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Tourette syndrome

Tourette syndrome — also called Tourette's syndrome, Tourette's disorder, or Gilles de la Tourette syndrome — is a neurological or neurochemical disorder characterized by tics: involuntary, rapid, sudden movements or vocalizations that occur repeatedly in the same way. more...

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The eponym was bestowed by Jean-Martin Charcot after and on behalf of his resident, Georges Gilles de la Tourette, (1859 - 1904), French physician and neurologist.


Symptoms include multiple motor and one or more vocal tics present at some time during the disorder although not necessarily simultaneously; the occurrence of tics many times a day (usually in bouts) nearly every day or intermittently throughout a span of more than one year; the periodic change in the number, frequency, type and location of the tics, and in the waxing and waning of their severity; symptoms disappearing for weeks or months at a time; and onset before the age of 18.

Vocal tics may fall into various categories, including echolalia (the urge to repeat words spoken by someone else after being heard by the person with the disorder), palilalia (the urge to repeat one's own previously spoken words), lexilalia (the urge to repeat words after reading them) and, most controversially, coprolalia (the spontaneous utterance of socially objectionable or taboo words or phrases, such as obscenities and racial or ethnic slurs). However, according to the Tourette Syndrome Association, Inc., only about 10% of TS patients suffer from this aspect of the condition. There are many other vocal tics besides those categorized by word repetition: in fact, a TS tic can be almost any possible short vocalization, with common vocal tics being throat clearing, coughing, sniffing, grunts, or moans. Motor tics can be of an endless variety and may include hand-clapping, neck stretching, shoulder shrugging, eye blinking, and facial grimacing.

The term "involuntary" has been used to describe TS tics, since it is known that most people with TS do have limited control over the expression of symptoms. Immediately preceding tic onset, individuals with TS experience what is called a "premonitory urge," similar to the feeling that precedes yawning. The control which can be exerted (from seconds to hours at a time) may merely postpone and exacerbate the ultimate expression of the tic. Children may be less aware of the premonitory urge associated with tics than are adults, but their awareness tends to increase with maturity. Tics are experienced as irresistible (like a yawn or sneeze or itch) and must eventually be expressed. People with TS often seek a secluded spot to release their symptoms after delaying them in school or at work. It is not uncommon for children to suppress tics during a visit to the doctor or while at school. Typically, tics increase as a result of tension or stress (but are not solely caused by stress) and decrease with relaxation or concentration on an absorbing task. In fact, neurologist and writer Oliver Sacks has described a man with severe TS who is both a pilot and a surgeon.


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A profile in courage: despite living with Tourette's Syndrome, young MetroStars goaltender Tim Howard isn't shying away from being a leader on the field
From Soccer Digest, 12/1/02 by Michael Lewis

ROLE MODELS COME IN DIFferent shapes and sizes, and with various responsibilities. In the sporting world, it's usually how a player purports himself on and off the field and how he deals with adversity and pressure situations that make him worthy of adulation. In that regard, Tim Howard finds himself in a multi-faceted role. Not only he is forced to be literally on his toes and not crack under pressure behind the MetroStars' porous defense, he also serves as a striking example of resilience to a number of non-soccer fans.

Howard has suffered from Tourette's Syndrome for the past 12 years. Yet despite that malady, he has become one of the leading goalkeepers in MIS. "We never allowed it to deter him from doing what he wanted to do with his life," says Kansas City Wizards goalkeeping coach Tim Mulqueen, Howard's long-time friend and mentor. "It's nice to have a role model to look up to and to help understand how another person copes with the same thing you have."

Tourette's Syndrome, also known as TS, is a neurological disorder characterized by repeated involuntary movements and uncontrollable sounds called tics. In some cases, such sounds include inappropriate words and phrases. There is no cure, although its symptoms can be medically treated.

Howard isn't the first professional athlete to battle TS. Former major league baseball player Jim Eisenreich enjoyed a productive career despite TS. So did basketball player Mahmoud Abdul-Rauf (nee Chris Jackson).

