Tim Howard and Tourette’s syndrome: how the disease affected the footballer’s career

Legendary American soccer star Tim Howard had a career playing for top clubs in the United States and in the APL. He was a fantastic goalkeeper with incredible skills and unwavering determination. The athlete announced the end of his career in 2019 at the age of 40.

Tim Howard, a New Jersey native, was born to American Matthew and Hungarian Esther. As a child, he was diagnosed with Tourette’s syndrome and obsessive-compulsive disorder. Fortunately, these diagnoses did not affect his soccer career and, according to the goalkeeper himself, sometimes gave him some advantage on the field.

neurologist at the Hadassah branch of the Hadassah Clinic in the Skolkovo International Medical Cluster

“Tim Howard himself notes that his disease has made him more focused and receptive, and this has given him an advantage while playing on the field. In other words, the disease itself has not only not prevented him from having a successful career, but on the contrary, in some ways it has helped him achieve unique results.”

The first symptoms in the future soccer star began at the age of 9-10, which had a particularly negative impact on his school life. The young man could not concentrate or sit still, and the first tics appeared. At first, his compulsive behavior was limited to touching inanimate objects, but soon developed into physical involuntary movements, including shrugging, blinking sharply and rolling his eyes.

As a child and into adulthood, Tim Howard felt he could only control his tics better by participating in sports.

Judging by the athlete’s video interviews, the syndrome is not very pronounced now and likely does not reduce quality of life.

What is Tourette syndrome?

Tourette syndrome is a neurological disorder that was first described by French neurologist Gilles de la Tourette in 1885. This pathology refers to tics – repetitive sudden, poorly controlled, rapid, non-rhythmic muscle contractions involving vocalizations (shouting out words, sounds). In an attempt to restrain any of these manifestations, the patient develops internal tension and discomfort.

In most cases, the debut of the disease falls on the age of four to six years, and the peak incidence – at the age of seven to nine years. In the age group of 15-16 years, the disorder is less common. Most tics disappear spontaneously. However, in about 1% of children, they persist into adulthood.

Data on the prevalence of Tourette syndrome vary between 0.1-3% in the pediatric population and are not well elucidated for the adult population.

A number of researchers believe that genetic predisposition underlies the onset of this neurological disorder. It is suggested that the older the age of onset, the higher the risk of chronicization and development of neurodegenerative or psychiatric diseases in the future.

In addition to genetic causes, the development of tics and, in particular, Tourette syndrome, is associated with autoimmune and perinatal factors. They can be divided into several types:

• Temporary (transient) tics, which last less than one year;
• persistent tics, which last more than one year;
• Tourette’s syndrome: motor (motor) and vocal tics that last more than a year.

In all cases, tics first appear before the age of 18. Primary tics, which include Tourette’s syndrome, are caused by damage to the central nervous system from toxic substances (e.g. cocaine) or other disorders (e.g. Huntington’s disease, viral encephalitis).

Symptoms of Tourette syndrome

The manifestations of the disease can be very varied. Usually the patient has a certain set of stereotypical tics, which can be in the form of rapid movements (motor), manifested by saying or shouting sounds or words (vocal), including sometimes coarse, profane words (coprolalia).

Simple tics represent one of the variants: either motor or vocal, and complex tics are a combination of several simple ones.

Both simple and complex tics can occur several times within an hour and disappear for several weeks. They usually do not occur during sleep. In Tourette’s syndrome, movements (motor tics) may have social significance, that is, they may be recognizable gestures, and because of this seem intentional.

Stress and fatigue increase the manifestations of the disease. However, tics often occur when the body is relaxed, such as while watching television.

On the contrary, when the patients are busy, such as children during school and adults during work tasks, the symptoms are significantly reduced or completely disappear.

Tourette’s syndrome does not lead to loss of work capacity, but in some cases, when coprolalia (uncontrolled shouting of swear words) is present, it significantly reduces the quality of life of patients due to the limitation of social contacts, the ability to work in a team, to make new acquaintances. Motor tics do not cause impairment of motor functions, do not lead to coordination disorders.

How to treat?

Treatment of Tourette syndrome can be divided into several types: non-medication, medication and therapy of associated pathologies.

Non-medicamentous first of all includes the implementation of cognitive-behavioral therapy. This is often the main and very effective method of treatment.

In some cases, Tourette syndrome is combined with other diseases, for example, with obsessive-compulsive disorder.

It is worth noting that Tim Howard was also diagnosed with Tourette syndrome combined with obsessive-compulsive disorder as a child. This case utilizes a class of medications often prescribed to treat depression.

Important components of successful treatment and control of Tourette’s syndrome are emotional support from the patient’s family, creating a comfortable school environment for children with this syndrome, and assistance in adapting to the children’s community from teachers. Educational courses, schools of patients and their relatives, active media coverage form the right attitude to this disorder by others and the patient himself.

Tim Howard knows firsthand what Tourette’s syndrome is, and for many years has been engaged in charitable assistance to patients with this pathology, as well as openly talking about his disease.