Treatment-refractory Tourette Syndrome

•The management of Tourette Syndrome is complicated by psychiatric comorbidities and variations in treatment goals•Some Tourette patients appear to have refractory symptoms due to non-adherence, misdiagnosis, or psychiatric comorbidities•Deep brain stimulation is emerging as a potential treatment for refractory Tourette Syndrome•New drug treatments are being developed and may help in refractory Tourette’s if deep brain stimulation is unavailable

Tourette Syndrome (TS) is a complex neurodevelopmental condition marked by tics and frequently associated with psychiatric comorbidities. While most cases are mild and improve with age, some are treatment-refractory. Here, we review strategies for the management of this population. We begin by examining the diagnosis of TS and routine management strategies. We then consider emerging treatments for refractory cases, including deep brain stimulation (DBS), electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and novel pharmacological approaches such as new vesicular monoamine transporter type 2 inhibitors, cannabinoids, and anti-glutamatergic drugs.