Tourette's syndrome is a complex neurodevelopmental disorder characterised by motor and vocal tics beginning in childhood.
It is part of a larger spectrum of tic disorders, ranging from mild transient tics to debilitating complex tics with behavioural issues and self-injurious behaviours.
The aetiology remains unclear but the condition is familial in most cases.
Diagnosis is based on clinical history. There is no identifiable biological marker.
The course can vary greatly among individuals, but prognosis is often promising. The majority of patients show improvement of their tics by late adolescence or young adulthood.
The standard of care is symptomatic medical and behavioural management. Deep-brain stimulation is still experimental. A crucial part of management includes patient, family, teacher, and peer education.
Tourette's syndrome (TS) is a childhood-onset neurodevelopmental disorder characterised by motor and vocal tics and often accompanied by psychiatric disorders, such as obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD), among others.
History and exam
Key diagnostic factors
- presence of risk factors
- early childhood onset
- abnormal movements
- vocal sounds
- premonitory sensation or "urge"
- otherwise normal neurological examination
Other diagnostic factors
- improvement of symptoms when focused on other tasks
- worsening of symptoms under stress
- ritualistic behaviours
- male sex
- age 3 to 8 years
- family history of TS or tics
- history of OCD or ADHD
- family history of OCD or ADHD
- maternal antenatal smoking
- first trimester maternal stress and severe nausea/vomiting
- low birth weight
1st investigations to order
- clinical diagnosis
Investigations to consider
- brain MRI
- premonitory urge for tics scale (PUTS)
without ADHD or OCD
- Provisional tic disorder
- Persistent (chronic) motor or vocal tic disorder
- Practice guideline recommendations summary: the treatment of tics in people with Tourette syndrome and chronic tic disorders
- Attention deficit hyperactivity disorder: diagnosis and management
ADHD: what is it?More Patient leaflets
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