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Tourette syndrome

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 2 Apr 2025
Last updated: 17 Jan 2023

Summary

Definition

History and exam

Key diagnostic factors

  • male sex and early childhood onset
  • positive past psychiatric history
  • positive family history
  • abnormal movements
  • vocal sounds
  • premonitory sensation or urge
  • otherwise normal neurological exam
Full details

Other diagnostic factors

  • improvement of symptoms when focused on other tasks
  • worsening of symptoms under stress
  • ritualistic behaviors
Full details

Risk factors

  • 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 prenatal smoking
  • first trimester maternal stress and severe nausea/vomiting
  • low birth weight
Full details

Diagnostic tests

1st tests to order

  • clinical diagnosis
Full details

Tests to consider

  • brain MRI
  • EEG
  • premonitory urge for tics scale (PUTS)
Full details

Treatment algorithm

ONGOING

without ADHD or OCD

with ADHD

with OCD

Contributors

Authors

Marco A. Grados, MD, MPH

Clinical Director

Associate Professor of Psychiatry and Behavioral Sciences

Department of Psychiatry and Behavioral Sciences

Division for Child and Adolescent Psychiatry

Johns Hopkins Medicine

Baltimore

MD

Disclosures

MAG declares that he has no competing interests.

Acknowledgements

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.

Peer reviewers

Anna Basu, BM, BCh, PhD, MA, MRCPCH

Specialised Registrar

Paediatric Neurology

Honorary Clinical Lecturer

Newcastle General Hospital

Newcastle-upon-Tyne

UK

Disclosures

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

Rochester

NY

Disclosures

JM is an author of a number of references cited in this topic.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Keen-Kim D, Freimer NB. Genetics and epidemiology of Tourette syndrome. J Child Neurol. 2006;21:665-671. Abstract

Mink JW. Neurobiology of basal ganglia and Tourette syndrome: basal ganglia circuits and thalamocortical outputs. Adv Neurol. 2006;99:89-98. Abstract

Cath DC, Hedderly T, Ludolph AG, et al; European Society for the Study of Tourette Syndrome (ESSTS) Guidelines Group. European clinical guidelines for Tourette syndrome and other tic disorders. Part I: assessment. Eur Child Adolesc Psychiatry. 2011;20:155-171.Full text  Abstract

Whittington C, Pennant M, Kendall T, et al. Practitioner review: treatments for Tourette syndrome in children and young people - a systematic review. J Child Psychol Psychiatry. 2016 May 2 [Epub ahead of print]. Abstract

Verdellen C, van de Griendt J, Hartmann A, et al; European Society for the Study of Tourette Syndrome (ESSTS) Guidelines Group. European clinical guidelines for Tourette syndrome and other tic disorders. Part III: behavioural and psychosocial interventions. Eur Child Adolesc Psychiatry. 2011;20:197-207.Full text  Abstract

Dutta N, Cavanna AE. The effectiveness of habit reversal therapy in the treatment of Tourette syndrome and other chronic tic disorders: a systematic review. Funct Neurol. 2013;28:7-12.Full text  Abstract

Roessner V, Plessen KJ, Rothenberger A, et al; European Society for the Study of Tourette Syndrome (ESSTS) Guidelines Group. European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment. Eur Child Adolesc Psychiatry. 2011;20:173-196.Full text  Abstract

Jimenez-Jimenez FJ, Garcia-Ruiz PJ. Pharmacological options for the treatment of Tourette's disorder. Drugs. 2001;61:2207-2220. Abstract

Rizzo R, Gulisano M, Calì PV, et al. Tourette syndrome and comorbid ADHD: current pharmacological treatment options. Eur J Paediatr Neurol. 2013;17:421-428. Abstract

Müller-Vahl KR, Cath DC, Cavanna AE, et al; European Society for the Study of Tourette Syndrome (ESSTS) Guidelines Group. European clinical guidelines for Tourette syndrome and other tic disorders. Part IV: deep brain stimulation. Eur Child Adolesc Psychiatry. 2011;20:209-217.Full text  Abstract

Nangunoori R, Tomycz ND, Quigley M, et al. Deep brain stimulation for psychiatric diseases: a pooled analysis of published studies employing disease-specific standardized outcome scales. Stereotact Funct Neurosurg. 2013;91:345-354.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

  • Differentials

    • Provisional tic disorder
    • Persistent (chronic) motor or vocal tic disorder
    • Stereotypies
    More Differentials

  • Guidelines

    • Practice guideline recommendations summary: the treatment of tics in people with Tourette syndrome and chronic tic disorders
    • Canadian guidelines for the evidence-based treatment of tic disorders: pharmacotherapy
    More Guidelines

  • Patient information

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    ADHD: what is it?

    More Patient information
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