Treatment Options In France

[usul]

hello there, I dont know if i can find an answer on my questions, but i do not know where to ask.

I live in a small village in france with no CBT expert, and even the physician does not know TS enough.

my wife has TS and takes no medication.

Most of her premonitory urges are like obsessions, meaning she thinks continuously to the tic until she does it to get some relief. the issue is that some of her tics are dangerous for herself : like when she takes in her hand a shar object, knife or pen or fork, she has to tick to jerk (extremely fast) the object on her eye. she manages to avoid her eye but she is scared of an accident.

if you do some HReversal, you would need to do a competing response like tensing the arm, right ? but then, she keeps on thinking about doing it, again and again... until she does it...

• question : there should be a way around it ?

the last question, is about another tic: tensing her belly and relaxing it at the same time.... how can you do a CR to that ? she does it every 5 seconds...

thanks for your help,

Usul

PS : France is really behind concerning non medication treatments... what a shame

 

[Retired]

Re: CIBT: A Promising Behavioral Treatment for Tourette Syndrome

Usul,

Thank you for your inquiry.

Many times, when looking for a competent medical professional to treat Tourette Syndrome, we need to be prepared to look beyond our immediate area.

The reality is that many physicians do not receive the necessary training in disorders like Tourette Syndrome, or they just fail to develop any clinical experience in the disorder.

Have you contacted:

FRANCE
Association Francaise Syndrome Gilles de la Tourette
M. Fran?ois Lefebvre
22 rue Th?ophile Vacher
95160 Montmorency
Tel: 06 08 03 16 07
Email: francois.lefebvre@france-tourette.org
Marie-Anne Thivolle
Tel: 04 72 76 94 98

because national advocacy organizations usually are aware of the medical practitioners within their jurisdiction who have the expertise and competence to treat Tourette Syndrome.

That being said, Comprehensive Behavioural Intervention for Tics (CBIT) is a fairly recent development in the non-medication treatment of Tourette Syndrome.

Once you locate a medical professional locally who treats Tourette Syndrome, that person may already have received training in the method, or may be willing to communicate with the Tourette Syndrome Association (U.S.A) or the Tourette Syndrome Foundation of Canada each of which offers training to medical professionals in CBIT.

The Canadian Foundation plans to offer a training program in September 2013 at their National Conference.

Additionally the European Society for the Study of Tourette Syndrome plans to offer training to medical professionals at their conference in Athens April 24 - 26, 2013.

Your physician who may wish to receive CBIT training may be interested in following up on these.

---

some of her tics are dangerous for herself : like when she takes in her hand a sharp object, knife or pen or fork, she has to tick to jerk (extremely fast) the object on her eye

It is not unusual for people with Tourette Syndrome to have associated disorders such as obsessive compulsive disorder (OCD) where compulsions like these might be expressed. Expressions like this are usually attributed to compulsions rather than to actual tics.

Your wife's best advice would be to consult a physician competent in treating Tourette Syndrome and associated disorders to correctly evaluate your wife's diagnosis and provide her with appropriate treatment options.

tensing her belly and relaxing it at the same time

Abdominal tensing would probably be considered a tic as it involves muscle activity. Tic expressions would be possible targets for CBIT training where suppression or redirection might be considered.

Have you ever been in contact with L'Association Francaise Syndrome Gilles de la Tourette to point you to a nearby medical professional who is interested in treating Tourette Syndrome?

 

[usul]

Re: CIBT: A Promising Behavioral Treatment for Tourette Syndrome

thanks Steve... I am indeed following their forum, but i have the feeling (maybe wrong) that they are behind concerning non medicated treatments. anyway, i will contact them...

But for my own interest, you talked about OCD but the movement are not controled ! I mean, she thinks about doing the movement, and try to control it, but after a while, the movement is automatic (hence the danger I mentioned)

--> do you believe it still can fall into the OCD category ?

another question : do you know if there exist medication (for TS AND/OR OCD) than can be taken while pregnant ?

thanks for your answer

U.

PS I will follow up with a medical professional

 

[Retired]

Re: CIBT: A Promising Behavioral Treatment for Tourette Syndrome

Usul,


When it comes to differentiating between tics related to Tourette and compulsions related perhaps to OCD, the distinction is made by observing the actual movement and if the movement involves some ritualistic behaviour.

Tics typically involve muscle flexing by extending or contracting any muscle group or individual muscle, including vocal muscles.

Compulsions can be repetitive, and usually involve interaction with some type of object, such as the sharp object your wife seems obsessed with, or frequent checking of some task, or touching some object.

There are no medications specifically indicated for suppressing Tourette tics, although a number of medications have been found through research that seem to relieve some tic activity in some people. Many times it is found that side effects of some of these medications tend to dull peoples' thinking processes, to the point where often people discontinue the medications and prefer to live with the tics.

It should be remembered that people with Tourett, for the most part, are psychologically and emotionally functioning satisfactorily, so introducing medications for tics should be evaluated on a benefits vs inconvenience (side effects) basis.

On the other hand, if the doctor diagnosis OCD as an associated disorder, then OCD is a much easier disorder to treat, using medications specifically indicated for OCD, and the treatment is usually accompanied by supportive psychotherapy.

As to whether any medication can and should be used during pregnancy is a determination to be made in consultation with the doctor, your wife and the benefits vs the risks at that time.

Some medications have absolute contraindications in pregnant women, while others can be used if the benefts outweigh the risks.

Your doctor would be familiar with the detailed prescribing information in your Country in this regard, as there can be variations from one Country to another in permitted uses of medications.

I would suggest contacting L'Association Francaise Syndrome Gilles de la Tourette directly to inquire about an appropriate doctor to see your wife.

Have you had direct contact with them?

 

[usul]

Thanks Steve, extremly clear !

concerning the association, i had not have direct contact... yet.... I will