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Tourette's syndrome

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of Tourette's syndrome are prepared by our editorial team based on guidelines from the American Academy of Neurology (AAN 2019). ...
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Diagnostic investigations

Evaluation of functional impairment: as per AAN 2019 guidelines, evaluate functional impairment related to tics from the perspective of the patient and, if applicable, the caregiver.
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Medical management

Alpha-adrenergic agonists: as per AAN 2019 guidelines, prescribe α-2 adrenergic agonists for the treatment of patients with tics when the benefits of treatment outweigh the risks.
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  • Antipsychotics

  • Topiramate

  • Cannabis-based medications

Nonpharmacologic interventions

Comprehensive behavioral intervention for tics: as per AAN 2019 guidelines, consider comprehensive behavioral intervention for tics as an initial treatment option relative to watchful waiting for patients with tics who do not experience functional impairment if they are motivated to attempt treatment.
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Therapeutic procedures

Botulinum toxin injections: as per AAN 2019 guidelines, consider prescribing botulinum toxin injections for the treatment of adolescent and adult patients with localized and bothersome simple motor tics when the benefits of treatment outweigh the risks.
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  • Deep brain stimulation

Specific circumstances

Assessment and management of co-occurring mental health conditions: as per AAN 2019 guidelines, assess for comorbid ADHD in patients with tics.
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Patient education

Patient and caregiver education
As per AAN 2019 guidelines:
Inform patients and their caregivers about the natural history of tic disorders.
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Counsel patients that treatments for tics infrequently result in complete cessation of tics.
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  • Psychoeducation for teachers and peers

Follow-up and surveillance

Watchful waiting: as per AAN 2019 guidelines, inform patients and caregivers that watchful waiting is an acceptable approach in people who do not experience functional impairment from their tics.
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  • Follow-up