Tourette Syndrome and Other Tic Disorders Guidelines

Updated: May 30, 2019
  • Author: William C Robertson, Jr, MD; Chief Editor: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP  more...
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Guidelines

Guidelines Summary

American Academy of Neurology

In 2019, the American Academy of Neurology (AAN) released guidelines for treating tics in people with Tourette syndrome. Recommendations address counseling, comorbid disorders, and treatment. [217]

Counseling

Inform patients and their caregivers about the natural history of tic disorders.

Evaluate functional impairment related to tics from the perspective of the patient and, if applicable, the caregiver.

If prescribing medications for tics, periodically re-evaluate the need for ongoing medical treatment.

Assessing comorbid disorders

Assess for comorbid ADHD in people with tics, evaluate the burden of ADHD symptoms, and ensure appropriate ADHD treatment is provided.

Assess for comorbid OCD in people with tics and ensure appropriate OCD treatment is provided.  

Ensure appropriate screening for anxiety, mood, and disruptive behavior disorders is performed in people with tics.

Ask the patient about suicidal thoughts and attempts and refer to appropriate resources.

Alpha-agonist treatment

If treating patients with tics with α2 adrenergic agonists, you must monitor heart rate and blood pressure.

If prescribing guanfacine extended release, you must monitor the QTc interval in patients with a history of cardiac conditions, patients taking other QT-prolonging agents, or patients with a family history of long QT syndrome.

Gradually taper α2 adrenergic agonists to avoid rebound hypertension.

Antipsychotic treatment

Counsel patients on the relative propensity of antipsychotics for extrapyramidal, hormonal, and metabolic adverse effects.

When prescribing antipsychotics for tics prescribe the lowest effective dose to decrease the risk of adverse effects.

If prescribing antipsychotics, you must perform electrocardiography and measure the QTc interval before and after starting pimozide or ziprasidone, or if antipsychotics are coadministered with other drugs that can prolong the QT interval.

Deep brain stimulation

Confirm the DSM-5 diagnosis of Tourette syndrome and exclude secondary and functional tic-like movements when considering DBS for medication-resistant tics.

A mental health professional must screen patients preoperatively and follow patients postoperatively for psychiatric disorders that may impede the long-term success of the therapy.

Confirm that multiple classes of medication (antipsychotics, dopamine depleters, α2 agonists) and behavioral therapy have been administered (or are contraindicated) before prescribing DBS for tics.