Tourette Syndrome
Tics
Sudden repetitive sterotyped movements, simple or complex
Seen more in males, can wax and wane, suppressible, and premonitory urges
Natural History
Onset between 5-6, worse between 10-12 years of age, and most patients have spontaneous remission/improvement over time
1/3rds rule
1/3 resolve, 1/3 improve, 1/3 remain the same
Comorbidities
ADHD, OCD, Anxiety, Leraning disability, pervasive developmental disroders, ODD, Sleep problems
May be more significant than tics, treating may reduce anxiety/stress
Approach
Education (Explanation, nautral hsitory, dispell myths)
Medications
1st line: Alpha Agonists (Clonidine, Guanfancine, Behavioural Treatment)
2nd Line: Atypical antipsychotics, antipsychotics, botox
behavioural Treatment
Habit reversal training (Tic Awareness, competing response training)
Tic Awareness (Self-monitoring of tics, focus on premonitory urge)
Competing response treatment (Engage in voluntary behaviour incompatible with tic)