What is the prognosis of Tourette syndrome (TS) and other tic disorders?

Updated: May 30, 2019
  • Author: William C Robertson, Jr, MD; Chief Editor: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP  more...
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Answer

TS almost always persists throughout life. Fortunately, by age 18 years, approximately 50% of patients are essentially free of tics. Tic severity tends to peak in early to mid adolescence and wanes thereafter. Tics may persist into adulthood but their severity is almost always diminished.

Many people with tics lead a fairly normal life. However, even mild tics can be distressing.

For example, a patient of one of this article's authors is a man with mild TS who has a successful professional career and a good family life. He is used to his tics and does not prefer any treatment with noticeable adverse effects. However, he finds his symptoms annoying and would rather be free of them if given the choice. He states, "It is like I am on stage 16 hours a day. Every waking moment I am trying not to tic when people are watching." Other people with TS have more severe symptoms. Occasionally, the symptoms can be disabling.

The most common disability is social in nature. [135, 136] Patients with loud vocalizations or large movements either endure substantial criticism or they withdraw from many activities. Prejudice in work and school settings is common.

Tics also interrupt the individual's behavior and thought. Most patients find that they sometimes lose track of a conversation or that they are slow to complete a task because of incessant interruptions by their tics.

Self-injurious behavior is not uncommon. Occasionally, self-injury is intentional and due to a comorbid problem (eg, suicide during an episode of major depression). At times self-injury is pseudointentional; an example is repeatedly hitting one's face as a complex tic.

Perhaps more common than self-injuries are inadvertent injuries. [137, 138] Sometimes, these injuries are due to complex tics or compulsions, such as a need to touch high-voltage wires. Other times, they are due to inattentiveness or impulsivity. (In one of the author's cases, the father of a man with TS does not allow him to use power tools because he had had several near catastrophes.) Inadvertent injuries such as broken bones, cervical arthritis, or shin splints can also occur after simple yet repetitive and/or intense tics.

In clinical samples, most morbidity is due to inattention, impulsivity, obsessions, compulsions, or complex behavioral symptoms such as inappropriate social behavior, rage attacks, or insistence on sameness.

A minority of people with chronic tic syndromes receive disability compensation.


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