Tourette Syndrome

There is no single test to diagnose Tourette syndrome, which can present with tics that range in severity. Symptoms may get worse with fatigue, excitement, anxiety, stress or illness, occur while asleep and change over time, and may include:

• Simple motor tics: Sudden, brief, repetitive and engaging a limited number of muscle groups, include eye blinks or twitching.  
• Simple vocal tics include throat clearing, grunting or barking. 
• Complex motor tics: Distinct, coordinated movement patterns involving several muscle groups. Complex motor ticks include sniffing or touching objects, hopping, jumping, bending or twisting.  
• Complex vocal tics include swearing (coprolalia) or repeating words and phrases other people speak (echolalia).  

Diagnosis begins with a discussion of your symptoms and medical history. We may recommend that you have blood tests or neuroimaging studies, such as magnetic resonance imaging (MRI) to rule out other causes. 

A Tourette syndrome diagnosis is based on four criteria: 

• Motor and vocal tics must be present, although they do not have to occur at the same time.  
• Tics should occur several times a day, almost every day or intermittently for more than a year. Tics should not disappear for a period longer than three months. 
• Tics should start before the age of 18. 
• Tics should not be caused by medications, other substances or conditions

Signs and symptoms normally emerge between the ages of 2 and 12, and the average is 7. Boys are three to four times more likely than girls to develop Tourette syndrome. Patients may have a higher propensity for other behavioral conditions, including attention deficit hyperactivity disorder (ADHD or ADD) and obsessive-compulsive behavior (OCD). 

Mild symptoms may not require treatment — the purpose of treatment is to help you control tics that interfere with your daily activities and functioning. 

Many patients’ symptoms resolve after their teen years. The causes of Tourette syndrome are unknown, though it is thought to be caused by abnormalities in one or more parts of the brain. Several drugs and therapies may be used to help control the symptoms of Tourette syndrome. Medications include: 

• Those that block or deplete the neurotransmitter dopamine (Haloperidol) 
• Stimulants to increase attention and concentration (Dextroamphetamine) 
• Central adrenergic inhibitors to help control behavioral symptoms (Clonidine) 
• Antidepressants to help with anxiety and depression (Fluoxetine) 
• Medications to relax certain muscles (botulinum toxin/Botox®) 

Our experts may also recommend psychotherapy to improve emotional wellness and behavioral therapy to help you learn to reduce tics by identifying the premonitory urge and working to suppress the tic.