Treatment options for tics in Tourette's syndrome 

Treatment
Pros
Cons

Psychological therapy

Behavioural therapy

Psychological treatment designed to teach children to be more in control of their tics

  • Proven to be effective in treating mild to moderate Tourette’s syndrome
  • May not be suitable for very young children or children with other behavioural problems

Medication

Alpha2-adrenergic agonists

Medication that reduces levels of norepinephrine in the brain

  • Reduces the frequency of both physical and phonic tics in most cases
  • Not suitable in pregnancy
  • Possible side effects include drowsiness, headaches, dizziness, fatigue, constipation, diarrhoea, dry mouth, sleeping difficulties (side effects are usually mild and improve with time)
Muscle relaxants

A type of medication that helps relax muscle tone

  • Useful in reducing both frequency and severity of physical tics
  • Daytime drowsiness is a common side effect, particularly at the start of a course. May, therefore, be unsuitable for people whose job involves driving or using tools and heavy machinery
  • Not suitable in pregnancy
  • Other possible side effects include constipation, diarrhoea, indigestion, nausea, vomiting, dry mouth, headache and changes in mental state, such as feeling confused
Dopamine antagonists

Medication that blocks the effects of dopamine on the brain. Dopamine is thought to be partially responsible for tic-like behaviour

  • Currently the most effective medication available for reducing tics
  • Causes a wider range of side effects compared with other medications
  • Possible side effects include weight gain, blurred vision, constipation, a dry mouth, drowsiness, shaking, trembling, muscle twitches, spasms, decreased sex drive

Surgery

Limbic leucotomy

A type of brain surgery where a small section of the brain is removed

  • May be effective in reducing tic frequency in people who fail to respond to behavioural treatments or medication, or are unable to tolerate the side effects of medication
  • May improve the symptoms of other behavioural conditions, particularly obsessive compulsive disorder (OCD)
  • Carries the risks associated with surgery, such as post-operative infection and excessive bleeding
  • Possible complications include lack of energy, memory loss and bowel incontinence
  • Limbic leucotomy has been used to treat a small number of people with Tourette's syndrome, and there is not yet sufficient evidence to justify its use as a standard treatment method for the syndrome
Deep brain stimulation (DBS)

Surgical procedure where electrodes are implanted in certain sections of the brain. The electrodes are stimulated using a ‘battery pack’ that is implanted elsewhere in the body. The stimulation appears to help regulate the workings of the brain

  • Initial research suggests that DBS may be helpful for people with a combination of Tourette’s syndrome, OCD and a history of self-harming behaviour
  • DBS is still very much at the experimental stage so access to treatment is limited
  • There is a lack of certainty about whether DBS is safe and effective in the long-term
  • DBS has been used to treat a small number of people with Tourette's syndrome, and there is not yet sufficient evidence to justify its use as a standard treatment method for the syndrome