The many examples of professional sports figures who have publicly acknowledged having tics underscores that this does not have to be impairing. An invaluable source of support for both patients and their families is the Tourette Syndrome Association, a self help group with both national and local chapters.

The goals of therapy are to eliminate tics and treat the conditions most commonly associated with them, like the inattention, hyperactivity, and impassivity in Attention Deficit/Hyperactivity Disorder and the obsessions and compulsions in Obsessive Compulsive Disorder.

There are a number of medications that can reduce and cure tourette’s syndrome and tics, if not get rid of them altogether. It turns out that many of the medications used to treat psychosis are also effective at suppressing tics, Haldol, Prolixin are the most commonly used.

Medication side effects, like sedation, muscle spasms, and feelings of restlessness are unfortunately also quite common, to some degree limiting their usefulness. It will be interesting to see whether the never atypical anti psychotic medications (Clozapine, Zyprexa) are helpful without the side effects. Clodine, a medication used to treat high blood pressure, and Klonopin, a medication used to treat anxiety and seizures, are less likely to cause side effects but are also often less effective.

A behavioral therapy technique called habit reversal training can be used as an alternative or supplement to medication. The person is taught to actively use an opposing muscle group to counteract the tic movement. For example, someone with a shoulder shrugging  tic can actively do the opposite, lower his shoulders, when he feels that the tic is about to happen.

Since tics often get worse when the person is in a stressful environment, interventions  that teach stress management can indirectly lower tic frequency. A structured and predictable environment with clear expectations both at home and at school is also helpful. Family therapy may address the strains on the family imposed by the illness.

Up to 60 percent of children with Tourette’s have symptoms of ADHD. Tics and the ADHD symptoms must each be addressed in treatment. One wrinkle is that the most commonly used treatment for ADHD, namely stimulants, often makes tics worse. For such children, behavioural approaches to ADHD may be preferred.

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A few reports of single cases that responded to various tourettes syndrome psychotherapy treatments can be found in the early literature on Tourette syndrome. In retrospect, these single case histories are likely to have coincided with the periodical waning of symptoms that is so characteristic of the disorder.

The presence of copralalia in the more severe and easily diagnosed cases led analytic therapists to theorize, often imaginatively, about the causes of TS, but nothing was accomplished in the way of long term relief of symptoms. Mild cases, especially those not exhibiting coprolalia, were simply characterized as “nervous” as is not infrequently the case today.

The common sense approaches of the time, usually various types of physical or psychological punishment, met with equal lack of success but were not recommended in the medical literature.

The discovery of haloperidol effect set the scene for a completely new and far more efficacious approach to the treatment of TS symptoms. Indirectly, by changing the attitude of the treating physicians from one of hopelessness to hopefulness, the advent of treatment with haloperidol also stimulated into the nature and pathogenesis of this perplexing disorder.

For a decade, haloperidol reigned supreme as the only treatment for TS, but this position was soon challenged by newer drugs with fewer side effects. Before considering the individual drugs available today, certain guidelines about the use of drugs in the treatment of Tourette’s syndrome should be considered.

First, a diagnosis of TS does not by any means imply that a patient should be treated with drugs. On the contrary, each case must be carefully evaluated. TS covers a broad spectrum of severity, from very mild forms with minor tics to full blown severe cases with violent involuntary movements, loud barking, coprolalia, and so on. Luckily, most cases diagnosed today fall within the milder range and severe cases of TS remain relatively rare.

Second, the effect of a given set of symptoms can vary enormously among patients. Certain symptoms in one individual may lead to major coping problems, whereas in another way may constitute a relatively minor inconvenience.

Third, many patients are particularly sensitive to the side effects of medications and prefer to endure their symptoms. This decision, however, is more wisely made after trials on medications than before. Before choosing to try medication, both the patient and the doctor should come to an understanding about which symptoms to target.

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