Clinical diagnosis and management of Tourette syndrome

Tics are major clinical symptoms of Tourette syndrome which has high comorbidity with attention deficit-hyperactivity disorder, obsessive compulsive disorder, learning disability, self injury behavior, or other psychobehavior problems. Its prevalence could be as high as 1/200. Tourette syndrome is no more a rare or degenerative disorder; it's a model of neuropsychiatric disorder in children. Although the pathogenesis of Tourette syndrome is still uncertain, the high incidence of familial cases up to 10 to 30% suggests a possibility of genetic origin. Pharmacological, electrophysiological, and neuroimaging evidences all implicate the hyper-responsiveness of dopamine influencing the cortical- striatal-thalamo-cortical circuits of patients with Tourette syndrome. Facing patients with tics, first of all we must exclude the possibilities of Tourettism with secondary etiologies. Ninety percent of patients with primary tics occur transiently and spontaneously subside within one year. Those patients with tics persisting longer than a year will be chronic tic disorder or Tourette syndrome depending on how many types of motor and/or vocal tics they have ever had. Tics are mild in 70 to 80% of patients with Tourette syndrome. For them, understanding and acceptance from family, teachers, and friends are most important. When tics are so severe that medication is necessary, haloperidol is no longer the first or only choice. Clonidine or atypical neuroleptics such as risperidone should be used first for their minor side effects. Many other medicines are still in trial. It is hoped that the readers can understand this common disease and help the patients cope with the symptoms from Tourette syndrome.