Tics are unvoluntary and repetitive and can be motor (twitches, movements) or vocal (a sound—sniffing, hooting, or speaking words out of context). The person with tics has an irresistible urge to make the sound or movement. This stems from a disorder in the brain. Many tics begin in childhood at the age of 5 to 6 years, worsen through adolescence, and, most often, improving in young adulthood.
If tics do not disrupt a person’s life, cause pain or emotional distress, or keep a person from functioning, no treatment may be needed. When tics do interfere with someone’s life, treatments are available.
In fact, the American Academy of Neurology has released new guidelines for tic disorders and tics in Tourette’s syndrome. The guideline is endorsed by the Child Neurology Society and the European Academy of Neurology and is the first published evidence-based guideline for neurologists published.
The guideline emphasizes that doctors should pay special attention to finding out whether or not a person with tics also has obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), or anxiety, because these often occur with tic disorders, and all can be treated. It is especially important to treat OCD, ADHD, or anxiety in people with tics, because those disorders can interfere with successful treatment of tics.
The guideline stresses that when treatment is needed, the doctor, the patient, and the family (for pediatric patients) should work together to choose the best treatment for an individual from several options.
For people with tics who are able to complete the program, a system of learning skills to relax and reverse habits, called Comprehensive Behavioral Intervention for Tics(CBIT), is likely the first best choice. Usually this program takes 10 to 12 weeks to learn.
For people with severe tics or for whom CBIT is not available medicine may be the best choice. A class of drugs called alpha-adrenergic agonists can be used to improve either or both tics and ADHD. When benefits outweigh risks, antipsychotic medications can be considered, but must be used with care, titrating the dose and educating patients not to stop taking medication without physician supervision and tapering to prevent abnormal movement problems called dyskinesia (diss-ki-knees-zuh).
More research is being done on tics and new treatments are in development. The Tourette Syndrome Association is conducting a survey of how tics affect the people who experience them to further this research. The survey can be accessed at treatingtourettetogether.org.
Michael S. Cartwright, MD, MS, and Hwajin Lee, MD
James Geyer, MD, and Paul Cox
Claire Smyth, BSc; David Roberts, BSc; and Kenneth Monaghan, PhD