Tic disorders

Last reviewed: 6 Sep 2022
Last updated: 01 Sep 2022

Summary

Definition

History and exam

Key diagnostic factors

  • observed tics
  • premonitory sensation
  • ability to suppress tics
  • symptoms may improve when distracted
  • otherwise normal neurologic exam
More key diagnostic factors

Other diagnostic factors

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

Risk factors

  • onset at age <18 years
  • male sex
  • family history of tics
  • family history of obsessive-compulsive disorder (OCD), ADHD, or depression
  • prenatal maternal smoking
  • history of OCD or ADHD
  • history of autism spectrum disorder (ASD)
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • MRI brain with and without contrast
  • electroencephalogram
  • cerebrospinal fluid analysis (lumbar puncture)
More investigations to consider

Treatment algorithm

ACUTE

symptoms not interfering with activities of daily living

symptoms interfering with activities of daily living: nonpregnant

severe tics refractory to behavioral and pharmacologic therapies

symptoms interfering with activities of daily living: pregnant

Contributors

Authors

Tamara Pringsheim, MD, FRCPC

Professor

University of Calgary

Department of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences

Calgary

Canada

Disclosures

TP has received research grants for Tourette syndrome from Alberta Health and the Alberta Children's Hospital Research Institute. TP is an author of several references cited in this topic.

Acknowledgements

Professor Tamara Pringsheim would like to gratefully acknowledge Dr Tanya K. Murphy, Dr Fatima Masumova, Dr Cathy L. Budman, Dr Amber Stocco, Dr Migvis Monduy, and Dr Bobbi Hopkins, previous contributors to this topic.

Disclosures

FM, AS, MM, and BH declare that they have no competing interests. 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 an author of several references cited in this topic. 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 references cited in this topic.

Peer reviewers

Francis Filloux, MD

Chief

Division of Pediatric Neurology

University of Utah School of Medicine

Salt Lake City

UT

Disclosures

FF declares that he has no competing interests.

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