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How is Tourette syndrome (TS) treated?

Neurologists treat tic disorders and Tourette's syndrome with different types of medications including those that can reduce the frequency and intensity of tics by modulating the levels of neurotransmitters such as dopamine and GABA, and treatments for associated anxiety disorders, since these can also reduce the severity of symptoms and improve overall quality of life.

Neurologists treat some patients with tic disorders and Tourette's syndrome with botulinum toxin injections into the specific muscles that are involved in a person's tics.This treatment may decrease both the tics themselves and the preceding urge to perform them.

For some people, behavioral techniques such as biofeedback or relaxation methods can alleviate stress that can aggravate tics. Other support services can also be helpful for patients with behavioral difficulties related to a tic disorder.

Although there is no cure for Tourette syndrome (TS), there are treatments to help manage the tics caused by TS. Many people with TS have tics that do not get in the way of their living their daily life and, therefore, do not need any treatment. However, medication and behavioral treatments are available if tics cause pain or injury; interfere with school, work or social life; or cause stress.

Comprehensive Behavioral Intervention for Tics (CBIT) is a new, evidence-based type of behavioral therapy for TS and chronic tic disorders. CBIT includes habit reversal in addition to other strategies, including education about tics and relaxation techniques. CBIT has been shown to be effective at reducing tic symptoms and tic-related impairment among children and adults.

Medications can be used to reduce severe or disruptive tics that might have led to problems in the past with family and friends, other students or coworkers. Medications also can be used to reduce symptoms of related conditions, such as ADHD or OCD.

Since tic symptoms do not often cause impairment, the majority of people with Tourette syndrome (TS) require no medication for tic suppression. However, effective medications are available for those whose symptoms interfere with functioning. Neuroleptics are the most consistently useful medications for tic suppression. Although a number of such medications are available, haloperidol and pimozide are more effective than others. Unfortunately, there is no one medication that is helpful to all people with TS, nor does any medication completely eliminate all the symptoms. Moreover, all medications have side effects. Most neuroleptic side effects can be managed by initiating treatment slowly and reducing the dose when side effects occur. The most common side effects of neuroleptics include sedation, weight gain, and cognitive dulling. Neurological side effects, such as tremor, dystonic reactions (twisting movements or postures), parkinsonian-like symptoms, and other dyskinetic (involuntary) movements are less common and are readily managed with dose reduction. Effective medications are also available to treat some of the associated neurobehavioral disorders that can occur in patients with TS. Recent research shows that stimulant medications, such as methylphenidate and dextroamphetamine, can lessen ADHD symptoms in people with TS without causing tics to become more severe. For OCD symptoms that significantly disrupt daily functioning, the serotonin reuptake inhibitors (clomipramine, fluoxetine, fluvoxamine, paroxetine, and sertraline) have been proven effective in some patients.

Psychotherapy may also be helpful. Although psychological problems do not cause TS, such problems may result from TS. Psychotherapy can help the person with TS cope better with the disorder and deal with the secondary social and emotional problems that sometimes occur with it. More recently, specific behavioral treatments that include awareness training and competing response training, such as voluntarily moving in response to a premonitory urge, have shown effectiveness in small controlled trials. Larger and more definitive NIH-funded studies are underway.

This information is based on source information from the National Institute of Neurological Disorders and Stroke.

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