Tourette syndrome

Simple motor tics tend to be brief, abrupt, and restricted to a small number of muscles. They are often the first type of tic to emerge and may include:

• Eye blinking
• Eye darting
• Facial grimacing or nose scrunching
• Head or shoulder twitching
• Jaw or mouth movements
• Nose twitching
• Shoulder shrugging

Simple vocal tics are less common than simple motor tics and tend to appear sometime after simple motor tics develop. These sounds may include:

• Barking
• Coughing
• Grunting
• Shouting
• Sniffing
• Throat clearing

These tics typically emerge sometime later in childhood after simple motor tic symptoms have already appeared. They involve coordinated movements of different muscle groups that can last longer and appear more intentional than simple motor tics. They may include:

• Bending
• Gesturing
• Hopping
• Jumping
• Sniffing or touching an object
• Stepping in a certain pattern
• Twisting

Complex vocal tics are the rarest of the tics associated with Tourette’s. They also emerge later than simple tics and can include:

• Repeating words or phrases
• Repeating another person’s words or phrases (echolalia)
• Using vulgar, obscene, or swear words (coprolalia)

Medications can help manage tics or reduce symptoms of other conditions that often occur with Tourette’s. Medications may include:

• Alpha-adrenergic blockers (clonidine or guanfacine): These first-line treatments for tics inhibit the release of noradrenaline. This hormone helps send messages from nerve-to-nerve and nerve-to-muscle.
• Botulinum toxin: These injections are inserted into a muscle to weaken or paralyze it temporarily. This treatment may relieve simple or vocal tics.
• Fluphenazine: This medication works to control tics by blocking or lessening the effects of dopamine in the brain to change mood, thinking, or behavior.
• Haloperidol: This medication helps to control motor and verbal tics by blocking the activity of dopamine in the brain.
• Pimozide: This medication controls severe motor or verbal tics by blocking the activity of dopamine.
• Risperidone: This medication helps rebalance levels of dopamine and serotonin. This reduces the uncontrollable urges to move or vocalize in Tourette syndrome.
• Tetrabenazine: This medication decreases the dopamine stored in the brain to reduce unwanted motor and verbal tics.
• Topiramate: This anti-seizure medication helps manage symptoms in some people with Tourette’s.

Your doctor may also prescribe medication to help manage symptoms of other behavioral or mental conditions that may occur with Tourette syndrome, such as:

• Anxiety
• Attention deficit hyperactivity disorder (ADHD)
• Autism
• Depression
• Obsessive-compulsive disorder (OCD)

A procedure called deep brain stimulation (DBS) involves the surgical placement of a medical device in the chest (similar to a pacemaker) that sends an electrical impulse through wires to specific areas of the brain that are responsible for the tics. These electrical signals can help to block the abnormal brain signals causing tics.

DBS may help reduce severe tics that are not controlled with medications or behavioral therapy. Researchers are studying DBS as a treatment for people with Tourette syndrome and people who have Tourette’s and obsessive-compulsive disorder.

People living with Tourette’s may benefit from a combination of medication and specific therapies to help control tics.

Comprehensive behavioral intervention for tics (CBIT) is a form of psychotherapy that teaches you ways to monitor tics and identify the beginnings of an urge for a tic. You then learn to do voluntary movements that compete with the tic to prevent the tic from happening. CBIT also teaches stress reduction techniques and ways to reduce tic triggers, such as stress or anxiety.