Because symptoms do not impair most patients and development usually proceeds normally, the majority of people with TS require no medication. However, medications are available to help when symptoms interfere with functioning. Unfortunately, there is no one medication that is helpful to all persons with TS, nor does any medication completely eliminate symptoms; in addition, all medications have side effects. Instead, the available TS medications are only able to help reduce specific symptoms.
Some patients who require medication to reduce the frequency and intensity of the tic symptoms may be treated with neuroleptic drugs such as haloperidol and pimozide. These medications are usually given in very small doses that are increased slowly until the best possible balance between symptoms and side effects is achieved.
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. Discontinuing neuroleptics after long-term use must be done slowly to avoid rebound increases in tics and withdrawal dyskinesias.
Recently scientists have discovered that long-term use of neuroleptic drugs may cause an involuntary movement disorder called tardive dyskinesia. However, this condition usually disappears when medication is discontinued. These side effects can be reduced by drugs commonly used to treat Parkinson's disease. Other side effects such as fatigue, depression, anxiety, weight gain and difficulties in thinking clearly may be more troublesome.
Clonidine and guanfacine, both antihypertensive drugs, are also used in the treatment of tics. The most common side effect from these medications that precludes their use is sedation. Fatigue, dry mouth, irritability, dizziness, headache, and insomnia are common side effects associated with clonidine use. Fluphenazine and clonazepam may also be prescribed to help control tic symptoms.
Effective medications are also available to treat some of the associated behavioral disorders. Stimulants such as methyphenidate and dextroamphetamine, usually prescribed for attention deficit-hyperactivity disorders, have also been reported to be effective without causing tics to become more severe. For obsessive-compulsive behaviors that significantly disrupt daily functioning, fluoxetine, clomipramine, sertraline or paroxetine may be prescribed.
Other types of therapy may also be helpful. Although psychological problems do not cause TS, psychotherapy may help the person better cope with the disorder and deal with the secondary social and emotional problems that sometimes occur. Psychotherapy does not help suppress the patient's tics. 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.
Relaxation techniques and biofeedback may be useful in alleviating stress that can lead to an increase in tic symptoms.
What is the prognosis?
Although there is no cure for TS, the condition in many individuals improves as they mature. Individuals with TS can expect to live a normal life span. Although the disorder is generally lifelong and chronic, it is not a degenerative condition. TS does not impair intelligence. Tics tend to decrease with age, enabling some patients to discontinue using medication. In a few cases, complete remission occurs after adolescence. Although tic symptoms tend to decrease with age, it is possible that neurobehavioral disorders such as depression, panic attacks, mood swings and antisocial behaviors can persist and cause impairment in adult life.
What is the best educational setting for children with TS?
Although students with TS often function well in the regular classroom, it is estimated that many may have some kind of learning disability. When attention deficit-hyperactivity disorder, obsessive-compulsive disorder, and frequent tics greatly interfere with academic performance or social adjustment, students should be placed in an educational setting that meets their individual needs. These students may require tutoring, smaller or special classes and, in some cases, special schools.
All students with TS need a tolerant and compassionate setting that both encourages them to work to their full potential and is flexible enough to accommodate their special needs. This setting may include a private study area, exams outside the regular classroom, or even oral exams when the child's symptoms interfere with his or her ability to write. Untimed testing reduces stress for students with TS.
Tourette's Syndrome. Last reviewed 11/14/2006
Sources:
- Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
- Revised National Institute of Neurological Disorders and Stroke
- National Institutes of Health National Institutes of Health - National Library of Medicine
