Andrey Nailor, M.D.·Published 21 May 2012·9 min read
Key points
Some parents swear by fish oil as a treatment for the "tics" caused by Tourette's disorder, but so far the research evidence is slim.
Tourette (TS) Syndrome is a neurological disorder characterized by tics - involuntary, rapid, sudden movements that occur repeatedly in the same way.
Despite the popular media image, most people with Tourette's do not uncontrollably hurl obscenities or slurs.
RESULTS: At end point, subjects treated with O3FA did not have significantly higher response rates or lower mean scores on the YGTSS-Tic (53% vs 38%; 15.6 ± 1.6 vs 17.1 ± 1.6, P > .1).
Some parents swear by fish oil as a treatment for the "tics" caused by Tourette's disorder, but so far the research evidence is slim.
In a small study of children with Tourette's, researchers found that omega-3 fatty acids were no better than a placebo at reducing the severity of tics - the sudden, involuntary movements or vocalizations that mark Tourette's.
On the other hand, children who took omega-3 did show an improvement in the degree to which their tics bothered them, researchers report in the journal Pediatrics.
For now, it's not clear what to make of the findings, according to lead researcher Dr. Vilma Gabbay, of the NYU Child Study Center in New York City and the Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York.
It's possible that the omega-3 supplements affected the children's well-being, said Gabbay.
There is evidence, for example, that omega-3s can help lift depression symptoms.
But the study was small and had other limitations. And the bottom line, Gabbay said, is that larger trials are needed to see whether there might be a role for omega-3 supplements in managing Tourette's.
The condition, also known as Tourette syndrome, is a neurological disorder that affects about one percent of the population. The characteristic tics usually start in childhood, and include actions like repeated throat-clearing, rapid blinking or mouth twitching.
Tourette (TS) Syndrome Tics
Tourette (TS) Syndrome is a neurological disorder characterized by tics - involuntary, rapid, sudden movements that occur repeatedly in the same way. To receive a diagnosis of TS a person must have both multiple motor and one or more vocal tics, not necessarily simultaneously, throughout a span of more than one year. The tics may occur many times a day (usually in bouts) nearly every day or intermittently. Tics periodically change in the number, frequency, type and location and wax and wane in their severity. Symptoms can sometimes disappear for weeks or months at a time. While most persons with TS have some control over their symptoms from seconds to hours at a time, suppressing them may merely postpone more severe outbursts. Tics are experienced as irresistable and (as the urge to sneeze) eventually must be expressed. Tics increase as a result of tension or stress and decrease with relaxation or concentration on an absorbing task.
Tics are categorized as Motor or Vocal, Simple or Complex. Simple tics are movements or vocalizations which are completely meaningless, whereas complex tics are movements or vocalizations which make use of more than one muscle group or appear to be meaningful.
Simple
- Abdominal jerking - Ankle flexing
Written and revised by
Andrey Nailor, M.D.
Our doctors write and review articles for accuracy and keep them up to date.
health.am provides general information, not medical advice. Always consult a qualified health professional about your own health.
- Banging - Body jerking - Body slamming - Chewing clothes - Copropraxia - Echopraxia - Hair twisting - Hitting - Hopping - Jumping - Kicking - Kissing - Picking - Pinching - Pulling clothes - Skipping - Scratching - Shivering - Smelling things - Somersaults - Stepping backwards - Tearing things - Throwing things - Twirling in circles - Walking on toes
Despite the popular media image, most people with Tourette's do not uncontrollably hurl obscenities or slurs.
Many children with Tourette's do not need any special treatment. But some kids have symptoms that interfere with their daily life, or have additional conditions that may warrant treatment, such as obsessive-compulsive disorder.
Will my child outgrow this? Most tics go away after a few months. However, sometimes a person will have 1 or 2 tics for many years. Children who have Tourette syndrome usually have their worst symptoms when they are between 9 and 13 years of age. Over half of these children get much better during the teen years and in early adulthood. Less than half of the people who have Tourette syndrome as children have moderate to severe tics as adults. What can I do to help my child? Learn about tics and Tourette syndrome and explain them to people who regularly interact with your child, such as relatives, teachers and day care providers.
Understand that your child has very little control over tics caused by Tourette syndrome. If you focus too much on the tics, they may get worse. In most cases, it's not helpful to encourage your child to try to stop a tic. Your child can hold back tics for a little while, but eventually the tics will come out.
"The problem is, the medications currently used are very hard to tolerate, or sometimes just don't work," Gabbay told Reuters Health.
Some of those medications include antidepressants, anti-seizure drugs and antipsychotics. Their side effects can range from weight gain to fatigue to depression.
Anecdotally, Gabbay said, some parents have claimed that omega-3 supplements help control their children's tics.
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Omega-3 fatty acids are found largely in oily fish, like salmon, mackerel and tuna - as well as fish oil pills.
There are biological reasons to believe that omega-3s could help quiet Tourette's tics, Gabbay said. Lab research suggests, for example, that the fats affect certain brain chemicals involved in nerve-cell communication and inflammation, and also thought to be involved in Tourette's.
But this is the first clinical trial to pit fish oil against a placebo to test it objectively.
Gabbay and her colleagues randomly assigned 33 children and teenagers with Tourette's to take either fish oil capsules or placebo capsules that contained olive oil. Depending on their age, the kids on fish oil took 500 or 1,000 milligrams of omega-3 a day.
