Dr. Ahorro, pediatric neurologist, shares in this exclusive interview an insider look on these two oftentimes misunderstood and misdiagnosed disorders:
Tourette’s Syndrome, a disorder that medical tests have yet to diagnose, presents itself through a series of repetitive involuntary jerking body motions or sounds known as “tics”. Dr. George Gilles De La Tourette of France identified this neurological disease in 1885.
Asperger’s Syndrome, or a mild classification of autism, reveals itself through social and emotional withdrawal, as well as eccentric habits, obsessive compulsive traits, and specific areas of interest that distract the child from age appropriate pursuits. Dr. Hans Asperger of Austria identified this disorder in 1944.
SP: What are the basic symptoms of Tourette’s Syndrome and at what age do they usually manifest?
DR. AHORRO (D.A.): The initial clinical picture of TS is usually one of multifocal (ed: coming from one or two places) tics affecting the face and head. These progress to vocal tics such as grunting, coughing sneezing, and barking, and, in most severe cases, to coprolalia (involuntary swearing) or compulsive echolalia (the repetition of sounds copied from another person). Comorbidities (the presence of more disorders) such as attention-deficit disorder, learning disabilities, and serious psychiatric disorders are seen in some patients with TS.
Symptoms generally appear between ages 5 and 10 years. Although periods of remission occur and TS tends to become less severe after adolescence, the condition usually persists for life, and only 8% of children have complete and permanent remission.
SP: What are the first noticeable symptoms of Asperger’s Syndrome? Is this very distinguishable from Autism?
DA: Asperger’s syndrome is thought to be possibly distinct from relatively high functioning autism, nonetheless, it is highly similar to and possibly on a continuum with autism.
Click here to learn more about the symptoms and cures for Asperger's Syndrome.
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Read on to learn more about the symptoms and cures for Asperger's Syndrome.
Children with Asperger’s are usually insensitive to social cues and obsessively indulge in special interest. Their language skills develop normally, but their use of language and other means to communicate is unusual or uncharacteristic. Their speech is formal, dull, and is uttered in a peculiar voice and with strange versification or prosody.
Their gestures are also deviant, stiff, limited, inexpressive, and stilted. Their visual-motor development may be delayed, and they are clumsy and walk with a stiff gait. They are severely impaired in reciprocal social interaction, for which they have little enthusiasm.
Their interests are quite limited, and they impose many routines and rituals on themselves. Children with Asperger’s exhibit mannerisms such as hand or finger flapping or twisting. Children with this syndrome are of normal or near normal intelligence, and their self-help and adaptive behavioral skills are age-appropriate.
SP: Are both disorders genetically acquired or are there other possible causes?
DA: Both these disorders may be genetically acquired but environmental and organic causes may also be implicated in the etiology of these disorders.
SP: Are there actual cures or any in development?
DA: There are no actual cures for both these disorders. In TS, medications are sometimes given to control the tics especially if these become an impediment to activities of daily living. Medications commonly used are haloperidol and fluphenazine. Any of these drugs may lose their efficacy after prolonged use, but effectiveness may return after an interval of withholding the drug.
As for Asperger’s, non-medical interventions like behavioral modification, communication therapy (eg. direct speech training, sign language, and augmented communication), and individual education program may be of help.
Click here to learn more about the cases of and available information about Tourette's and Asperger's Syndrome in the Philippines.
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Read on to learn more about the cases of and available information about Tourette's and Asperger's Syndrome in the Philippines.
SP: Are there many cases or TS and Asperger’s in the Philippines?
DA: The true incidence of both these disorders in the Philippines has not been established but they are not that uncommon.
SP: What are the possible misdiagnoses for each?
In the early stages of TS, differential diagnoses may include Sydenham’s Chorea (acute rheumatic fever) and also simple mannerisms.
Other psychiatric disorders should be ruled out in patients with Asperger’s.
SP: Are there many people turning to the internet for medical advice or simply ignoring the disorders? What’s your take on this?
DA: The proliferation of information available on the internet makes it accessible to anyone. Many if not all have already browsed on the Internet for information before seeking medical attention. It is not discouraged but we advise caution in using these information. They can use this information as guidelines on what information they want their doctors cleared and emphasized. There are websites where reliable information can be found and usually your doctors can guide you which ones to seek out.
SP: In your experience, how have the lives of parents with children with TS and / or Asperger’s been affected?
DA: Like most chronic disabilities, both TS and Asperger’s can be burdensome not only to the parents but also to the other members of the family. This does not only impact on the financial security of the family but also on the emotional and social security of the family.
Click here to learn more about the treatment and available support groups / organizations for Tourette's and Asperger's Syndrome.
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Read on to learn more about the treatment and available support groups / organizations for Tourette's and Asperger's Syndrome.
SP: Are medications, consultations, and therapy expensive?
DA: I think this is relative depending on the income of the family. But here in the Philippines where majority of the population belong to the lower socio-economic strata, it can be expensive. There are, however, government hospitals that provide accessible interventions for our people belonging to this social strata.
SP: Is it possible for these children with TS and Asperger’s to live normal, independent lives as adults?
DA: Yes. With proper interventions, they may live normal, independent lives as adults.
SP: In the Philippines, what is the current situation for those with TS and Asperger’s? Are there many physicians actively dealing with these disorders.
DA: Although the interventions are available in the Philippines, it is quite limited. There are only a few neurologists, developmental pediatricians and psychiatrists compared to the population and majority are practicing in the major cities. Those in the remote provinces may not have access at all.
SP: Are there any organizations or support groups for each?
DA: The Autism Society of the Philippines is one support group I know that help families with children who have been diagnosed with Autism Spectrum disorder. I am not aware if one exists for TS.
Click here to learn more about Dr. Ahorro's advice to parents with children diagnosed with Tourette's or Asperger's Syndrome.
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Read on to learn more about Dr. Ahorro's advice to parents with children diagnosed with Tourette's or Asperger's Syndrome.
SP: With your experience, what advice can you give parents who are dealing with either disorder in their families?
DA: First, it is important to establish the diagnosis first by seeking medical consultation from specialists equipped to make the diagnosis. Regular check-up and strict compliance with therapy (medical or non-medical) is the key to help improve the situation in these children. Caution in using information gathered from other sources (e.g. Internet) should be practiced and like what I usually advise the parents of my patients, it is your right to ask questions from your doctors to help you understand the problems of your children. Knowing everything about the disorders that afflict your children will help you in accepting the situation and in dealing with it appropriately.
Dr. Ahorro is an internationally renowned and published pediatric neurologist, whose subspecialty is Demyelinating Diseases in Children (neurological disorders wherein movement, sensation or cognition are impeded). She received her residency training and fellowship for pediatrics and neurology at the Philippine Children’s Medical Center (PCMC), and her fellowship for Demyelinating Disease in The Hospital for Sick Children in Ontario, Canada.
She consults and is also a shareholder of Calamba Doctor’s Hospital and at AMSVAAR in Laguna, as well as Heathserve and St. James Hospital in the same region. She also is a visiting consultant in most hospitals from Sta. Rosa to Los Banos. Dr. Ahorro is also called upon by major hospitals in Metro Manila when needed.
Photo from flickr.com
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