At a glance
What it is
A disorder involving repetitive movements or unwanted sounds (tics) that cannot be easily controlled. Onset is typically between ages 2 and 15, with average around 6 years.
Symptoms
Motor tics (eye blinking, head jerking, shoulder shrugging) and vocal tics (grunting, coughing, throat clearing). Complex tics include repeating words or obscene gesturing.
Approach
Behavioural therapy, medications to control dopamine or reduce related symptoms, and neurosurgical options including radiofrequency brain lesioning and deep brain stimulation for severe refractory cases.
What Tourette syndrome is
Tourette (too-RET) syndrome is a disorder that involves repetitive movements or unwanted sounds (tics) that can't be easily controlled. For instance, you might repeatedly blink your eyes, shrug your shoulders or blurt out unusual sounds or offensive words.
Tics typically show up between ages 2 and 15, with the average being around 6 years of age. Males are about three to four times more likely than females to develop Tourette syndrome.
Although there's no cure for Tourette syndrome, treatments are available. Many people with Tourette syndrome don't need treatment when symptoms aren't troublesome. Tics often lessen or become controlled after the teen years.
Symptoms and types of tics
Tics — sudden, brief, intermittent movements or sounds — are the hallmark sign of Tourette syndrome. They can range from mild to severe. Severe symptoms might significantly interfere with communication, daily functioning and quality of life.
Tics are classified as simple or complex, and as motor or vocal. Motor tics usually begin before vocal tics do, but the spectrum of tics that people experience is diverse.
**Simple motor tics** — eye blinking, head jerking, shoulder shrugging, eye darting, nose twitching, mouth movements.
**Complex motor tics** — touching or smelling objects, repeating observed movements, stepping in a certain pattern, obscene gesturing, bending or twisting, hopping.
**Simple vocal tics** — grunting, coughing, throat clearing, barking.
**Complex vocal tics** — repeating one's own words or phrases, repeating others' words or phrases, using vulgar, obscene or swear words.
In addition, tics can vary in type, frequency and severity; worsen if you're ill, stressed, anxious, tired or excited; occur during sleep; change over time; and typically worsen in the early teenage years and improve during the transition into adulthood.
Causes and risk factors
The exact cause of Tourette syndrome isn't known. It's a complex disorder likely caused by a combination of inherited (genetic) and environmental factors. Chemicals in the brain that transmit nerve impulses (neurotransmitters), including dopamine and serotonin, might play a role.
Risk factors include having a family history of Tourette syndrome or other tic disorders, and being male — males are about three to four times more likely than females to develop the condition.
Complications and associated conditions
People with Tourette syndrome often lead healthy, active lives. However, Tourette syndrome frequently involves behavioral and social challenges that can harm self-image.
Conditions often associated with Tourette syndrome include attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), autism spectrum disorder, learning disabilities, sleep disorders, depression, anxiety disorders, pain related to tics (especially headaches), and anger-management problems.
Treatment options
There's no cure for Tourette syndrome. Treatment is aimed at controlling tics that interfere with everyday activities and functioning. When tics aren't severe, treatment might not be necessary.
Medications
- Dopamine blockers — fluphenazine, haloperidol (Haldol), risperidone (Risperdal) and pimozide (Orap).
- Tetrabenazine (Xenazine) for severe cases; possible side effect is severe depression.
- Botulinum (Botox) injections into the affected muscle to relieve a simple or vocal tic.
- ADHD medications — stimulants such as methylphenidate and dextroamphetamine (may exacerbate tics in some people).
- Central adrenergic inhibitors such as clonidine and guanfacine for behavioural symptoms.
- Antidepressants such as fluoxetine for sadness, anxiety and OCD.
- Antiseizure medications — topiramate (Topamax) has shown response in some patients.
Therapy and advanced procedures
- Behaviour therapy — Cognitive Behavioural Interventions for Tics, including habit-reversal training.
- Psychotherapy for accompanying problems such as ADHD, obsessions, depression or anxiety.
- Radiofrequency brain lesioning — an effective and safe technique for treating severe cases, essentially painless and done under local anesthesia.
- Deep brain stimulation (DBS) — for severe tics that don't respond to other treatment; still in early research stages and needs more study to determine safety and effectiveness.
Key facts
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This page provides general information about tourette syndrome and is not a substitute for individual medical assessment. If your symptoms are severe or worsening, contact a clinician promptly.