Tourette syndrome

Last reviewed: 26 Apr 2022
Last updated: 21 Sep 2021

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
More key diagnostic factors

Other diagnostic factors

  • improvement of symptoms when focused on other tasks
  • worsening of symptoms under stress
  • ritualistic behaviors
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • brain MRI
  • EEG
  • premonitory urge for tics scale (PUTS)
More investigations to consider

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 has received a contract grant from Freespira, Inc. and travel expenses from the Cornelia deLange Syndrome Foundation.

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.

  • 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 leaflets

    Tourette’s syndrome

    Obsessive-compulsive disorder

    More Patient leaflets
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