Tourette Syndrome

Diagnosis

There is no specific test for Tourette syndrome. Diagnosis is based on the history of signs and symptoms.

Criteria for diagnosing Tourette syndrome include:

• Both motor tics and vocal tics are present, though not necessarily at the same time
• Tics occur several times a day, nearly every day or intermittently, for more than a year
• Tics begin before age 18
• Tics are not caused by medications, other substances, or another medical condition
• Tics change over time in location, frequency, type, complexity, or severity

Because signs of Tourette syndrome can mimic other conditions, diagnosis may be overlooked. For example, eye blinking might initially be linked to vision issues, or sniffling attributed to allergies.

To rule out other causes, a doctor might recommend:

• Blood tests
• Imaging studies such as MRI

Treatment

There is no cure for Tourette syndrome. Treatment focuses on controlling tics that interfere with daily activities. Mild tics may not require treatment.

Medications can help control tics or related conditions:

• Dopamine-blocking or dopamine-reducing medications, such as fluphenazine, haloperidol, risperidone, and pimozide. Tetrabenazine may also be used but can cause severe depression
• Botulinum (Botox) injections into affected muscles for simple or vocal tics
• ADHD medications, including stimulants such as methylphenidate or dextroamphetamine. In some cases, these may worsen tics
• Central adrenergic inhibitors, such as clonidine and guanfacine, to help with behavioral symptoms. Side effects may include sleepiness
• Antidepressants, such as fluoxetine, to address sadness, anxiety, or OCD
• Antiseizure medications like topiramate, which may reduce tics in some individuals

Therapies that may help include:

• Behavior therapy, including habit-reversal training, to monitor tics, identify premonitory urges, and learn incompatible movements
• Psychotherapy to cope with Tourette syndrome and manage accompanying problems such as ADHD, obsessions, depression, or anxiety

For severe tics that do not respond to other treatments, deep brain stimulation (DBS) may be considered. DBS involves implanting a battery-operated device in the brain to deliver electrical stimulation to areas controlling movement. This treatment is still in early research stages and requires further study to confirm safety and effectiveness.