Cultural influences on diagnosis and perception of Tourette syndrome in Costa Rica

Background and Objectives: Tourette syndrome (TS) is a neuropsychiatric dis order in which the pattern of symptom presentation can vary greatly between individuals. Although globally described, TS has not been well characteriz ed in many parts of the world. Differences in individual and cultural perce ptions of TS may impact its expression and recognition in some countries, c onfounding the identification of affected individuals. This study examines the phenomenology and presentation of TS in Costa Rica. Method: Clinical da ta on 85 Costa Rican subjects with TS (aged 5-29 years) initially recruited for a genetic study between 1996 and early 2000 were obtained by direct in terview and review of medical records. Results: The clinical characteristic s of TS were similar to that found elsewhere. The gender ratio was 4.6.1, t he mean age of onset was 6.1 years, and 20% of subjects had coprolalia. How ever, the perceived impact of TS was different. Many subjects denied that t heir TS caused impairment or distress, even when objective evidence of impa irment was available. Conclusions: TS in Costa Rica is phenomenologically s imilar to TS seen in other parts of the world, but differs in perceived imp airment. In other countries where cultural forces affect disease definition . close scrutiny of symptom expression and possible adjustment of phenotype definition may be important.