Howard has a mild case--you wouldn't necessarily know there was anything amiss if you talked to him or hung out with him for a while. Still, he kept it a secret for many years. "I wasn't fully diagnosed until 1990," says Howard. "The symptoms were there for a year. We were trying to figure out what was happening. Physically, it doesn't often hinder me. But while I was growing up, trying to suppress and hide it took a toll on me mentally.

"When I got to MLS, it became another thing altogether. I now had to deal with a job and day-to-day training, and at 18, I wasn't used to doing all of that."

Howard admits he was concerned about revealing his condition. He considered the many questions that people would ask, and thought: What would my teammates say? What would the coaches say? what would the media say?

In spring 2001 after he was literally handed the MetroStars starting goalie job following the trade of Mike Ammann to D.C. United, Howard decided to reveal that he suffered from TS. "I don't know why I did it," he says. "I felt it had been long enough."

Guess what? Nothing happened with his teammates. The media reported about it in a sensitive matter and no one doubted Howard's ability as a goalkeeper. "Everyone has been supportive," says Howard. "My teammates have been amazing. My coaches have been, too. They never said a word about it. My teammates never poked fun at me, and in this environment it's kind of easy to do that sort of stuff."

Going public with his affliction was relatively painless, so Howard took it a step further, becoming a spokesman for the Tourette's Syndrome Association of New Jersey. He eventually earned the MLS Humanitarian of the Year Award for his work with the association and for his other efforts to increase awareness of TS. "I consider myself a great example of why this condition should not hold anyone back from anything they want to accomplish," says Howard. "I love to be able to pass that message on to children who might need some inspiration."

Howard certainly doesn't mind being a role model. "Ever since I've gone public about it, I've tried to become a better person," he says. "I try to hold myself to a higher standard. If others looks up to me, that's awesome. If not, that's fine, too."

Mulqueen knows the 6'3", 210-pound Howard better than any other coach. He'll never forget the first time he saw Howard play soccer--as a 12-year-old at a Rutgers soccer camp in 1991. "He was probably the best player on the field," he says. "He could do anything he wanted. His movements were so fluid. He was a natural."

Mulqueen coached Howard's youth soccer club, his first pro team, the North Jersey Imperials, and eventually was his goalkeeping coach with the MetroStars. "Tim has always been able to stop shots and to catch crosses," says Mulqueen. "If you watch Timmy play, whether he makes a great save or gives up a goal, he treats it the same way. He never gets rattled. He's very composed. He has a calming effect on his team and, let's face it, the MetroStars can be pretty volatile."

Sometimes it's easy to forget that Howard is only 23, because he conducts himself as someone well beyond his years on and off the field. But Mulqueen sees some flaws in Howard's game because of the keeper's youth. "Most young goalkeepers have to improve their decision making," says Mulqueen. "They're impulsive. And they let the game come to them instead of the other way around."

Howard agrees. "My angle play could get a lot better," he says. "I need to be more aggressive as well.

"It's about growing and learning the game. I've had conversations with Kasey Keller and he told me how many games he played in his first two years overseas before he became comfortable--and he was playing against topnotch competition."

Howard has learned from his mistakes. In his first game as a professional, Howard gave up a soft goal: The Imperials had scored and their opponents then did the same from the ensuing kickoff because Howard wasn't prepared. "I was having some sort of conversation with a teammate," he says. "It wasn't the best time to talk. Earlier this season, after the Metros scored the other team was ready to take a quick kickoff. I thought, `I'm going to get back. I've seen this before.'"

Howard's first game with the MetroStars came under even more intense conditions. Starting goalie Tony Meola was out with a yellow-card suspension and Howard, without a minute's MLS experience, was thrown into the lion's den against the Colorado Rapids. "I was his little protege," Howard says of his relationship with Meola.

After a shaky start, the then 19-year-old Howard acquitted himself well in a 4-1 triumph, becoming the youngest MLS keeper to win a game.

Howard admits that the opportunity to play and develop at such a young age in the highest level of American pro soccer "was a blessing." "I'm 18 years old and I can go directly into this league and be a No. 3 guy," he said when he signed with MLS.

He wasn't a No. 3 goalie for very long. Howard backed up Ammann for two seasons, getting his feet wet in U.S. Open Cup competition before the MetroStars traded Amamann in spring 2001.

