Treatment

The goal of therapy in patients with TS is to reduce motor and vocal tics and alleviate associated behavioral problems, such as obsessive-compulsive behaviors, ADHD, and impulsivity. Many patients do not have significant functional impairment because their symptoms are mild and therefore do not require medication. However, for those with symptoms that are functionally disabling and affect academic, occupational, or social performance, there are a number of medications that may alleviate particular symptoms.

Drug therapy may include low doses of certain antipsychotic (dopamine receptor antagonist) medications (neuroleptics), such as haloperidol (Haldol®), pimozide (Orap®), fluphenazine (Prolixin®),and risperidone (Risperdal®), which have been found to be effective in reducing the frequency and intensity of tics. These medications should be prescribed with caution since their use may be associated with certain severe side effects. Adverse effects associated with neuroleptic therapy include the development of tardive dyskinesia (TD), a movement disorder characterized by persistent, repetitive (stereotypic) involuntary movements usually involving the lower face and mouth. Although TD often resolves with the discontinuation of drug therapy, particularly in children, the condition is not always reversible. Therefore, those who receive long-term neuroleptic therapy should be periodically evaluated to determine whether dosage level may be decreased or therapy may be discontinued. Neuroleptic therapy may also be associated with certain short-term side effects, such as drooling, contraction of the facial and neck muscles, slow movement (bradykinesia), restlessness (akathisia), and other symptoms.

Injections of botulinum toxin (BTX) into the muscles involved in tics may markedly alleviate not only the abnormal movements but also the premonitory sensations or urges that precede the tics. The administration of the antianxiety medication clonazepam (Klonopin®) or certain antidepressant medications may be helpful in the management of some of the associated behavioral symptoms. Therapy with clonidine (Catapres®) or guanfacine (Tenex®), alpha 2-adrenergic agonists, may relieve symptoms of ADHD and impulsivity, but these drugs are generally not very effective in controlling tics. In addition, in patients with obsessive-compulsive behaviors, treatment with certain antidepressant agents known as selective serotonin reuptake inhibitors (SSRIs) may be beneficial. Such medications include fluvoxamine (Luvox®), fluoxetine (Prozac®), clomipramine (Anafranil®), and many others.

On occasion, biofeedback, relaxation methods, or other behavioral techniques may be helpful in alleviating stress that potentially aggravates tics. In addition, for those with associated behavioral difficulties, individualized academic, vocational, social, or other supportive services are often beneficial.

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