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From Jeff Koterba's earliest memories, they were just part of him — the drawing, always the drawing, and the tics and fidgets folks back in the day called "nervous habits."
Where: Great Escape Cinema,
7440 Crown Point Ave.
Tickets: $75 all-access pass,
$45 all-film pass, $45 weekend pass, $7 individual movies in competition
What: Film about World-Herald cartoonist Jeff Koterba and Tourette syndrome
When: 8:30 p.m. Thursday, Block 1 of Nebraska short films
Where: Great Escape Cinema,
7440 Crown Point Ave.
Understanding Tourette Syndrome
>> Is a neuropsychiatric disorder first described in 1885. About three in 1,000 people suffer from it.
>> Is characterized by motor and vocal tics that ebb and flow in intensity. Motor tics are sudden, repetitive involuntary movements that often affect muscles of the head and neck but can be seen throughout the body. Vocal tics typically take the form of grunts or throat-clearing. Symptoms vary from very mild to severe, although most cases are mild. About 15 percent of patients present with coprolalia, involuntary shouting of words or obscenities.
>> Starts in childhood and typically is most pronounced in early adolescence. The exact cause is unknown, but it is believed to have a strong genetic tie. Males are affected up to four times more often than females. About half of cases resolve spontaneously without treatment by age 18.
>> Treatment varies with severity and individual preference. Either medications or behavioral therapy — or both — can be used.
>> Is frequently associated with other disorders, including obsessive-compulsive disorder; attention-deficit, hyperactivity disorder; and depression. It's important to treat these conditions along with Tourette's.
Sources: Dr. Joanna Faryna, Alegent Health Psychiatric Associates; Tourette Syndrome Association, http://www.tsa-usa.org/index.html. Additional resources: Jim Eisenreich Foundation for Children with Tourette Syndrome, http://www.tourettes.org/
Koterba kept drawing. And he kept twitching. It was what it was, who he was.
Years later, he saw public service announcements on late-night TV. They featured Jim Eisenreich, the professional baseball player who found success with the Minnesota Twins, Kansas City Royals and other teams but whose Tourette Syndrome earned him jeers from fans.
"I thought, 'That's interesting, but that's not what I have. I just have nervous habits,'" said Koterba, a World-Herald cartoonist, a musician and the author of a memoir, "Inklings."
Later, though, he asked a doctor if he had Tourette's. The doctor referred Koterba, then in his late 20s, to a psychiatrist, who diagnosed the neuropsychiatric disorder. Koterba shares the diagnosis with roughly three in 1,000 people, according to recent statistics, but the public still doesn't understand the disorder all that well.
"I just don't think Tourette Syndrome was in the lexicon when I was growing up," Koterba said. "Even now, there are some people who are ignorant about it."
Some associate it primarily with a relatively rare symptom called coprolalia that involves involuntary shouts and obscenities, a view Koterba calls the "Hollywood version" of Tourette. But most, like Koterba himself, have a milder version characterized by motor and vocal tics that ebb and flow in intensity. At the same time, much remains to be learned on the scientific front. The cause remains unknown.
So does a scientific determination of whether Tourette's is linked in some way to artistic and athletic talents, as Koterba believes. That belief, of course, is a key focus of "Voluntary Gestures," the new film about Koterba.
Koterba and filmmaker Stefan Morel are far from the first to explore a possible link. Various experts have tried to determine whether Mozart, known for his brilliance and quirky behavior, had Tourette's. Dr. Oliver Sacks, the famed neurologist, wasn't convinced about Mozart. But Sacks saw the creativity link in other artists and athletes. In 1992, he wrote in the British Medical Journal that, with Tourette's,
". . . one may have the rather rare situation of a biological condition becoming creative or becoming an integral part of the identity and creativity of an individual."
Dr. Joanna Faryna, Koterba's doctor and a psychiatrist with Alegent Health Psychiatric Associates, said the subject is under study.
Doctors and researchers, she said, do know a "relative hyperactivity" of a neurotransmitter called dopamine in the brain is involved in Tourette's.
"Some research suggests that increased dopamine in the brain may help with imagination, drive and creativity," she wrote in an email.
Koterba said he's seen the link in others. Many of the people he's met with Tourette's are artists of some kind — writers, playwrights, actors.
Like him, they tend to twitch less when they're concentrating, he said. When he can totally focus on something else — when he's drawing, writing, playing music — it seems to override the urge to twitch, the kind of urge he's constantly vigilant against in other situations. He estimated that he had dozens of those urges during just a portion of a recent sit-down interview.
Faryna said deep focus has been associated in research literature with the ability to suppress urges.
"I think his experience with this is relatively common among people who are also very creative," she said in an interview.
Deep focus isn't foolproof, however, Koterba said. Occasionally, audience members have mistaken a twitch that's slipped through for a wink from the stage during a music gig. If he's stressed, he may white out and redraw a part of a cartoon that was perfectly fine to begin with.
While on stage, he moves around a lot. Same goes with drawing. He's up walking around as he works through an idea. After playing a gig or completing a cartoon, he's calmer, more relaxed.
Typically, Faryna said, treatment for Tourette's involves medication or behavioral therapy or a combination of the two, depending on severity of symptoms and individual preferences.
Koterba said he has tried medications in the past but currently is not taking any, specifically because he worries about their impact on his creativity. He's also found that exercising and cutting back on caffeine and sugar help considerably.
Still, stress exacerbates symptoms for many with Tourette's. So why pick a career with daily deadlines and throw in musical performances on top of it?
Koterba acknowledged that the deadlines are stressful. But without them, he said, he probably wouldn't have the opportunity to take a break from the tics.
"It's sort of a double-edged sword," he said. "Because of the cartooning, I get to have relief from Tourette's. I could see in a profession that wasn't so deadline stressful that maybe I wouldn't have an opportunity to focus every day."
And it's not like he plans to relax. Having published "Inklings: A Memoir" in 2009, he's working on another book. He and his son, Josh, 25, are working on an album together. Koterba plays guitar, mandolin and bouzouki, entirely by ear. He's never taken lessons, although he said he's learned a lot from fellow musicians, including Josh.
Koterba is performing live less these days than he once did. He occasionally sits in with Donnybrook, an Irish band that includes musicians from former bands The County Corkers and Celtic Wind. The Prairie Cats, the swing band he fronts, currently is on hiatus.
To him, it's all intertwined, like strands of DNA, from the time he can first remember.
"It (Tourette's) is probably a bigger part of me than I admit to myself," he said. "But I'm a creative person first, and a dad first. If I wasn't constantly doing surveillance on my brain and my body, maybe I could be doing more, or maybe I'd just become a slug."