From the Guidelines
Tourette's syndrome is a neurological disorder characterized by repetitive, involuntary movements and vocalizations called tics, which can be effectively managed with a combination of behavioral therapy and medication, prioritizing treatments that minimize morbidity, mortality, and improve quality of life. The most recent and highest quality study 1 emphasizes the importance of recognizing Tourette's syndrome as part of a spectrum of neurodevelopmental disorders, highlighting its association with obsessive-compulsive disorder (OCD) and other related conditions.
Key Characteristics of Tourette's Syndrome
- Involuntary movements (motor tics) or sounds (phonic or vocal tics)
- Tics can be sudden, brief, intermittent, involuntary, or semi-voluntary
- Examples of phonic tics include coughing, throat clearing, sniffing, grunting, squeaking, screaming, barking, blowing, and making sucking sounds
- Ability to suppress tics helps differentiate them from other hyperkinetic movement disorders
Diagnosis and Management
- Diagnosis is based on clinical history and the exclusion of other biological causes
- Comprehensive Behavioral Intervention for Tics (CBIT) is highly effective in managing tics, teaching patients to recognize premonitory urges and develop competing responses 1
- Medications such as alpha-2 adrenergic agonists (e.g., clonidine, guanfacine) and antipsychotics (e.g., risperidone, aripiprazole, pimozide) can be used to reduce tic severity, with the choice of medication depending on the severity of symptoms and the presence of comorbid conditions
- Recent studies suggest that the concomitant use of stimulants and Tourette's syndrome may not be as contrainductive as previously thought, but caution is still advised, especially in patients with a history of substance abuse or dependence 1
Quality of Life and Morbidity Considerations
- Stress, fatigue, and excitement can worsen symptoms, while adequate sleep and stress management techniques can help reduce tic frequency
- Patients with Tourette's syndrome often experience comorbid conditions such as OCD, attention deficit hyperactivity disorder (ADHD), and anxiety disorders, which should be managed concurrently to improve overall quality of life
- The goal of treatment should always prioritize minimizing morbidity, mortality, and improving quality of life, considering the most recent and highest quality evidence available 1
From the Research
Definition and Characteristics of Tourette's Syndrome
- Tourette's Syndrome (TS) is a condition of the nervous system characterized by sudden, repeated, involuntary twitches and movements, called tics, which can be motor, vocal, simple, or complex 2.
- TS is a neuropsychiatric disorder that may be associated with conductual disorders such as obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD) 3.
- Tics can be physically, emotionally, mentally, and socially distressing and challenging for those suffering from it, and are often accompanied by various comorbidities 2.
Symptoms and Diagnosis
- TS is characterized by multiple motor and vocal tics, which can be simple or complex, and are preceded by an inner urge 4.
- Tics can be temporarily suppressed, but this leads to a powerful re-emergence, and the performance of tics results in immediate but transient relief 4.
- TS is often diagnosed in childhood, with onset before age 18, and is more common in males than females 4.
Treatment Options
- Treatment for TS can be broadly classified into non-pharmacological and pharmacological treatment, with non-pharmacological therapy including various behavioural interventions such as cognitive-behavioral intervention for tics, cognitive-behavioral therapy, exposure and response prevention, relaxation techniques, deep brain stimulation, and habit reversal training 2.
- Pharmacological treatment options include antipsychotics (such as haloperidol, pimozide, risperidone, and aripiprazole), alpha agonists (such as clonidine and guanfacine), and other medications such as botulinum toxin and baclofen 2, 3, 5, 6, 4.
- The choice of treatment depends on the severity of symptoms, the presence of comorbidities, and the individual's response to treatment, with aripiprazole, risperidone, clonidine, and guanfacine being commonly used medications 6.