Tourette Syndrome (TS) is an inherited, neurological disorder characterized by repeated involuntary movements and uncontrollable vocal (phonic) sounds called tics. In a few cases, such tics can include inappropriate words and phrases.
The disorder is named for Dr. Georges Gilles de la Tourette, the pioneering French neurologist who first described an 86-year-old French noblewoman with the condition in 1885.
The symptoms of TS generally appear before the individual is 18 years old. TS can affect people of all ethnic groups; males are affected 3 to 4 times more often than females.
It is estimated that 200,000 Americans have full-blown TS, and that perhaps as many as 1 in 100 show a partial expression of the disorder, such as chronic multiple tics or transient childhood tics.
The natural course of TS varies from individual to individual. Although TS symptoms range from very mild to quite severe, the majority of cases fall in the mild category.
### Current understanding TS was originally considered a rare psychogenic condition but is now thought to be a relatively common genetic disorder. It remains misunderstood by the lay public, and many people are still unaware that cursing tics (coprolalia) affect only a minority of patients (8%).
One of the first descriptions of tics appeared in 1825, when the French physician Jean Itard described 10 people with repetitive tics, including complex movements and inappropriate words. Subsequently Charcot assigned his resident, George Gilles de la Tourette, to report on several patients treated at the Salpetriere Hospital for repetitive behaviors. The goal was to define an illness distinct from hysteria and chorea.
In Tourette's 1885 paper, Study of a Nervous Affliction, he concluded that these patients suffered from a new clinical condition: "convulsive tic disorder." Tourette and Charcot thought it was untreatable, chronic, progressive, and hereditary. Although Charcot persisted in his efforts to distinguish "Gilles de la Tourette's tic disease" from other illnesses, his contemporaries generally did not agree.
Over the next century, little progress was made with respect to pathogenesis. A popular theory was that tics resulted from a brain lesion or lesions similar to those seen with rheumatic chorea or encephalitis lethargica. Another commonly proposed idea was that repetitive tics were caused by emotional and psychiatric factors and therefore would be best treated by Freud's psychoanalytic method.
In the United States, the view that TS was a rare, bizarre psychological disorder prevailed for much of the 20th century. In the 1970s, Drs Arthur and Elaine Shapiro, with Bill and Eleanor Pearl of the fledgling Tourette Syndrome Association (TSA), used the efficacy of haloperidol and other clinical data to support the conclusion that TS was a relatively common neurological disorder and not a mental or emotional problem.
After 20 weeks, the study found, kids in both groups were showing improvements in their tic severity. But the fish-oil group did no better than the placebo group.
However, kids on fish oil were more likely to report improvements in well-being and the impact their tics were having on their lives.
More than half were considered "responders" on that front, versus between one-quarter and one-third of kids in the placebo group.
Exactly what all that means is unclear.
It's possible, according to Gabbay, that omega-3s affected how kids perceived their tics, even though there was no clear effect on tic severity.
But, she said, "I'm not going to tell parents that omega-3s are the magic pill."
A larger clinical trial is needed, according to Gabbay. And it would probably be wise to use a different placebo, she noted.
Olive oil is not an ideal placebo, Gabbay explained, because it can indirectly affect the body's levels of omega-3 fatty acids.
Something like corn oil would be a "better placebo," she said.
For now, Gabbay recommended that parents pay attention to the amount of omega-3 fatty acids in their children's diets. If you can get them to eat more fish, that would be a good way to boost their omega-3 intake.
The typical American diet, including that of kids, tends to be low in omega-3 and high in omega-6 fats - which are found in margarine, vegetable oils and an array of snack foods, sweets and fast food. And that imbalance is thought to be generally unhealthy, Gabbay pointed out.
If you can't get your child with Tourette's to eat fish, omega-3 capsules might be worth a shot, according to Gabbay. "But don't have the expectation that it will benefit tic severity," she said.
A month's supply of one-gram fish oil capsules can run well over $15.
The supplements seem to be generally safe, Gabbay noted. She and her colleagues found no higher risk of side effects in kids using fish oil compared with the placebo group.
A Double-Blind, Placebo-Controlled Trial of Omega-3 Fatty Acids in Tourette's Disorder
RESULTS: At end point, subjects treated with O3FA did not have significantly higher response rates or lower mean scores on the YGTSS-Tic (53% vs 38%; 15.6 ± 1.6 vs 17.1 ± 1.6, P > .1). However, significantly more subjects on O3FA were considered responders on the YGTSS-Global measure (53% vs 31%, P = .05) and YGTSS-Impairment measure (59% vs 25%, P < .05), and mean YGTSS-Global scores were significantly lower in the O3FA-treated group than in the placebo group (31.7 ± 2.9 vs 40.9 ± 3.0, P = .04). Obsessive-compulsive, anxiety, and depressive symptoms were not significantly affected by O3FA. Longitudinal analysis did not yield group differences on any of the measures.
CONCLUSIONS: O3FA did not reduce tic scores, but it may be beneficial in reduction of tic-related impairment for some children and adolescents with TD. Limitations include the small sample and the possible therapeutic effects of olive oil.
Vilma Gabbay, MD, MS, James S. Babb, PhD, Rachel G. Klein, PhD, Aviva M. Panzer, BS, Yisrael Katz, BS, Carmen M. Alonso, MD, Eva Petkova, PhD, Jing Wang, MS, and Barbara J. Coffey, MD, MS
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