Tourette's syndrome is a hereditary tic disorder that begins during childhood. Symptoms include simple, complex, and vocal tics. Diagnosis is clinical. Treatment may include clonidine and antipsychotics.

Tourette's syndrome is probably autosomal dominant with variable penetrance; the specific genetic abnormality is unknown. Male:female ratio is 3:1. Simple transient tics, chronic tic disorder, and Tourette's syndrome form a continuum or spectrum.

Symptoms and Signs

The movement disorder may begin with simple tics (eg, facial grimacing, head jerking, blinking, sniffing) that progress to multiple complex tics, including respiratory and vocal ones (eg, loud, irritating vocalizations; snorting). Vocal tics may begin as grunting or barking noises and evolve into compulsive utterances that are often loud or shrill. Patients may voluntarily suppress tics for seconds or minutes. Coprolalia (involuntary scatologic or obscene utterances) occurs in a few patients. Severe tics and coprolalia are physically and socially disabling. Echolalia (immediate repetition of one's own or another person's words or phrases) is common. In most children, tics tend to wane during the teenage years.

Comorbid disorders (eg, attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, learning disabilities, anxiety) and poor socialization are common and may be more problematic and more likely to need intervention than the tics.

Diagnosis

• Clinical evaluation

Diagnosis is clinical. To differentiate Tourette's syndrome from transient tics, physicians may have to monitor patients over time.

Treatment

• Clonidine
• Sometimes antipsychotics

Treatment to suppress tics is recommended only if they are significantly interfering with the children's activities or self-image; treatment does not alter the natural history of the disorder. Clonidine 0.05 to 0.1 mg po tid or qid is effective in some patients. Adverse effects of fatigue may limit dosage; hypotension is uncommon.

Antipsychotics (eg, risperidone 0.25 to 1.5 mg po bid, haloperidol 0.5 to 2 mg po bid or tid, pimozide 1 to 2 mg po bid, olanzapine 2.5 to 5 mg once/day) may be required. The lowest dose required to make tics tolerable is used; doses are tapered as tics wane. Adverse effects of dysphoria, parkinsonism, akathisia, and tardive dyskinesia may limit use of antipsychotics; using lower daytime doses and higher bedtime doses may decrease adverse effects.

Last full review/revision May 2009 by Margaret C. McBride, MD