Typically regarded as a rare entity of interest only because of its peculiar manifestations, Tourette's syndrome has been recognized more recently as a relatively common disorder with effects that can be disabling and that are amenable to treatment with a number of routinely prescribed psychiatric medications. Jankovic summarizes recent advances in our understanding of the pathogenesis of Tourette's syndrome and addresses the recognition of this disorder in clinical practice, as well as symptom-specific treatment.
Most physicians have heard of the (occasionally obscene) speech tics that can occur with Tourette's syndrome, but many other tics are more common. Rapid motor movements such as blinking, nose twitching, and jerking motions of the head or limbs are more typical motor tics. More complex motor movements, such as hair brushing, truncal twisting, and throwing motions, also occur.
Tics can be involuntary or semi-voluntary. Many patients report a compulsive aspect to the tic. They fear some indescribable adverse outcome if they do not perform the ritual movement. The author notes that obsessive-compulsive disorder is not the only psychiatric disorder that overlaps with Tourette's syndrome. Attention-deficit disorder and other behavioral problems, especially those manifested by poor impulse control, are part of the disease spectrum in patients with Tourette's syndrome.
The syndrome affects males more often than females, and the onset of tics usually occurs in childhood. Patients may have different tics over time and can, in some cases, suppress their tics as they reach adulthood.
Treatment first requires appropriate recognition. Tics are the most obvious target for treatment, and dopamine-receptor blockers such as haloperidol and pimozide are the most studied agents. Early intervention in childhood for attention-deficit disorder and other behavioral problems may help to decrease the social sequelae of the syndrome. The stimulant medications often used for attention-deficit problems may initially exacerbate the frequency or severity of tics. Obsessive-compulsive features typically show up later in the course of the disorder and are treated with selective serotonin-reuptake inhibitors, such as fluoxetine or clomipramine.