Treatment options for tic disorders

ABSTRACT

Introduction: Gilles de la Tourette syndrome (GTS) is a neurodevelopmental disorder, characterized by the presence of multiple motor and, at least one, phonic tics, for more than one year, beginning before 18 years of age; its treatment is often a challenge for the clinician

Areas covered: GTS treatment requires a multidisciplinary management to treat each patient’s symptom. Although individuals with GTS often have comorbid psychiatric disorders, the focus of this review will only be on the management of tics.

Expert opinion: The authors summarized the steps that clinicians should follow treating GTS patient; the impact of the tics on a patients’ life should be the first step; different patients could present different levels of tolerance to the symptoms. Second, comorbidities should be considered before starting a treatment for tic. Finally, clinicians must focus the attention of the patient and family, on the length of the treatment and the duration of time after which the effects of the drug will occur. Before the treatment, the potential side effects must be mentioned to the parents, and the choice of treatment must be made in the light of the patient’s tolerance to these.

KEYWORDS:

• Alpha-2 agonists
• antipsychotics
• tics
• Tourette syndrome
• vesicular monoamine transporter-2 inhibitors

Article highlights

• The management of tic disorders involves a combination of education, behavioral, and pharmacological interventions, depending on functional impairments.

• Antipsychotics, both typical and atypical, are the most effective treatment for tic disorders.

• Evidences suggested that the combination of CIBT and pharmacological treatment is able to improve the symptoms (more than 30% compared to drug therapy alone).

• There is evidence that other drugs are effective for the treatment of tic disorders, the side-effect profiles of which are more tolerable than those of antipsychotics.

• Regular and controlled monitoring is mandatory in patients who undergo pharmacological treatment.

• A number of new agents are under development.

Declaration of interest

R Rizzo and M Gulisano are involved in clinical trials TV5017-3006 and TV5017-30,064. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.