Because tic symptoms do not often cause impairment, the majority of people with Tourette syndrome require no medication for tic suppression. However, effective medications are available for those whose symptoms interfere with functioning. Neuroleptics are the most consistently useful medications for tic suppression; a number are available but some are more effective than others (for example, haloperidol and
pimozide).
Unfortunately, there is no one medication that is helpful to all people with Tourette syndrome, nor does any medication completely eliminate symptoms. In addition, all medications have side effects. Most neuroleptic side effects can be managed by initiating treatment slowly and reducing the dose when side effects occur. The most common side effects of neuroleptics include sedation, weight gain, and
cognitive dulling. Neurological side effects such as tremor, dystonic
reactions (twisting movements or postures), parkinsonian-like symptoms, and
other dyskinetic (involuntary) movements are less common and are readily managed
with dose reduction.
Discontinuing neuroleptics after long-term use must be done
slowly to avoid rebound increases in tics and withdrawal dyskinesias. One form of withdrawal dyskinesia called tardive
dyskinesia is a movement disorder distinct from Tourette syndrome that may result from the chronic use of neuroleptics. The risk of this side effect can be reduced by using lower doses of neuroleptics for shorter periods of time.
Other medications may also be useful for reducing tic severity, but most have not been as extensively studied or shown to be as consistently useful as neuroleptics. Additional medications with demonstrated efficacy include alpha-adrenergic agonists such as clonidine and
guanfacine. These medications are used primarily for
hypertension but are also used in the treatment of tics. The most common side effect from these medications that precludes their use is sedation.
Effective medications are also available to treat some of the associated neurobehavioral disorders that can occur in patients with Tourette syndrome. Recent research shows that stimulant medications such as methylphenidate and
dextroamphetamine can lessen
ADHD symptoms in people with Tourette syndrome without causing tics to become more severe. However, the product labeling for stimulants currently contraindicates the use of these drugs in children with tics/Tourette syndrome and those with a family history of
tics. Scientists hope that future studies will include a thorough discussion of
the risks and benefits of stimulants in those with Tourette syndrome or a family history of Tourette syndrome
and will clarify this issue. For obsessive-compulsive symptoms that
significantly disrupt daily functioning, the serotonin reuptake inhibitors (clomipramine, fluoxetine, fluvoxamine, paroxetine, and sertraline) have been proven effective in some patients.
Psychotherapy may also
be helpful. Although psychological problems do not cause Tourette syndrome, such problems may
result from Tourette syndrome. Psychotherapy can help the person with Tourette syndrome better cope with the
disorder and deal with the secondary social and emotional problems that
sometimes occur. More recently, specific behavioral treatments that include
awareness training and competing response training, such as voluntarily moving
in response to a premonitory urge, have shown effectiveness in small controlled
trials. Larger and more definitive NIH-funded studies are underway.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Panic attacks are sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. A person experiencing a panic attack may believe that he or she is having a heart attack or that death is imminent. The fear and terror that a person experiences during a panic attack are not in proportion to the true situation and may be unrelated to what is happening around them. Most people with panic attacks experience several of the following symptoms: racing heartbeat, faintness, dizzyness, numbness or tingling in the hands and fingers, chills, chest pains, difficulty breathing, and a feeling of loss or control. There are several treatments for panic attacks.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Obsessive compulsive disorder (OCD) is an anxiety disorder that causes a person to suffer repeated obsessions and compulsions. Symptoms include irresistible impulses despite a person's realization that the thoughts are irrational, excessive hand washing, skin picking, lock checking, or repeatedly rearranging items. People with OCD are more likely to develop trichotillomania, muscle or vocal tics, or an eating disorder. Treatment for OCD includes psychotherapy, behavioral therapy, and medication.
Genetic disease is a disorder or condition caused by abnormalities in a person's genome. Types of genetic inheritance include single inheritance (for example, cystic fibrosis, sickle cell anemia, Marfan syndrome, and hemochromatosis), multifactoral inheritance, chromosome abnormalities (for example, Turner syndrome, and Klinefelter syndrome), and mitochondrial inheritance (for example, epilepsy and dementia).
Asperger syndrome (AS, Asperger's syndrome) is an autism spectrum disorder. Asperger syndrome is characterized by a degree of impairment in language and communication skills, and repetitive or restrictive thoughts or behaviors. The most common symptom of Asperger syndrome is the obsessive interest in a single object or topic. Other conditions that may co-exist with Asperger syndrome include: ADHD, tic disorders, depression, anxiety disorders, and OCD. Diagnosis of Asperger syndrome is complicated, and treatment is generally directed toward minimizing the symptoms of the syndrome and behavioral and educational interventions.
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