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
Marco A. Grados, MD, MPH
Associate Professor of Psychiatry and Behavioral Sciences
Department of Psychiatry and Behavioral Sciences
Division for Child and Adolescent Psychiatry
Johns Hopkins Medicine
MAG has received a contract grant from Freespira, Inc. and travel expenses from the Cornelia deLange Syndrome Foundation.
Dr Marco Grados would like to gratefully acknowledge Dr Blanca Garcia-Delgar, Dr Barbara J. Coffey, Dr Victoria Chang and Dr Steven Frucht, the previous contributors to this topic.
Anna Basu, BM, BCh, PhD, MA, MRCPCH
Honorary Clinical Lecturer
Newcastle General Hospital
AB declares that she has no competing interests.
Jonathan Mink, MD, PhD
Professor of Neurology, Neurobiology, Anatomy and Pediatrics
Chief Child Neurology
University of Rochester
JM is an author of a number of references cited in this topic.
- Provisional tic disorder
- Persistent (chronic) motor or vocal tic disorder
- Attention deficit hyperactivity disorder: diagnosis and management
- Practice guideline recommendations summary: the treatment of tics in people with Tourette syndrome and chronic tic disorders
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