What are effective treatments for Tourette's syndrome?

Tourette syndrome is a problem with the nervous system that causes people to make sudden movements or sounds - known as tics - that they cannot control (involuntary movements). For example, someone with Tourette's may blink or clear their throat repeatedly. Some people may blurt out words they have no intention of saying.

Treatments can control tics, but some people prefer to do without treatment as they are not bothered by the treatments.

Tourette syndrome often starts in childhood, and more boys than girls get it. Symptoms often get better as children grow up. For some people, they go away completely.

There's no specific test that can diagnose Tourette syndrome. The diagnosis is based on the history of your signs and symptoms. The criteria used to diagnose Tourette syndrome include:

• Both motor tics and vocal tics are present, although not necessarily at the same time
• Tics occur several times a day, nearly every day or intermittently, for more than a year
• Tics begin before age 18
• Tics aren't caused by medications, other substances or other medical condition
• Tics must change over time in location, frequency, type, complexity or severity

A diagnosis of Tourette syndrome may be overlooked because the signs can mimic other conditions. Eye blinking might be initially associated with vision problems, or sniffling attributed to allergies.

There is no cure for Tourette syndrome. Treatment is aimed at controlling tics that interfere with everyday activities and functioning. Medications to help control tics or reduce symptoms of related conditions include:

• Medications that block or lessen dopamine. Haloperidol and risperidone can help control tics. Possible side effects include weight gain and involuntary repetitive movements. Tetrabenazine may be recommended, although it may cause severe depression.
• Botulinum (Botox) injections. An injection into the affected muscle may help relieve a simple or vocal tic.
• ADHD medications. Stimulants such as methylphenidate can help increase attention and concentration. However, for some people with Tourette syndrome, medications for ADHD can exacerbate tics.
• Central adrenergic inhibitors. Medications such as clonidine and guanfacine, typically prescribed for high blood pressure, may help control behavioural symptoms such as impulse control problems and rage attacks. Side effects may include sleepiness. The two medicines are not available in many parts of the world.
• Antidepressants. Fluoxetine might help control symptoms of sadness, anxiety and OCD.
• Antiseizure medications. Recent studies suggest that some people with Tourette syndrome respond to topiramate (Topamax), which is used to treat epilepsy.

Apart from medications, other treatment modalities can also be considered.

Cognitive behavioural therapy

Cognitive behavioural interventions for tics, including habit-reversal training, can help you monitor tics, identify premonitory urges and learn to voluntarily move in a way that is incompatible with the tics.

There are four stages involved in the treatment.

1. First, awareness training is used to bring greater attention to tics and other behaviours so that the affected person can gain better self-control.
2. Second, once the patient has developed a good awareness of his tic or impulsive behaviour, the next step is to develop a competing response—an action meant to replace the old tic or impulsive behaviour. Usually, the competing response is opposite of that of the tic or impulsive behaviour and is something that can be carried out for longer than just a couple of minutes.
3. Third, to prevent tics and impulsive behaviours from coming back, people undergoing habit reversal training are encouraged to make a list of problems caused by their behaviour. Parents and friends are also asked to praise the person for their accomplishments thus far.
4. Fourth, the generalisation of skills thus learned. In this phase of treatment, people are encouraged to practice their new skills in a variety of different contexts, not just those that they have mastered to date.

Psychotherapy

In addition to helping a person cope with Tourette syndrome, psychotherapy can help with accompanying problems, such as ADHD, obsessions, depression or anxiety.

Deep brain stimulation (DBS)

For severe tics that fail to respond to other treatment, DBS might help. DBS involves implanting a battery-operated medical device in the brain to deliver electrical stimulation to targeted areas that control movement. However, this treatment is still in the early research stages and needs more research to determine its safety and effectiveness in the treatment of Tourette syndrome.