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Tourette's syndrome

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).


1.Diagnostic investigations

Evaluation of functional impairment: evaluate functional impairment related to tics from the perspective of the patient and, if applicable, the caregiver.
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2.Medical management

Alpha-adrenergic agonists: prescribe alpha-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

3.Nonpharmacologic interventions

Comprehensive behavioral intervention for tics: 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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4.Therapeutic procedures

Botulinum toxin injections: 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

5.Specific circumstances

Assessment and management of co-occurring mental health conditions: assess for comorbid ADHD in patients with tics.
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6.Patient education

Patient and caregiver education
Inform patients and their caregivers about the natural history of tic disorders.
Counsel patients that treatments for tics infrequently result in complete cessation of tics.

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  • Psychoeducation for teachers and peers

7.Follow-up and surveillance

Watchful waiting: 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