Evidence-based treatment of Tourette’s disorder and chronic tic disorders

ABSTRACT

Introduction: Chronic Tic Disorders and Tourette’s Disorder (collectively referred to as TD) are characterized by sudden, rapid, and repetitive motor movements or vocalizations called tics. Children, adolescents, and adults with TD often experience co-occurring psychiatric symptoms and impairments in multiple domains. As a result of tics and other symptoms, patients with TD can develop negative self-views, require considerable accommodations, and experience a poor quality of life. Therefore, the efficient and effective management of TD bears considerable importance.

Areas covered: This expert review evaluated the empirical support for behavioral and pharmacological interventions based on the results of randomized controlled trials (RCTs). Behavioral interventions evaluated include habit reversal training (HRT), comprehensive behavioral intervention for tics (CBIT), and exposure response prevention (ERP). Reviewed pharmacological interventions included alpha-2 agonists, antipsychotics, and anticonvulsants.

Expert opinion: This review identified several efficacious behavioral and pharmacological interventions for TD. However, several gaps in the management of TD include: (1) the access/availability of behavioral interventions, (2) novel and more efficacious treatment approaches, and (3) the development of more comprehensive interventions to manage TD. In order to advance the treatment of TD, additional research is necessary to efficiently, effectively, and comprehensively develop and evaluate new treatments for patients with TD.

KEYWORDS:

• Tourette’s disorder
• behavior therapy
• comprehensive behavioral intervention for tics
• pharmacotherapy
• randomized controlled trials

Article highlights

• Patients with TD and co-occurring conditions experience significant distress and impairment. The efficient and effective management of TD and co-occurring conditions is essential to alleviate distress and impairment associated with TD.

• There are two primary interventions for patients with TD: behavioral and pharmacotherapy treatment. The evidence for these approaches based on randomized controlled trials (RCTs) was reviewed.

• Behavioral treatments such as habit reversal training (HRT), the comprehensive behavioral intervention for tics (CBIT), and exposure response prevention (ERP) were found to be efficacious in RCTs during short-term treatment phases and long-term follow-up periods.

• Pharmacological interventions (i.e. antipsychotics and alpha-2 agonists) were found to be efficacious in RCTs during short-term treatment periods.

• Despite the efficacy of existing interventions, several treatment challenges remain. These challenges include improving the accessibility and response rate of existing interventions and developing comprehensive treatment approaches for the management of TD.

Declaration of interest

JF McGuire has received support from the Tourette Association of America, American Academy of Neurology, the Brain Research Foundation, American Psychological Foundation, and the Hilda and Preston Davis Family Foundation. He also receives royalties from Elsevier and serves as a consultant for Bracket, Syneos Health, and Luminopia. MA Grados serves as a member of the Cornelia de Lange Syndrome Foundation (CdLS) Medical Advisory Board. He also receives research/grant support from the Palo Alto Health Sciences, Inc. and the Centers of Disease Control and Prevention through the Tourette Association of America. HS Singer serves as a consultant for Cello Health BioConsulting, ClearView Healthcare Partners, Teva, Abide Therapeutics, and Trinity Partners. He receives research/grant support from the Tourette Association of America and royalties from Elsevier Inc. Dr. Essoe recieves support from the Tourette Association of America. 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.