ConditionBrain & nerves
Tourette Syndrome
Tourette syndrome is a neurological condition that causes tics: sudden, repeated, involuntary movements and sounds. It is diagnosed when a person has had both multiple motor tics and at least one vocal tic for more than a year, starting before age 18, usually between ages 5 and 7. Tics tend to peak in early adolescence and often improve by adulthood. Most people also have ADHD, OCD or anxiety. Behavioral therapy (CBIT) is first-line treatment; medicines help when tics are severe.
Also called: Tourette's, Tourette's disorder, Gilles de la Tourette syndrome, TS
At a glance
- What it is
- A tic disorder with multiple motor tics and at least one vocal tic for over a year, starting before 18.
- How common
- About 1 in 160 school-age children in the US, possibly more; boys 3 to 4 times more often.
- Typical course
- Starts at 5 to 7, peaks around 10 to 12, often improves in late teens and adulthood.
- Common co-conditions
- ADHD, OCD, anxiety, learning difficulties, sleep problems.
- Treatment
- Education, behavioral therapy (CBIT), treating ADHD and OCD; medicines such as alpha-2 agonists or antipsychotics for disruptive tics.
When to get help
Call 911 or go to the ER
- Thoughts of self-harm or suicide: call or text 988 (US), or call 911
- Self-injurious tics causing serious injury, such as hitting the eye or neck
See a doctor within a day or two
- Sudden, dramatic onset of tics with OCD symptoms, anxiety, food refusal or behavioral changes, especially after a strep infection
- New uncontrollable movements together with weakness, confusion, fever or seizure-like episodes
Book a routine appointment
- Tics lasting more than a few weeks, or causing pain, embarrassment, bullying or school problems
- Tics with attention problems, obsessive thoughts or compulsions
- New tics starting in adulthood
- Tics that change suddenly or interfere with daily life
Usually safe to manage at home
- Mild simple tics such as blinking or sniffing in a child, not bothering them, that come and go over weeks
What tics are
Tics are sudden, rapid, repetitive movements or sounds. They are not done on purpose, but many people feel a building urge (a premonitory urge) beforehand, like an itch, and feel relief after the tic. Many can suppress tics briefly, but this is tiring and the tics often return more strongly later.
| Simple | Complex | |
|---|---|---|
| Motor tics | Eye blinking, nose twitching, shoulder shrugging, head jerking, facial grimacing | Jumping, touching, twirling, copying others' movements (echopraxia), obscene gestures (copropraxia) |
| Vocal (phonic) tics | Sniffing, throat clearing, grunting, coughing, squeaking | Words or phrases, repeating others' words (echolalia), repeating own words (palilalia), obscene words (coprolalia) |
Despite its media image, coprolalia (swearing tics) affects only about 1 in 10 people with Tourette syndrome.
Diagnosis
There is no blood test or scan for Tourette syndrome. Diagnosis is based on history and observation. DSM-5-TR criteria:
- both multiple motor tics and at least one vocal tic have been present at some time, not necessarily at the same time
- tics have persisted for more than 1 year since the first tic
- onset before age 18
- not caused by a substance or another medical condition
Related tic disorders:
- Provisional (transient) tic disorder: tics for less than 1 year, very common in children
- Persistent motor or vocal tic disorder: only one type of tic for over a year
Tests may be done to rule out other causes, such as seizures or Sydenham's chorea after strep infection.
Causes
Tourette syndrome involves differences in brain circuits linking the basal ganglia and frontal cortex, and in neurotransmitters such as dopamine. It is strongly genetic, often running in families, though no single gene causes it. Pregnancy and birth factors, such as smoking in pregnancy and low birth weight, may play a role. It is not caused by parenting or emotional problems.
Tic triggers
Tics typically wax and wane. They can worsen with:
- stress, anxiety or excitement
- tiredness
- illness
- being asked about tics or focusing on them
They often lessen during focused, absorbing activities such as sports, music or video games, and during sleep.
Co-occurring conditions
Most people with Tourette syndrome have at least one other condition, which often affects life more than the tics:
- ADHD: about half or more
- OCD and obsessive-compulsive behaviors
- anxiety and depression
- learning disabilities
- autism
- sleep problems
- anger and rage attacks
Treatment
Many people with mild tics need no treatment beyond education and support.
Education and support
Understanding that tics are involuntary helps families, teachers and classmates respond calmly. Avoid telling a person to stop ticcing. School accommodations, such as breaks, a quiet testing space or extra time, can help.
Behavioral therapy
Comprehensive Behavioral Intervention for Tics (CBIT) is recommended as first-line treatment. It includes:
- habit reversal training: noticing the premonitory urge and doing a competing response that makes the tic physically harder
- identifying and adjusting situations that worsen tics
- relaxation techniques
CBIT reduces tic severity in many children and adults.
Medicines
When tics cause pain, injury, social problems or significant distress:
- alpha-2 agonists (guanfacine, clonidine), also helpful for ADHD
- topiramate
- antipsychotics (aripiprazole, risperidone, haloperidol, pimozide) for more severe tics; side effects need monitoring
- VMAT2 inhibitors are being studied
- botulinum toxin injections for specific bothersome motor tics
ADHD and OCD are treated alongside, with stimulants generally considered safe for most people with tics.
Deep brain stimulation
For a small number of adults with severe, treatment-resistant tics, deep brain stimulation is an option at specialist centers.
Outlook
Tourette syndrome does not affect intelligence or life expectancy. Tics often peak around ages 10 to 12 and improve in late adolescence; many adults have mild or no tics. Co-occurring conditions may persist and need ongoing support.
Frequently asked questions
What are the first signs of Tourette syndrome?
The first signs are usually simple motor tics such as eye blinking, facial grimacing or head jerking, often starting between ages 5 and 7. Vocal tics such as sniffing, throat clearing or grunting usually appear later.
Does everyone with Tourette syndrome swear?
No. Coprolalia, involuntary swearing or socially inappropriate words, affects only about 1 in 10 people with Tourette syndrome. Most have tics such as blinking, shrugging, sniffing or throat clearing.
Can Tourette syndrome go away?
Tics often improve significantly in late adolescence and early adulthood, and many adults have only mild tics or none. For others, tics continue but can be managed with behavioral therapy and medicines.
Can people control their tics?
Many people can suppress tics briefly, but it takes effort and the urge builds until the tic is released. Behavioral therapy such as CBIT teaches strategies that reduce tics over time.
Sources
This guide was written from current patient and clinical guidance, including:
- CDC: About Tourette Syndrome
- National Institute of Neurological Disorders and Stroke: Tourette Syndrome
- American Academy of Neurology: Practice guideline: Treatment of tics in people with Tourette syndrome and chronic tic disorders (2019)
- Tourette Association of America: What is Tourette
- American Psychiatric Association: DSM-5-TR criteria for Tourette's disorder