Tourette syndrome

Tic disorders are not uncommon in children and adolescents. The classification of these disorders includes transient tics, chronic motor or vocal tics, and combined motor and vocal tics – better known as Tourette syndrome. The tics can vary from mild facial tics to complex vocal tics involving repetition of certain phrases. A detailed history should include evaluation of the degree of impairment due to the tics. Special attention should be given to difficulties that may arise at school. Other associated features include obsessive compulsive disorders and attention deficit hyperactivity disorder. Treatment of Tourette syndrome includes reassurance and explanation. Occasionally medication is required, especially if the tics are severe, or cause pain or major social difficulties. The most common drugs prescribed for children and adolescents include the neuroleptics and clonidine. There is new research from the USA indicating positive benefits with psychological treatments such as habit reversal and exposure–response prevention. In adults, surgeons are beginning to explore the possibility of using deep brain stimulation, but this is still at an experimental stage. Tics tend to improve in most young people after teenage years, but may persist into adulthood.