The Best Medications for Tourette’s Syndrome (Tics)

Chronic tic disorders, including Tourette syndrome, affect some 1.4 million Americans. The Centers for Disease Control and Prevention (CDC) estimates that Tourette disorder is present in 0.3% of children in the 3-17 age group, or nearly 175,000 children in the US. However, this chronic tic disorder is frequently undiagnosed, and the actual occurrence may be closer to 0.6% of children.

Tics are sudden twitches or unwanted, repetitive movements or sounds that are 100% involuntary, meaning that someone with tics cannot stop their body from performing these actions. Tics are not harmful, except for severe forms of tics, which can cause stress and interfere with work or school, leading to a less-than-ideal quality of life. Certain tics can even result in pain and serious injury.

Different types of tic disorders are distinguished by the type of tic: motor tics (movement), vocal tics (sound), or the combination of motor and vocal, along with the amount of time since the first episode of tics distinguishes one case from another. Tourette’s syndrome (TS) can be categorized as one type of chronic tic disorder. The criteria for TS are described in the next section.

Tics typically improve and sometimes even disappear on their own during adolescence and early adulthood. Many children with mild disease presentation can function well without any type of treatment. However, children with more severe tics, complex tics, or frequent tic symptoms, including Tourette’s syndrome, may require treatment, which includes behavioral therapy, medication, or a combination of both.

Please continue reading to learn about some medications used to reduce tics in patients with severe tics disorder, including Tourette’s syndrome.

What is Tourette’s syndrome?

Tourette syndrome (TS) is a movement disorder affecting many school-aged children. Tics symptoms typically appear between the age of 2 and 5, and the risk of developing tics is about 3-4 times higher in males than females. A patient would meet the criteria for TS if:

He or she experiences both motor and vocal tics for at least a year.
Symptoms of tics begin before the age of 18.
Tics are not the side effects of medications or the symptoms and results of other health conditions such as seizures, brain inflammation due to a viral infection, or Huntington's disease.

Examples of simple motor tics include quick eye blinks, eye jerks, tongue movement (sticking out the tongue), head jerks, shoulder shrugs, hopping, and squatting. Complex motor tics may include more than one motor tic, muscle group, or body part; some examples of complex motor tics are touching people and things, obscene gesturing or gyrating movements, and facial grimacing. Head banging and lip biting are examples of complex motor tics that can be harmful.

Vocal tics associated with Tourette’s syndrome can include grunting, throat clearing, coughing, hissing, snorting, and barking. Complex vocal tics may include repeating one's own words, repeating other people’s words, explosive outbursts, or using obscene or offensive words.

What causes Tourette’s syndrome?

Genes play a crucial role in TS. The exact cause of TS is unknown; recent studies have identified some structural changes in 2 genes that increase the risk of TS. Genetic studies have shown that TS is inherited as a dominant gene, and there is about a 50% chance that parents with this condition will pass it on to their children. In addition to the genetic factor, brain chemicals also play a role here; abnormal breakdown of dopamine can also trigger TS.

TS is a complex disorder likely to be multifactorial, resulting from the interaction between different genes and environmental factors. There are ongoing studies about the role of environmental factors and TS, though more research is necessary to gain a deeper understanding of the environmental risk factors listed below:

Smoking during pregnancy
Pregnancy complications
Low birth weight
Certain infections

Tourette disorder tics usually appear between 2 and 15 years (the average age at the time of Tourette syndrome diagnosis is 6 years). Males have a 3-4 times higher risk of developing Tourette syndrome than females.

Children with Tourette syndrome frequently have other neurological conditions such as attention deficit hyperactivity disorder (ADHD), learning disabilities, autism spectrum disorder, obsessive-compulsive disorder (OCD), sleep disorders, anxiety, depression, anger management issues, tics-related pain, especially headaches.

Some studies have found that children with TS or other chronic tic disorders have lower self-esteem and decreased quality of life compared to those that don’t have these medical conditions. The study’s result and conclusion are not surprising considering the physical disruption and emotional burden these patients endure. Self-esteem and self-image problems sometimes lead to an increased risk of substance abuse along with other complications.

Does medication help with Tourette syndrome?

While there is no cure for Tourette syndrome, medical treatment and behavioral therapy can help patients with TS. Many people with this condition don’t need any treatment for tics if the symptoms are not severe. Also, the tics tend to become controlled and less bothersome after the teenage years.

Tourette’s syndrome can lead to social challenges in everyday life and cause self-esteem issues in affected individuals. Therefore, appropriate care coordination is essential for TS patients to improve their quality of life and prevent future complications.

