Primary tic disorders are complex, multifactorial disorders in which tics are accompanied by other sensory features and an array of comorbid behavioral disorders. Secondary tics are proportionally much less frequent, but their etiology is diverse. This review aims to guide clinicians in the recognition of the phenomenology, pathophysiology, and treatment of these disorders.
Advances include greater phenomenologic insights, particularly of nonmotor (sensory) features; increased knowledge of disease mechanisms, particularly coming from neuropsychological, functional imaging, pathologic, and animal model studies; growing evidence on the efficacy of alpha-2 agonists and the newer generation of dopamine-modulating agents; and recent strides in the evaluation of cognitive-behavioral therapy and deep brain stimulation surgery.
The correct diagnostic approach to tic disorders requires accurate historical gathering, a thorough neurologic examination, and detailed definition of the patient’s psychopathologic profile. Treatment should always begin with individualized psychoeducational strategies. Although pharmacologic treatments remain beneficial for most patients, cognitive-behavioral treatments have thus far shown promising efficacy. Deep brain stimulation surgery should still be limited to adult patients refractory to pharmacotherapy and cognitive-behavioral therapy.
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Address correspondence to Dr Davide Martino, King’s College Hospital, Department of Neurology, 9th Floor, Ruskin Wing, Denmark Hill, London SE5 9RS, firstname.lastname@example.org.
Relationship Disclosure: Dr Martino reports no disclosure. Dr Mink serves on the data and safety monitoring board of Edison Pharmaceuticals, Inc, serves as a consultant to Medtronic, Inc and as an associate editor of Neurology, and performs occasional legal record review.
Unlabeled Use of Products/Investigational Use Disclosure: Drs Martino and Mink discuss the unlabeled use of multiple therapies for the treatment of Tourette syndrome. In the United States, only pimozide and haloperidol are labeled for the treatment of Tourette syndrome.
Supplemental digital content: Videos accompanying this article are cited in the text as Supplemental Digital Content. Videos may be accessed by clicking on links provided in the HTML, PDF, and iPad versions of this article; the URLs are provided in the print version. Video legends begin on page 1308.