The disturbance must not be caused by the direct physiologic effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington's disease, postviral encephalitis)īoth multiple motor tics and one or more phonic tics must be present at some time during the illness, although not necessarily concurrently The tics must occur many times a day (usually in bouts) nearly every day or intermittently over more than one year, during which time there must not have been a tic-free period of more than three consecutive months Tourette's Syndrome Classification Study Group 5īoth multiple motor tics and one or more phonic tics must be present at some time, although not necessarily concurrently Medically refractory motor and disabling phonic tics such as coprolalia can be ameliorated by botulinum toxin (Botox) injections.ĭeep brain stimulation is being used at an increasing rate for medically refractory tics in Tourette's syndrome.ĭiagnostic and Statistical Manual of Mental Disorders, 4th ed. Tetrabenazine (investigational) is a promising dopamine-depleting drug controlled trials are ongoing. Haloperidol (Haldol) and pimozide (Orap) have been studied most extensively but are infrequently used because of potential side effects.įluphenazine (Prolixin brand no longer available) displays a more benign safety profile than haloperidol or pimozide, but has been studied in controlled trials to a lesser degree. Guanfacine (Tenex) has the same pharmacologic mechanism as clonidine, but displays a more benign side-effect profile.ĭopamine-receptor–blocking drugs are the most effective treatment for tics. Clonidine (Catapres) also tends to improve sleep and attention. Appropriate diagnosis and treatment can substantially improve quality of life and psychosocial functioning in affected children.Īlpha 2-adrenergic agonists are useful in treating patients with Tourette's syndrome, although they improve tics to a lesser degree than dopamine-receptor–blocking drugs. Dopamine-receptor–blocking drugs are associated with potential side effects including sedation, weight gain, acute dystonic reactions, and tardive dyskinesia. Alpha 2-adrenergic agonists are the first line of pharmacologic therapy, but dopamine-receptor–blocking drugs are required for multiple, complex tics. Treatment can be behavioral, pharmacologic, or surgical, and is dictated by the most incapacitating symptoms. The etiology of this syndrome is thought to be related to basal ganglia dysfunction. Given its diverse presentation, Tourette's syndrome can mimic many hyperkinetic disorders, making the diagnosis challenging at times. It is often associated with psychiatric comorbidities, mainly attention-deficit/hyperactivity disorder and obsessive-compulsive disorder. Tourette's syndrome is the most common cause of tics, which are involuntary or semi-voluntary, sudden, brief, intermittent, repetitive movements (motor tics) or sounds (phonic tics). The incidence peaks around preadolescence with one half of cases resolving in early adulthood. Tourette's syndrome is a movement disorder most commonly seen in school-age children.
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