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Drug Induced Tourette Syndrome

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What is Tourette Syndrome?

Tourette syndrome (TS) is a neurological disorder. With Tourette syndrome there are repetitive, involuntary movements or vocalizations. These involuntary movements are known as tics.

Tourette syndrome comes on most abruptly first in childhood, but is most noticed in teenage years. NIH.gov states that males are three to four times as likely to get the symptoms of TS. An estimate 200,000 Americans have the most severe form of TS.

Tourette syndrome can be chronic and last a lifetime, although the worst of it is experienced in teenage years. As the person gets older the tics become more controllable and are usually onset by stressors or triggers. For example, seeing another person with tics will trigger the person with Tourette syndrome to bring back their tics in return.

Some of the most common tics are eye blinking, among other eye movements and facial grimacing, shoulder shrugging, and head or shoulder jerking. Some of these can be combined with one another to make more complex tics. Some tics involve self-harm but only a small percentage adding up to 10 to 15% of individuals (NIH.gov states).

Tics are most times made worse with exciting experiences or anxious experiences to where the muscle groups are aroused. Then the brain cannot focus on controlling the tics in a fashion that is helping the individual cope. As stated above seeing someone else do a tic or something related will bring out the Tourette syndrome in the effected.

Tourette syndrome gets better when coupled with relaxation and calming techniques like breathing techniques, or visualization techniques where the mind can reset itself from the tics. Tics are diminished during sleep but do not go away completely.

Tics come and go over time and vary in type, but are most commonly seen in the face and head area. Also, even though tics are involuntary, some people have learned to suppress or disguise their tics with something else; something less noticeable. This makes Tourette’s sometimes an invisible or difficult syndrome to see, but still very much uncomfortable to the affected.

 

Movement Disorders Associated with Withdrawal of Drug Abuse

tourette syndrome Drug Induced Tourette Syndrome TourettesTable 201

Courtesy of pharmacytimes.com

When dopamine floods the brain in drug abuse there is a suppression of tics and bodily movement. It’s shown that opioid abuse will lessen your rhythms of movement and even suppress things like tics and cardiovascular efficiency.

While detoxing off of drugs that flood the brain with dopamine there is a blockage or lowered rate of the dopamine in the system. NIH.gov goes on to state, “For example, heroin has been found to be mixed with the synthetic potent opioid fentanyl hydrochloride; cocaine with diltiazem; and methylephedrine and ecstasy with pseudoephedrine, dextromethorphan and caffeine. Caffeine and pseudoephedrine are known to cause postural and action tremors that closely resemble essential tremor.”

Opioid substances, like heroin, progress forebrain dopamine levels by stopping the inhibitory gamma aminobutyric acid (GABA). Opioids such as morphine (or street grade heroin) have been reported to increase myoclonus. Myoclonus is known as a spasmodic jerky contraction of groups of muscles. This can often, and most significantly be characterized as what neurologists will call, “medically induced Tourette’s syndrome.”

NIH.gov states, “Myoclonus has been frequently reported in association to opiate use, and opiate-induced myoclonus is recognized as a syndrome. It is often generalized, tends to respond to naloxone or benzodiazepines and patients concurrently using dopamine blockers (including antipsychotics and antiemetics), nonsteroidal-antiinflammatories and antidepressants seem to be at a higher risk. Opioids such as morphine, hydrocodone and parenteral tramadol have been reported to precipitate myoclonus. Interestingly, methadone-induced acute chorea resolving after switching to a different opioid has been reported and suggests non-opioid mechanisms in its genesis.”

This can lead to an intensive neurotoxic syndrome shown by recurrent convulsions, myoclonus (spasms of muscle groups), and asterixis (flapping tremor).

 

Case Study of Opioid Induced Spasms

Clinical Vignette #4: “A 43 year old Filipino man presented to the Movement Disorders center with a ten year history of a “creepy-crawly” feeling of his legs that was relieved by voluntary movement and was consistent with restless legs syndrome. He had been treated with pramipexole at the time of evaluation. Fifty milligrams of Tramadol were added as adjunctive treatment, which caused a significant reduction in his discomfort. Symptoms resolved completely upon titrating up to 100 mg a day, but he developed mutifocal, asynchronous, fast jerks of his arms and legs, consistent with myoclonus. The abnormal movements abated after Tramadol was titrated back to 50 mg daily.”

