Tourette

Tourette syndrome (TS) is a neurodevelopmental disorder defined by multiple motor tics and at least one vocal tic, beginning in childhood. Tics are sudden, rapid, recurrent, nonrhythmic movements or sounds. Onset is usually in early childhood, often between ages 4 and 6 for motor tics; vocal tics appear within a few years. TS lies on a spectrum of tic disorders and can persist into adolescence or adulthood for some individuals.

Common motor tics involve the face and neck (eye blinking, facial grimacing, head jerks, shoulder shrugs). Vocal tics include throat clearing, grunting, sniffing, and occasionally utterances or phrases. Complex tics may involve sequences of movements. Coprolalia, or involuntary obscene speech, occurs in a minority and is less common than popular depictions suggest.

Diagnosis is clinical: onset before 18, multiple motor tics and at least one vocal tic present at some time, tics persisting for more than a year, and not due to substances or another medical condition.

Causes and epidemiology: TS has a genetic component; several genes may contribute. Neurobiological models emphasize dysregulation of cortico-striato-thalamo-cortical circuits and neurotransmitters such as dopamine. Prevalence estimates range from 0.3% to 0.9% among school-age children; males are affected more often than females (approximately 3:1). Common comorbidities include ADHD, OCD, anxiety, and mood disorders.

Management: Many individuals do not require treatment. Education and support, plus behavioral therapy such as CBIT (habit reversal). For disruptive tics, medications include guanfacine or clonidine for mild cases, or antipsychotics such as risperidone or aripiprazole; botulinum toxin can treat focal tics. Deep brain stimulation is considered only in very severe cases. Prognosis varies; many improve in adolescence or adulthood.