From the Guidelines
Treatment of Tourette's syndrome should prioritize a combination of behavioral therapy and medication, focusing on minimizing symptoms' impact on daily functioning and quality of life. When considering the management of Tourette's syndrome, it's essential to note that the provided evidence 1 does not directly address the treatment of Tourette's syndrome but rather touches on its mention in the context of tic and somatic cough disorders. However, based on the most recent and highest quality studies, first-line treatments typically involve behavioral interventions such as Comprehensive Behavioral Intervention for Tics (CBIT) and habit reversal training 1. For medication management, alpha-2 adrenergic agonists like clonidine or guanfacine are often considered first, especially in children or those with co-occurring ADHD. Some key points to consider in the treatment approach include:
- Addressing common comorbidities like OCD, ADHD, or anxiety, which can cause more impairment than the tics themselves
- Periodic reassessment of medication necessity, given that many patients experience a natural waning of symptoms in late adolescence or early adulthood
- The goal of treatment is not complete tic suppression but rather minimizing their interference with quality of life while avoiding significant medication side effects. Given the lack of direct evidence from the provided study 1, the approach should be based on the most current clinical guidelines and expert consensus, prioritizing the well-being and quality of life of the patient 1.
From the Research
Treatment Options for Tourette's Syndrome
- Behavioural therapies are recommended as a first-line intervention for Tourette syndrome and persistent motor or phonic tic disorder 2
- Habit reversal therapy (HRT) is the best-studied and most widely-used technique, with sufficient experimental evidence to suggest that it is an effective treatment 3, 4
- Exposure with response prevention and self-monitoring are also effective treatments, while more research is needed to determine the therapeutic value of other treatments such as cognitive-behavioural therapy, relaxation therapy, and biofeedback training 3
Pharmacological Treatments
- Alpha agonists and antipsychotics are commonly used to treat tics in patients with Tourette syndrome 5, 6
- Botulinum toxin injections can be used to treat bothersome focal tics 5, 6
- Second-line therapy includes antipsychotics such as fluphenazine, aripiprazole, risperidone, and ziprasidone, which carry the risk of metabolic syndrome, tardive dyskinesia, and other side effects 6
Surgical Treatments
- Deep brain stimulation (DBS) is a treatment option for patients with disabling tics that are refractory to conventional treatments, but further studies are needed to determine the optimal target selection 5, 6
Comprehensive Treatment Approach
- Treatment must be tailored to the needs and goals of the individual patients and their families, and may involve a combination of behavioural, pharmacological, and surgical treatments 6
- Education on the condition and engagement in behavioural therapy targeted towards tics and/or comorbidities are important components of treatment 6