Howard was just about everyone's All-Star in 2001, capturing MLS goalkeeper of the year honors earning a spot on both the SOCCER DIGEST All-Star Team. This year he didn't enjoy such an impressive season as the MetroStars staged a playoff race collapse, losing seven of their last nine matches. Howard finished 10th in the league with a 1.61 goals-against average, but led all keepers in saves (140) and shots faced (195). "I like to push myself to be at the top," says Howard. "Whether or not I was there this year, I'm not quite sure."

Metros defender Steve Jolley is sure that Howard was the league's best. "The team struggled defensively and Tim kept us in games," says Jolley. "He doesn't have many weaknesses. In terms of athletic ability, you can't even compare him to others. He is a great shot-stopper. As he matures and learns more about the game, he will become one of the best U.S. keepers.

"If I was [MetroStars general manager] Nick Sakiewicz or someone from the league, I'd do everything I could to keep Howard. He is an incredible asset to MLS."

Howard's performances attracted the attention of U.S. coach Bruce Arena, who considered the youngster for the No. 3 keeper spot in the World Cup. But Arena opted for the experience of Meola, who had a pair of Cup appearances (1990 and 1994) under his belt. "It was a big let-down," admits Howard. "But once I got over it, I became my old self."

There is always 2006, however, and qualifying for that Cup begins in less than two years. "The World Cup is my ultimate goal," says Howard. "Qualifying games are only two years away and that time will go by very quickly. I want to be in the mix."

Howard didn't hurt his cause in his international debut, a solid performance in a 1-0 win over Ecuador in March. "It was a great feeling," he says of earning his first cap. "Sometimes after the monotony of club ball, it's good to have butterflies in your stomach. It lets you know you're living in the moment."

Several times in 2002, Howard took on the added responsibility of the captain's armband when Tab Ramos was sidelined with injuries. He started to show abilities as a team leader, not just by example, but vocally as well. "It's certainly a privilege," he says. When you get the captain's armband, you have to take it seriously. Sometimes people don't take it seriously enough. To me, being a captain isn't about winning or losing, it's about character."

Which is something Tim Howard knows all about.

Looking Out for No. 1

WHAT IS THE MOST CONTESTED POSITION on the U.S. national team? That's easy: goalkeeper. There are several candidates, but only one man can wear the No. 1 shirt at any given time.

In the 2002 World Cup, that man was Brad Friedel, who performed so well that many members of the media thought he and not Oliver Kahn of Germany was the tournament's top goalkeeper. But just because Friedel manned the nets for this past World Cup doesn't necessarily mean he'll be there in 2006. It will come down to form and who is injury free.

U.S. coach Bruce Arena has plenty of time to decide who will be No. 1 (he didn't pick Friedel until the team had arrived in Korea). Other national team coaches should have Arena's problems. Assuming they stay fit and in form--and don't retire from the international game--Kasey Keller and Friedel have to be considered the early favorites. Keller, who turns 33 in late November, performs for Tottenham in the English Premiership, while Friedel, 31, does his thing a little further up north in Blackburn. Kansas City Wizards keeper Tony Meola, 33, who was the third man in Korea, says he wants to continue to pursue a spot on the national team. Don't let their ages fool you. They're only reaching the prime years for a goalkeeper.

Then comes the next generation. MetroStars goalkeeper Tim Howard, 23, has shown grace under fire in his first two seasons. D.C. United's Nick Rimando, 23, and San Jose Earthquakes' Joe Cannon, who turns 28 on January 1, are not far behind.

Highly touted D.J. Countess of the Dallas Burn who is expected to be the goalkeeper of the Under-23 team that will try to qualify for the 2004 Olympics, could find himself in the mix if gets some much-needed playing time in the pros, He turns 21 in early January.

Add the Chicago Fire's Zach Thornton, 29, who has played internationally, and that gives Arena eight goalies from whom to choose. And that doesn't count anyone who might blossom before qualifying kicks off in 2004.

Like we said, every coach should have Arena's problem.

COPYRIGHT 2002 Century Publishing
COPYRIGHT 2002 Gale Group

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