Tics and Tourette Syndrome (TS)

Treatment of Tics and TS

The goal of therapy in patients with tic disorders is to reduce motor and vocal tics to a point where they are no longer causing psychosocial or physical problems, as well as alleviating associated behavioral problems, such as OCD and ADHD. Several nonpharmacologic treatments have been shown to be beneficial—including education interventions; increasing awareness among family members, peers, and school faculty1-4; habit reversal30; and exposure therapy.31

Pharmacotherapy is not recommended unless the patient's tics are causing significant functional impairment (e.g., academic, occupational, or social performance) or physical discomfort. First-line therapy for tics includes clonidine and guanfacine—alpha2-adrenergic agonists—and topiramate.2,4,32 These medications have a fair record of tic suppression and a low incidence of serious adverse events. Dopamine receptor-blocking agents—typical and atypical antipsychotic drugs—comprise second-line treatment of tics.2,4,32 These medications are generally more effective than first-line medications but should be prescribed only when needed, since serious side effects can be associated with their use. Injection of botulinum toxin into involved muscles may reduce abnormal movements and the premonitory sensations or urges that precede the tics.33-35 Some adult patients, at least 25 years of age, who have chronic, severe, debilitating tics that are refractory to pharmacologic and behavioral interventions may be candidates for treatment with deep brain stimulation.36-39 Medications may also be necessary to address associated conditions, such as ADHD, OCD, anxiety, and depression.