Welcome to Culture Clinic, MedPage Today's collaboration with Northwell Health to offer a healthcare professional's take on the latest viral medical topics.
A of 26-year-old Scottish singer Lewis Capaldi experiencing a Tourette's episode at his concert in Glastonbury, England is making the rounds on social media -- notably for the audience stepping in to sing for Capaldi when he no longer could.
Neurosurgeon Sheng-fu Larry Lo, MD, director of the spine tumor surgery program at Northwell Health in New York, said having the assurance of the audience was helpful in resolving a Tourette's episode.
"There definitely is a sort of stress, fatigue, and anxiety element to triggering these episodes," Lo said.
Capaldi in 2022 and said he got Botox injections in his shoulder, which often moves with his tics.
"The worst thing about it is when I'm excited, I get it," Capaldi said on Instagram live, as reported by Sky News. "When I'm stressed, I get it. Some days it's more painful than others. It's not a big a deal. It looks a lot worse than it is."
While Tourette's is often diagnosed in childhood and symptoms tend to abate with age, Lo noted it's not unheard of for adults in their 20s to discover they have the syndrome, as Capaldi did.
Lo said that that when someone suspects Tourette's, the first step is "seeing a neurologist and seeing a behavioral psychologist to kind of reassure them that this is ... a real neurological problem. First-line treatment is going to essentially be ... social support and understanding the disease process."
While there's no fix-all medication or surgery for Tourette's, there are treatment options ranging from psychotropics to cognitive behavioral therapy, Lo said. Getting behavioral therapy on how to react when tics occur, for instance, can be helpful, but treating Tourette's successfully in each person requires a multipronged approach, he said.
"As a neurosurgeon, typically we don't consider patients for surgical treatment until they're a little bit older to show that their tics are truly refractory because often times these tics kind of occur quite young and then by the time they're like mid 20s or 30s, it goes away," Lo said.
Lo anticipates Capaldi will rest and work with his medical team on strategies to manage his Tourette's.
On Tuesday, Capaldi posted a announcing that he was taking a break from performing for the foreseeable future.
"First of all, thank you to Glastonbury for having me, for singing along when I needed it and for all the amazing messages afterwards," he wrote. "But the truth is I'm still learning to adjust to the impact of Tourette's and on Saturday it became obvious that I need to spend more time getting my mental and physical health in order, so I can keep doing everything I love for a long time to come," he continued, and thanked his support system for helping him through the past year.
Capaldi also has been open about his struggles with anxiety and depression, and mental health is a theme in "Lewis Capaldi: How I'm Feeling Now," the Netflix documentary about Capaldi's unlikely rise to stardom.
"I feel like I'm in a race against the clock to get my mental health in order," Capaldi said in the documentary's trailer.
Prior to Glastonbury, Capaldi had cancelled several shows to take care of his health.
Capaldi skyrocketed to fame in 2019 when his debut record, "Divinely Uninspired to a Hellish Extent," topped the charts in both the U.K. and U.S. with hit songs like "Someone You Loved" and "Before You Go." Capaldi vaulted from playing modest Scottish pubs to winning Best New Artist at the 2020 Brit Awards. His second album, "Broken by Desire to Be Heavenly Sent," came out in May.