Last reviewed: September 2018
Last updated: January  2018



History and exam

Key diagnostic factors

  • presence of risk factors
  • observed tics
  • premonitory sensation
  • ability to suppress tics
  • symptoms may improve when distracted
  • otherwise normal neurological examination

Other diagnostic factors

  • symptoms worse with stress, anxiety, or excitement
  • variable severity over time
  • symptoms of comorbid psychiatric disorder

Risk factors

  • onset at age <18 years
  • male sex
  • FHx of tics
  • FHx of OCD, ADHD, or depression
  • hx of OCD or ADHD

Diagnostic investigations

Investigations to consider

  • MRI brain with and without contrast
  • EEG
  • CSF analysis (lumbar puncture)
Full details

Treatment algorithm


Authors VIEW ALL

Maurice A. and Thelma P. Rothman Chair of Developmental Pediatrics


National Tourette Centre of Excellence, Southeast Consortium - USF


Departments of Pediatrics and Psychiatry

University of South Florida




TKM has received research grants from Auspex Pharmaceuticals, the National Institute of Mental Health, Shire Pharmaceuticals, Pfizer Inc., F. Hoffman-La Roche Ltd., AstraZeneca Pharmaceuticals, Centers for Disease Control and Prevention, Massachusetts General Hospital, Sunovion Pharmaceuticals, Neurocrine Bioscience, Psyadon Pharmaceuticals, and PANDAS Network. She is on the advisory board for the International Obsessive Compulsive Foundation. She is also a co-author of several studies referenced in this topic.


National Tourette Centre of Excellence at Northwell Health


Movement Disorders Program in Psychiatry


Hofstra Northwell School of Medicine

Northwell Health




CLB has received research funding from Otsuka, Psyadon, Auspex, Teva, Neurocrine, and Synchroneuron Pharmaceuticals. She is a consultant for Bracket and a paid speaker for the Centers for Disease Control and Prevention (CDC) - National Tourette Syndrome Association Partnership. She is an author of several reference cited in this topic.

Dr Tanya K. Murphy and Dr Cathy L. Budman would like to gratefully acknowledge Dr Amber Stocco, Dr Migvis Monduy, and Dr Bobbi Hopkins, previous contributors to this monograph. AS, MM, and BH declare that they have no competing interests.

Peer reviewers VIEW ALL


Division of Pediatric Neurology

University of Utah School of Medicine

Salt Lake City



FF declares that he has no competing interests.

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