Tourette syndrome and other chronic tic disorders: an update on clinical management

ABSTRACT

Introduction: The management of Tourette syndrome (TS) and other chronic tic disorders occurs in multiple stages and begins with comprehensive assessment and complex psychoeducation. Behavioral and pharmacological interventions (second stage) are needed when tics cause physical or psychosocial impairment. Deep brain stimulation surgery or experimental therapies represent the third stage.

Areas covered: Discussed are recent advances in assessment and therapy of chronic tic disorders, encompassing the three stages of intervention, with the addition of experimental, non-invasive brain stimulation strategies. A PubMed search was performed using as keywords: ‘tic disorders’, ‘Tourette syndrome’, ‘assessment’, ‘rating scales’, ‘behavioral treatment’, ‘pharmacological treatment’, ‘deep brain stimulation’, ‘transcranial magnetic (or current) stimulation’, and ‘transcranial current stimulation’. More than 300 peer-reviewed articles were evaluated. The studies discussed have been selected on the basis of novelty and impact.

Expert commentary: Comprehensive assessment of tic disorders and psychoeducation are crucial to a correct active management approach. Behavioral treatments represent first line of active interventions, with increasing potential offered by telehealth. Antipsychotics and alpha agonists remain first line pharmacological interventions for tics, although VMAT-2 inhibitors appear promising. Deep brain stimulation is a potential option for medically refractory, severely disabled patients with tics, but age and target selection require further investigation.

KEYWORDS:

• Tourette syndrome
• Tic disorders
• behavioral therapy
• medication
• psychoeducation
• deep brain stimulation
• transcranial magnetic stimulation

Declaration of interest

D Martino reports: grants from Hotchkiss Brain Institute, the European Union (FP7 Programme), the National Institutes of Health Research and the National Health Service (UK); lecturing honoraria and travel support from Allergan, Sunovion, and the Movement Disorders Society; and royalties from Springer Verlag. TM Pringsheim reports research grants from the Canadian Institutes of Health Research, the Mathison Centre for Mental Health Research and Education, the Alberta Mental Health Strategic Clinical Network, the Sick Kids Foundation, and Shire Canada. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.