For those people who have had tourettes for more than 20 years. What long term effects do you have?

I've had TS 16 yrs, not 20, but that's still a long time. For me, it hasn't done lasting physical damage, (chipped tooth, chipped a bone in my hand) although it's been quite painful and disabling. Between all my friends w/ severe TS, they've had several surgeries to treat broken bones, torn tendons, broken teeth, from tics. I know of a man w/ TS who ended up with paralysis on one side of his body from back tics. He had to have spine surgery to stop the paralysis from worsening, and then he had two brain DBS surgeries to implant neurostimulators to control his tics. I know of another man who had such severe tics he couldn't do anything without help, and he too had the brain surgery (Jeff Matovic).

I have hyperextendsible ligaments in my body, but that was present before my tics became severe.

One of my friends recently had arm surgery to fix a torn tendon which was due to a tic, and another guy had DBS surgery for his tics, which worked remarkably well. Another friend of mine uses Botox injections in her neck to control neck tics. I require the use of a wheelchair or cane to get around, depending on how bad my tics are, and use a mouthpiece to muffle vocal outbursts. Without preventive measures like my wheelchair, I have no doubt I would have at least broken a bone or two from my tics due to losing balance and falling over.