Tics und Tourette-Störung für die Praxis

Abstract

Primary tic disorders, including Tourette syndrome (TS) are neuropsychiatric disorders characterized by childhood onset motor and/or vocal tics. Beyond the defining feature of repetitive tic movements or sounds, the large majority of affected individuals also fulfil diagnostic criteria for other psychiatric disorders, most commonly obsessive-compulsive disorder, attention deficit hyperactivity disorder AD(H)D, anxiety, and affective disorders. Primary tics should be distinguished from other hyperkinesias, as for example chorea or myoclonus, and also functional neurological disorders presenting with tic-like movements. Although the exact pathophysiology of tic disorders still remains elusive, studies on animal models, post-mortem findings and results from behavioral and neuroimaging investigations point towards specific alterations of the cortico-striato-thalamo-cortical loops. Behavioral interventions, particularly habit reversal therapy and exposure and response prevention are first line treatments. Pharmacological approaches include antipsychotic medication, botulinum toxin injections as well as cannabis-based therapies. In severe, treatment refractory cases, the application of deep brain stimulation can be considered.