Source provided by: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966544/

 

 

My Story of Living With Medically/Drug Induced Tourette’s syndrome

tourette syndrome Drug Induced Tourette Syndrome dopamine aripiprazol

Courtesy of flipper.diff.org 

In part 14 of the Substance For You Saga (http://substanceforyou.com/substance-for-you-saga-pt-14/) I touched on meeting a neurologist who coined my tics as being medically induced. At that point I had been a chronic heroin user among alcohol, marijuana, and other illicit substances. On top of all the street drugs I was doing I was on drugs like Prozac (anti-depressant) and Seroquel (anti-psychotic), both known to alter the dopamine receptors in my brain. I was on these as prescribed from a doctor claiming to be an addiction psychiatrist. This was to mellow my mood from my first binge with heroin and alcohol. She clearly had the situation wrong, only upping the doses and not treating problems. The doctor only made them worse.

As I had tried to get clean from the heroin I'd also tried to cold turkey my anti-psychotic and anti-depressant medication. This started causing a blockage or lowering of the dopamine. This had severe side effects when my brain couldn’t handle the severe withdrawal. This, as stated above is known to spur on things like opioid induced Tourette’s and/or Parkinson’s.

It only took a maximum of a week for the “restless leg syndrome,” or creepy crawleys to aspire into my body–as was also found in the Filipino man in the case study done by NIH.gov. Soon to follow this would be the tremors in my face, eyes, shoulders, and neck. They were very uncontrollable and would be followed by thousands of eye blinks, eyebrow squints, and head jerks throughout the day and my sleep.

These symptoms persisted only to get worse over time, not better. Eventually the chronic pain from the muscle spasms—that were uncontrollable—became too immense for me to handle. I began wanting to use drugs again but only knew this would exacerbate the symptoms or worse, kill me. So, my father—with the best health insurance around—urged me and damn near begged me, to see a neurologist.

I remember times in car rides where I would need to be occupied with headphones just from the attention deficit long enough to sit still to go anywhere. I'd be humming a tune for the entire car ride. On one trip to the Upper Peninsula of Michigan–where my uncle lived–I hummed the same tune, while making whistling noises for 7 straight hours.  My mother had to wear earplugs in order to escape it she'd said. Only in my worst times, I'd resort back to my Obsessive Compulsive Disorder and do my Tourette-like spasms into sequences of four and on each side of my body only to synchronize the chances of not landing on “bad luck.”

The pain was excruciating and I looked like I was mentally ill; as I was. I couldn’t control myself from outburst and I was hurting really bad. My blood pressure was extremely high, in the range of 210 over 170 putting me at risk for heart failure, stroke, aneurisms, and other medical conditions that could kill me. It also put my liver into a state of shock and gave my gut a wrenching pain that would ultimately lead to a portal and superior vein thrombosis. A portal and superior vein thrombosis is blood clots in both the vein going in to the liver and going out of the liver.

I was diagnosed with medically induced, or opioid induced Tourette’s syndrome and was immediately started on a course of medication (non-narcotic), to not just stop the tics but save my life. If anyone ever contemplated being put on medication while trying to stay 100% sober it was I. But, the only problem was that if I didn’t start a course of therapy soon it would become permanent and could potentially lead to chronic debilitating symptoms, which would lead to an early death. So, I complied.

Today, five years later, I've learned how to treat my body healthy and ultimately learned an overall healthy lifestyle through the power of recovery and my support team of doctors, family, and recovery friends. I read the mini-book, “In Times of Illness” more times than I can remember and know that if my sponsor wasn’t by my side to tell me, “It’s okay Brian, it’s going to save your life. You won’t die this time, unless you don’t follow doctors orders,” than I might not be here today.

I’m episode free of Tourette’s for nearly two and a half years now. The year before that I'd only have a flare up during times of extreme panic or anxiety. It does getting better if you follow extreme precautions of doctors and medical personnel trained in the right fashion.

The one thing I urge of you is these types of ailments are real; drugs are extremely dangerous and can lead to fatalities even after withdrawal. So, if I could say one thing it is to be careful with what you put in your body because you never know when it will come back to haunt you, how it will affect your body, and the extreme measures you will need to go to save your own life, from even just one single use or abuse!

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