Tics and Tourette’s Syndrome

Abstract Tourette’s syndrome (TS) is a childhood-onset complex neurobehavioral disorder. The defining feature of TS is the presence of tics, which are described as sudden-onset, recurrent, brief-lasting, irregular, involuntary movements (motor tics) or sounds (phonic tics). Most patients with TS also have a variety of comorbid behavioral disorders, particularly attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, and mood disorders. The etiopathogenesis of TS has not been fully understood but genetically-determined involvement of the GABAergic system resulting in “disinhibition” has been postulated to play a key role. Educating the patients, caregivers, and school officials in detail about the spectrum, severity, and natural course of the symptoms of TS is an important step in the management of TS. If available, cognitive-behavioral intervention should be offered to all patients with tics as the initial step of management. Comorbid medical and behavioral abnormalities should be kept in mind and individualized when choosing the most appropriate pharmacotherapy for tics. The common classes of medications useful for the treatment of tics include alpha-2 agonists (clonidine, guanfacine), antipsychotics (haloperidol, pimozide, aripiprazole), dopamine-depleting drugs (tetrabenazine, deutetrabenazine, valbenazine), benzodiazepine (clonazepam), and antiepileptics (topiramate). While botulinum toxin should be considered in patients with troublesome focal tics, deep brain stimulation may be an option in patients with “malignant” TS. A multidisciplinary approach along with appropriate use of the aforementioned therapeutic options should lead to optimal functional outcomes in TS patients.