Guidelines for treating tics in people with Tourette syndrome were published in May 2019 by the American Academy of Neurology.[1]

Assessing Comorbid Disorders

Assess for comorbid ADHD in people with tics, evaluate the burden of ADHD symptoms, and ensure appropriate ADHD treatment is provided.

Assess for comorbid OCD in people with tics and ensure appropriate OCD treatment is provided.

Ensure appropriate screening for anxiety, mood, and disruptive behavior disorders is performed in people with tics.

Ask the patient about suicidal thoughts and attempts and refer to appropriate resources.

Alpha-Agonist Treatment

If treating patients with tics with alpha2-adrenergic agonists, heart rate and blood pressure must be monitored.

If prescribing guanfacine extended release, the QTc interval must be monitored in patients with a history of cardiac conditions, in patients taking other QT-prolonging agents, and in patients with a family history of long QT syndrome.

Gradually taper alpha2-adrenergic agonists to avoid rebound hypertension.

Antipsychotic Treatment

Counsel patients on the relative propensity of antipsychotics for extrapyramidal, hormonal, and metabolic adverse effects.

When prescribing antipsychotics for tics, prescribe the lowest effective dose to decrease the risk of adverse effects.

If prescribing antipsychotics, perform electrocardiography and measure the QTc interval before and after starting pimozide or ziprasidone or if antipsychotics are coadministered with other drugs that can prolong the QT interval.

Deep Brain Stimulation

Confirm the DSM-5 diagnosis of Tourette syndrome and exclude secondary and functional tic-like movements when considering DBS for medication-resistant tics.

A mental health professional must screen patients preoperatively and follow patients postoperatively for psychiatric disorders that may impede the long-term success of the therapy.

Confirm that multiple classes of medication (antipsychotics, dopamine depleters, alpha2-agonists) and behavioral therapy have been administered (or are contraindicated) before prescribing DBS for tics.

For more Clinical Practice Guidelines, go to Guidelines.

For more information on Tourette syndrome, go to Tourette Syndrome and Other Tic Disorders.