From the Guidelines
Treatment for Tourette's syndrome typically involves a combination of behavioral therapy and medication, tailored to the individual's symptoms and their impact on daily functioning. Comprehensive Behavioral Intervention for Tics (CBIT) is often recommended as a first-line treatment, teaching patients to recognize premonitory urges and develop competing responses to suppress tics. For medication, alpha-2 adrenergic agonists like clonidine (0.1-0.3 mg daily) or guanfacine (1-4 mg daily) are commonly used first, especially in children with mild to moderate tics, as they have been shown to be efficacious in treating ADHD and tic disorders, with a relatively smaller effect size compared to stimulants 1. Some key points to consider when treating Tourette's syndrome include:
- The potential benefits of non-stimulants, such as atomoxetine, clonidine, and guanfacine, which may be considered as first-line treatment options in disruptive behavior disorders, tic disorder, and Tourette's syndrome 1.
- The importance of addressing any co-occurring conditions like ADHD, OCD, or anxiety, as these often cause more impairment than the tics themselves.
- The goal of treatment is symptom management rather than complete elimination of tics, as Tourette's symptoms naturally wax and wane over time and often improve in adulthood.
- The use of antipsychotics, such as risperidone, aripiprazole, or pimozide, may be considered for more severe cases, but their use is often limited by side effects such as weight gain and sedation 1.
- Botulinum toxin injections and habit reversal training may also be used to help manage symptoms, particularly for focal motor tics or to substitute tics with less noticeable movements. Overall, the treatment of Tourette's syndrome requires a comprehensive and individualized approach, taking into account the patient's specific symptoms, co-occurring conditions, and response to treatment.
From the Research
Treatment Options for Tourette's Syndrome
The treatment for Tourette's syndrome can be broadly classified into non-pharmacological and pharmacological treatment.
- Non-pharmacological therapy includes various behavioural interventions, such as:
- Pharmacological treatment includes:
- Antipsychotics, such as haloperidol, pimozide, aripiprazole, risperidone, and olanzapine 2, 6
- Alpha agonists, such as clonidine and guanfacine 2, 6
- Botulinum toxin and baclofen, which have shown efficacy in dealing with tics in TS with other comorbidities 2, 6
- Topiramate, vesicular monoamine transporter-2 inhibitors, and cannabinoids, which may be considered in certain cases 6
Effectiveness of Treatment Options
- Behavioural therapies, such as Comprehensive Behavioral Intervention for Tics (CBIT) and Habit Reversal Therapy (HRT), have been shown to be effective in reducing tic severity 3, 4
- Relaxation training, when included in conjunction with CBIT, has been found to be effective in reducing tic severity, but relaxation training alone is not effective in reducing tic severity in patients with Tourette's Disorder 5
- Pharmacotherapies, such as alpha-2 agonists and second-generation antipsychotics, have been found to be effective in treating tics, but prescribers should be mindful of potential side effects 6