Tourette disorder is a neurodevelopmental condition with several motor tics and at least one vocal tic lasting more than a year, starting before age 18. Tics often peak in early adolescence and improve by adulthood for many people.
Key symptoms
- Motor tics such as blinking, grimacing or shoulder shrugs
- Vocal tics such as throat clearing, sniffing or words
- A premonitory urge before the tic and relief after
- Tics that wax and wane and worsen with stress
- Attention, obsessive or anxiety symptoms
What you find on exam
- Observe tics and note that they can be briefly suppressed
- Normal neurological exam otherwise
- Screen for ADHD, OCD, anxiety and depression
- Ask about school, social life and bullying
Tests
- Clinical diagnosis based on history and observation
- No routine labs or imaging
- Tic rating scales to track severity
Treatment basics
- