How are Tourette syndrome (TS) and other tic disorders treated?

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

Some general principles must be kept in mind. First, present treatments of Tourette syndrome (TS) are purely symptomatic. No curative or preventive treatments are known. Second, tics often are not the worst problem. Third, this is a chronic disorder, and usually the goal is long-term benefit rather than quick improvement at any cost. Fourth, symptoms frequently improve or worsen over any period of time, even in untreated TS.

Corollaries of these principles include the following:

  • Treatment is not always needed

  • Treatment should be directed first at the most troublesome symptom

  • Apparent success or failure of any treatment may be coincidental

  • Beginning with reasonable trials of single agents is usually better than rushing to high doses or polypharmacy

TS has been described as either a neurological or a psychiatric disorder. These labels have nothing to do with the cause or treatment of TS but simply relate to the fact that neurologists and psychiatrists have been the main medical experts who have researched and treated TS.

These specialists have been well represented on the medical and scientific advisory boards to the Tourette Syndrome Association (TSA). A parent of a child with TS gave the author the following advice on choosing a physician: "We don't care if it's a psychiatrist or a neurologist, but we do care that it is someone who has experience treating Tourette's syndrome and who will treat all the symptoms."

Chronic motor (or vocal) tic disorder is managed similarly to TS and not discussed separately.

Discussed below are proven treatments for tics from replicated controlled studies, other treatments for tics, treatment for obsessive-compulsive symptoms in patients with tics, treatment for attention deficit–hyperactivity disorder (ADHD) in patients with tics, and treatment for other symptoms in patients with tics.


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