Pharmacologic treatment of tics and Gilles de la Tourette syndrome

Treating children and adults with Gilles de la Tourette syndrome (GTS) remains a clinical challenge and typically requires a multidisciplinary approach, owing to the complexity of the disorder and the frequent presence of comorbidities such as obsessive-compulsive disorder and attention-deficit/hyperactivity disorder. This chapter focuses on the pharmacologic management of tics in the context of GTS. It reviews key considerations in the selection of therapeutic agents from the broad range of pharmacologic options available in clinical practice. The strongest evidence supports the use of dopamine receptor antagonists, particularly atypical antipsychotics such as aripiprazole and risperidone. However, other agents - including α-2 adrenergic agonists, vesicular monoamine transporter 2 inhibitors, and topiramate - also play an important role in treatment strategies. Pharmacologic management of GTS should be individualized, taking into account symptom severity, functional impact, and the risk-benefit profile of each therapeutic option.