From the Guidelines
Treatment for tic disorders should prioritize alpha-2 adrenergic agonists like clonidine and guanfacine as first-line pharmacological options, especially when ADHD symptoms are present, due to their efficacy in reducing tic severity and improving quality of life 1. When considering treatment options for patients with tic disorders, it's essential to weigh the benefits and limitations of various approaches.
- Behavioral interventions, such as Comprehensive Behavioral Intervention for Tics (CBIT) and Habit Reversal Training, are effective in reducing tic severity and should be considered as first-line treatments.
- For medication management, alpha-2 adrenergic agonists like clonidine (0.1-0.3 mg/day) and guanfacine (1-4 mg/day) are often used first for mild to moderate tics, particularly when ADHD symptoms are present, as they have been shown to be efficacious in treating ADHD and improving functional impairment and quality of life 1.
- The use of atomoxetine, a non-stimulant medication, may also be considered for patients with tic disorders, especially those with comorbid ADHD, as clinical trials have found that tics did not worsen under treatment with atomoxetine 1.
- Antipsychotics, such as risperidone, aripiprazole, or pimozide, may be prescribed for more severe tics, while topiramate and tetrabenazine are alternative options.
- Botulinum toxin injections can target specific troublesome tics, and education about the waxing and waning nature of tics, stress reduction techniques, and supportive care are important components of comprehensive management.
- Treatment should be individualized based on tic severity, functional impairment, comorbidities, and side effect profiles, with medication doses starting low and increasing gradually, and regular monitoring for effectiveness and side effects.
From the Research
Treatment Options for Tic Disorders
The treatment options for patients with tic disorders include various behavioral therapies.
- Behavioral therapies are recommended as a first-line intervention for Tourette syndrome and persistent motor or phonic tic disorder 2.
- Comprehensive Behavioral Intervention for Tics (CBIT) is a first-line treatment for tic disorders, which combines habit reversal training (HRT) and a functional intervention to identify and neutralize tic-related environmental factors 3.
- CBIT has demonstrated acute and durable efficacy when delivered alone or in combination with medication, in person, or via telehealth, and in the presence or absence of common comorbid conditions 3.
- Habit Reversal Training (HRT) is also an effective treatment for tic disorders, with a small to medium effect size 4.
- Exposure and Response Prevention (ERP) is another effective behavioral therapy for tic disorders, which can be delivered in a group setting 5.
Delivery Methods
These behavioral therapies can be delivered through various methods, including:
- Face-to-face one-on-one treatment 2
- Treatment by video conferencing 2
- Group treatment 5
- Internet-delivered treatment 2, 5
Efficacy
The efficacy of these treatments has been demonstrated in various studies, with significant reductions in tic severity and comorbid symptoms 2, 3, 4, 5.
- CBIT has been shown to be superior to group-Educational Intervention for Tics (group-EIT) in reducing motor tic severity at 3-month follow-up 5.
- HRT has been found to be effective in reducing tic symptoms, with a small to medium effect size 4.
- ERP has been shown to be effective in reducing tic severity and comorbid symptoms in a group setting 5.