Tics and Tourette Syndrome:

Tourette Syndrome is a complex neurobehavioral disorder that typically presents during childhood and is characterized by motor and vocal tics, often accompanied by various behavioral comorbidities, including attention deficit and obsessive-compulsive disorder. Although treatment must be individualized for each patient and their specific goals, education about the condition and behavioral therapy should be provided to all patients. In cases where tics are troublesome and cannot be controlled by behavioral therapy, pharmacological treatments, such as alpha agonists, topiramate, and vesicular monoamine transport type 2 inhibitors, are often used as first-line therapies. Botulinum toxin injections can be used to target bothersome focal tics. Antipsychotics, including fluphenazine, aripiprazole, risperidone, and ziprasidone, are second-line therapy, but come with a risk of metabolic syndrome, tardive dyskinesia, and other side effects. While much more research is needed before new therapies such as cannabis-derived products or transcranial magnetic stimulation can be recommended, ongoing clinical trials with D1 receptor antagonist ecopipam and other experimental therapeutics offer hope. Deep brain stimulation may be considered for patients with refractory tics.

Tourette Syndrome is a common neuropsychiatric disorder that affects males more than females and typically emerges before the age of 18. It is characterized by multiple motor and vocal tics that are abrupt, rapid, repetitive, and preceded by an inner urge. While patients may be able to suppress their tics temporarily, this often results in a more powerful re-emergence. Tics fluctuate in frequency, type, severity, and complexity throughout the day, improving during concentration and worsening during relaxation or stress. Psychiatric comorbidities such as ADHD and OCD are also frequently present. Education and counseling can be beneficial for patients, families, and teachers. Pharmacological treatment is not always necessary, but atypical antipsychotics are often used as first-line treatment. Alpha adrenergic agonists, atomoxetine, and methylphenidate are useful in patients with tics and ADHD, while selective serotonin re-uptake inhibitors can be useful in individuals with tics and OCD. Botulinum toxin can be effective in focal tics, and deep brain stimulation may be considered in severe, treatment-resistant cases.