking their head up and down and they also spoke very loudly. They seemed unable to control such random movements.

Having witnessed such symptoms I decided to research into what the person could be suffering from. I discovered Tourette’s syndrome, which seemed to match the symptoms I had observed. It is a neurological condition; affecting the nervous system and brain, and it is commonly characterised by involuntary noises and movements called tics.

This condition normally starts in childhood and continues into adult life. Some children will develop tics, but they will grow out of them after several months- transient tics. Hence, to be classified as Tourette’s syndrome, these tics must have been present at least a year. Examples of vocal tics are grunting, coughing or shouting words, and physical movements include the jerking of the head or jumping up and down. Such tics can also be categorized as simple- small movements or uttering a single sound, or complex- making a series of movements or speaking a long phrase.

Before experiencing a tic, most people have unusual and uncomfortable feelings before so- premonitory sensations. These sensations are relieved after a tic. Tics will often follow a pattern and can be worsened by factors such as stress, anxiety and tiredness. Conversely, doing an enjoyable activity will reduce tics.

What are the causes of Tourette’s syndrome?

Diagram to show the area of the brain which causes Tourette's syndrome
Diagram to show the area of the brain which causes Tourette’s syndrome

 

The actual cause of this condition remains unknown, although it is believed to be linked to problems in the basal ganglia; an area of the brain. This is a group of specialised brain cells inside the brain that aid the regulation of the body’s movements. Tics are therefore the result of a temporary problem in this area which disrupts the decision-making process. A tic is effectively an unconscious urge to perform an action that the actual conscious mind regards as unwanted. What causes this to happen is still unknown, though dopamine is a naturally occurring chemical in the brain which can have powerful affects and so could be responsible.  

 

 

How can it be treated?

Fortunately there are treatments for Tourette’s syndrome and these may be classified as treatments without medication (behavioural therapy for example), medication (muscle relaxants, dopamine antagonists) and surgery (only in severe cases and so is extremely rare; it is a last resort).

This condition is also associated with Obsessive Compulsive disorder, ADHD and learning difficulties which are all psychological and behavioural problems which affect children in particular. Fortunately, this syndrome does not commonly affect a person’s intelligence.

To find out more about Tourette’s syndrome go to http://www.netdoctor.co.uk/conditions/adhd/a5227/tourettes-syndrome/.