Some of the medications used for controlling tics are listed below:

Antipsychotics

These medications are effective in treating tics and TS due to their ability to modify the dopamine levels in the brain. Examples include atypical antipsychotics (second-generation antipsychotics) such as pimozide (Orap), risperidone (Risperdal), and fluphenazine. Unfortunately, antipsychotics can cause several adverse effects, including weight gain, movement disorder, and diabetes.

Tetrabenazine (Xenazine), formerly used as an antipsychotic, has been found to be effective in treating tics. Common adverse effects caused by this medicine are drowsiness, fatigue, severe depression, and insomnia. But overall, tetrabenazine is well-tolerated, and another advantage is that it doesn’t cause weight gain like other agents.

Haloperidol (Haldol) is a first-generation antipsychotic that is very effective in treating tics. However, haloperidol is not the preferred treatment for tics or TS due to its severe effects on cognitive function.

ADHD Medications

Other drugs used to treat co-occurring conditions can help in treating tics. For example, methylphenidate (Ritalin LA, Metadate CD, others) and dextroamphetamine (Dexedrine, Adderall XR, others), which are prescribed for ADHD symptoms, may help with tic reduction. However, ADHD medications can make tics worse in some individuals with Tourette syndrome.

Selective Serotonin Reuptake Inhibitors

SSRI antidepressants such as fluoxetine (Prozac, Sarafem, others) are used to treat OCD (obsessive-compulsive disorder) and anxiety. These medicines may help to control tics in some people with Tourette syndrome.

Alpha-2-Adrenergic Agonists

Medications called alpha-2-adrenergic agonists, typically used to treat high blood pressure, can also help control impulses and anger attacks. These medicines can be useful in treating tics in individuals with Tourette syndrome. Examples include clonidine (Catapres, Kapvay) and guanfacine (Intuniv, Tenex). Possible side effects of these medications include sleepiness.

Anti-Seizure Medications

Studies have shown that an epilepsy medication, topiramate (Topamax), may help reduce tics in some people with Tourette syndrome.

Botulinum Toxin Injections

An injection of botulinum toxin (Botox®) into the affected muscle can temporarily improve vocal or simple tics.

Behavioral Techniques

Cognitive behavioral therapy (CBT), habit-reversal therapy, and parent training can be used in addition to medications in children with Tourette syndrome.

CBT can help to identify tic urges. Habit reversal training can help a child learn voluntary movements that prevent or reduce tics.

Besides the treatment of Tourette syndrome, behavior therapy and behavioral techniques can also help with related disorders such as obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), anxiety, and depression.

Deep Brain Stimulation (DBS)

Deep brain stimulation (DBS) may be recommended by pediatric neurology for severe tics with no treatment response to medications and psychotherapy after more than a year. This involves implanting a DBS device in the brain, which electrically stimulates specific areas that control movement. This is an experimental treatment at present. More research is needed to determine the beneficial effect versus potential risks of DBS for Tourette syndrome.

What is the first line of treatment for Tourette's disorder?

Alpha-2-adrenergic agonists like clonidine (Catapres, Kapvay) and guanfacine (Tenex, Intuniv) are usually the first lines of medication treatment for chronic tic disorders like Tourette syndrome. These medications work well when Tourette's symptoms are mild, but they may not effectively control multiple tics or complex tic symptoms. Clonidine is also helpful for children with TS and ADHD since it improves insomnia, anxiety, and hyperactivity.

What is the best medication to treat tics?

A Dopamine receptor blocking drug such as typical and atypical antipsychotics are the most effective pharmacological agents used to treat TS and severe tics. Examples include haloperidol (Haldol), pimozide (Orap), risperidone (Risperdal), and fluphenazine.

Which treatment is new for Tourette's disorder?

A relatively new atypical antipsychotic called aripiprazole (Abilify) has shown promise in the treatment of tics and repetitive behaviors in people with Tourette syndrome. However, a placebo-controlled study or a double-blinded study against other antipsychotics is needed to evaluate the safety and efficacy of this medication for tic disorders.

In addition to medical treatments, a new treatment called median nerve stimulation (MNS) has been found to significantly reduce tics in people with Tourette syndrome (TS). This treatment involves administering repetitive nerve stimulation to the median nerve at the wrist. The median nerve stimulation promotes rhythmic brain activity and suppresses repetitive movements. Median nerve stimulation has shown promise in reducing the urge to tic along with tic frequency and intensity in people with Tourette syndrome. Early results are especially good in people with severe tics. The researchers say their goal is to develop a watch-like MNS stimulator device, similar to an Apple Watch or Fitbit so that people with Tourette syndrome can wear it to control their tics.

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