Treatment of non-motor symptoms in tourette syndrome

Abstract

We present two cases that highlight the importance of non-motor symptoms in the management of tics in Tourette syndrome (TS). Attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) are frequent comorbidities in TS. Their presentation in TS can be significantly different from that in the general population. Failure to recognize these differences can lead to missed opportunities for effective management and to unnecessary suffering on the part of TS patients. In children, tic severity is influenced by developmental issues that may be more subtle in adults. In children and adults, tic severity is highly variable but heavily influenced by the above and other possible comorbidities of TS. These include anxiety, mood disorders, learning disabilities, and acquired maladaptive behaviors used to cope with the stress brought on by TS. Tics are also heavily influenced by external factors such as self esteem issues stemming from being repeatedly taunted by peers early on and by well-meant disciplinary strategies used by parents and teachers that may end up enabling tics over time (e.g., blaming everything on the tics, using tics to avoid expectations and responsibilities, and in school, placing unrealistic expectations and little support with tic control). We hope these cases and the suggested reading allow the reader to better recognize, prioritize, and orchestrate the various treatment paths to controlling tics in TS.