Tourette syndrome

Last updated: August 21, 2023

Summarytoggle arrow icon

Tourette syndrome is a severe neurological movement disorder characterized by tics that are involuntary, repeated, intermittent movements or vocalizations. It is a genetic disorder that commonly manifests in boys and is often associated with attention deficit hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD). Diagnosis is based upon multiple motor tics and at least one vocal tic, lasting for longer than a year, and the exclusion of other suspected medical conditions. Differential diagnoses include transient motor and phonic tics, which last less than a year, Huntington disease, dystonia, myotonia, or stereotypic movement disorder. Treatment is symptomatic and includes behavioral therapy, alpha-adrenergic agonists, and dopamine antagonists. Approximately 50% of cases resolve by adulthood.

Epidemiologytoggle arrow icon

  • Sex: > [1]
  • Age of onset: usually 4–6 years of age (tics are most severe between 10–12 years of age and then decline during adolescence) [2]

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

Clinical featurestoggle arrow icon

  • Tics: sudden and rapid involuntary, intermittent, nonrhythmic movements or vocalizations without any recognizable purpose
    • May wax and wane in frequency
    • Temporarily suppressible
    • Premonitory urge: An urge or sensation preceding the tic is relieved by its onset.
Overview of tics
Type Simple Complex
Vocal tics
  • Throat clearing
  • Grunting
  • Lip smacking
  • Barking
  • Sniffing
  • Coprolalia: uttering obscene or socially inappropriate words or phrases
  • Palilalia: repeating words or phrases with increasing rapidity
  • Echolalia: repeating vocalizations of others
Motor tics
  • Facial grimacing
  • Blinking
  • Shoulder shrugging
  • Head jerking
  • Jumping
  • Twisting the body
  • Echopraxia: repeating movements of others

Diagnosticstoggle arrow icon

Tourette syndrome is a clinical diagnosis based on all of the following:

  • Multiple motor tics and at least 1 vocal tic with a variable anatomical location, frequency, number, complexity, type, or severity over time
  • Onset before 18 years of age
  • Lasting > 1 year
  • Not explained by other medical conditions or substance use (e.g., cocaine) [3]

Differential diagnosestoggle arrow icon

Other tic disorders [4]

Sporadic transient tic disorder

A subtype of tic disorder particularly common in children, which manifests with motor or vocal tics that occur over a period of less than one year before resolving.

  • Motor and/or vocal tics
  • Age of onset: < 18 years
  • Symptoms occur for less than 1 year (resolve spontaneously)
  • Not explained by any other medical conditions or substance abuse
  • Do not meet the criteria for Tourette syndrome

Persistent motor tic disorder or persistent vocal tic disorder

Subtypes of tic disorder particularly common in children, which manifests with motor or phonic tics only.

  • Motor or vocal tics (not both)
  • Age of onset: < 18 years
  • Persist > 1 year
  • Not explained by any other medical conditions or substance abuse
  • Do not meet the criteria for Tourette syndrome

Adult-onset tic disorder [5][6]

Other differentials

The differential diagnoses listed here are not exhaustive.

Managementtoggle arrow icon

Although Tourette syndrome may improve or resolve spontaneously, there is no curative treatment; therefore, management aims to reduce the frequency of tics and improve function and quality of life. [9]

Prognosistoggle arrow icon

  • Symptoms improve during adolescence. [2]
  • May resolve spontaneously by 18 years of age (50% of cases) [11]

Referencestoggle arrow icon

  1. Pringsheim T, Okun MS, Müller-Vahl K, et al. Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology. 2019; 92 (19): p.896-906.doi: 10.1212/wnl.0000000000007466 . | Open in Read by QxMD
  2. Thenganatt MA, Jankovic J. Recent advances in understanding and managing tourette syndrome. F1000Research. 2016; 5: p.152.doi: 10.12688/f1000research.7424.1 . | Open in Read by QxMD
  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. DSM library ; 2013
  4. Bloch MH, Leckman JF. Clinical course of Tourette syndrome.. J Psychosom Res. 2009; 67 (6): p.497-501.doi: 10.1016/j.jpsychores.2009.09.002 . | Open in Read by QxMD
  5. Leckman JF, Zhang H, Vitale A, et al. Course of tic severity in Tourette syndrome: the first two decades.. Pediatrics. 1998; 102 (1 Pt 1): p.14-9.doi: 10.1542/peds.102.1.14 . | Open in Read by QxMD
  6. Du JC, Chiu TF, Lee KM, et al. Tourette syndrome in children: an updated review.. Pediatrics and neonatology. 2010; 51 (5): p.255-64.doi: 10.1016/S1875-9572(10)60050-2 . | Open in Read by QxMD
  7. Jones KS, Ramphul K. Tourette Syndrome And Other Tic Disorders. StatPearls. 2020.
  8. Robakis D. How Much Do We Know about Adult-onset Primary Tics? Prevalence, Epidemiology, and Clinical Features. Tremor and Other Hyperkinetic Movements. 2017; 7: p.441.doi: 10.5334/tohm.373 . | Open in Read by QxMD
  9. Chouinard S. Adult onset tic disorders. Journal of Neurology, Neurosurgery & Psychiatry. 2000; 68 (6): p.738-743.doi: 10.1136/jnnp.68.6.738 . | Open in Read by QxMD
  10. Ollendick TH, Hersen M. Handbook of Child Psychopathology. Springer Science & Business Media ; 2013
  11. Freeman RD, Soltanifair A, Baer S. Stereotypic movement disorder: easily missed. Dev Med Child Neurol. 2010; 52 (8): p.733-738.doi: 10.1111/j.1469-8749.2010.03627.x . | Open in Read by QxMD

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