What supplements are recommended to reduce motor tics?

Vitamin D3 Supplementation Shows the Strongest Evidence for Motor Tics

Based on the available evidence, vitamin D3 supplementation (with monitoring of serum 25-hydroxyvitamin D levels) is the most strongly supported supplement for reducing motor tics, particularly in children with documented vitamin D deficiency. 1

Primary Recommendation: Vitamin D3

The most compelling evidence comes from a 2019 study demonstrating that children with chronic tic disorders have significantly lower serum 25(OH)D levels compared to healthy controls, and that vitamin D3 supplementation for 3 months led to significant improvements in motor tics, phonic tics, total tic severity, and overall impairment without adverse reactions 1. This intervention is particularly attractive given its excellent safety profile and low cost.

Implementation Strategy:

• Check baseline serum 25-hydroxyvitamin D levels in children with motor tics
• If deficient, initiate vitamin D3 supplementation
• Reassess tic severity after 3 months of treatment
• The study showed improvements across multiple validated measures (YGTSS and CGI-SI scores)

Secondary Option: L-Theanine Plus Vitamin B6

A 2022 pilot study found that combined supplementation with L-Theanine and vitamin B6 was significantly more effective than psychoeducation alone in reducing both tics and anxiety symptoms 2. This combination may be particularly useful when motor tics co-occur with anxiety disorders, which affects 2-45% of patients with Tourette syndrome.

Key Considerations:

• This was an open-label trial (lower quality evidence than the vitamin D3 study)
• The authors explicitly note that placebo-controlled trials are needed
• Most effective when anxiety symptoms accompany the tic disorder

Real-World Usage Patterns

Survey data reveals that 56% of children with Tourette syndrome currently use nutritional supplements 3. The most commonly used supplements include:

• Probiotics
• Omega-3 fatty acids
• Multivitamins
• Magnesium

However, 75% of caregivers reported perceived improvement primarily through subjective observation rather than controlled trials 3. Notably, pediatricians were unaware of supplement use in 42% of cases, highlighting the importance of direct inquiry about supplement use.

Critical Caveats

The evidence base for supplements in motor tics remains limited. Only vitamin D3 has demonstrated objective improvement in a controlled study with validated outcome measures. The L-Theanine/B6 combination shows promise but requires confirmation in placebo-controlled trials.

Common Pitfalls to Avoid:

• Do not assume all supplements are equally effective—most lack rigorous evidence
• Do not overlook vitamin D deficiency as a potentially modifiable factor
• Do not fail to document supplement use in the medical record
• Do not substitute supplements for evidence-based behavioral therapies or medications when indicated

Algorithmic Approach

1. First-line assessment: Check serum 25(OH)D levels in all children with motor tics
2. If deficient: Initiate vitamin D3 supplementation and reassess at 3 months
3. If anxiety co-occurs: Consider adding L-Theanine plus vitamin B6 combination
4. Monitor response: Use validated scales (YGTSS) rather than subjective reports alone
5. Document: Record all supplement use and communicate with the treatment team

The vitamin D3 evidence is the strongest available, with objective measurements showing both the deficiency state and improvement with supplementation in a controlled study design 1.