Tourette Syndrome and Tic Disorders

This article describes the clinical features of Tourette syndrome and its diagnostic criteria, etiology, and pathophysiology, as well as common myths associated with tic disorders. It discusses the behavioral, pharmacologic, neuromodulation, and alternative treatment approaches to tic disorders.

With the significant increase in functional ticlike behavior, especially during the COVID-19 pandemic, diagnostic criteria for functional ticlike behavior have been delineated to separate these ticlike movements from the tics observed in Tourette syndrome. Although behavioral therapy such as comprehensive behavioral intervention for tics remains the first-line treatment for tics, modifications to comprehensive behavioral intervention for tics have been developed to make this type of treatment more accessible. Pharmacologic trials for vesicular monoamine transporter 2 inhibitors have failed to meet the primary endpoint of tic reduction; however, they may still be helpful as add-on therapy for select individuals. A first-in-class compound called ecopipam met the primary endpoint for tic reduction and was well-tolerated, and may be a promising new treatment for Tourette syndrome. Deep brain stimulation may be considered for tics refractory to more conservative approaches.

Tourette syndrome and tic disorders can substantially affect quality of life. Educating patients about the natural history and expected course of the disease is the most important first step in management. Choosing a treatment based on comorbidities, tic severity, and patient preference is crucial for a beneficial outcome.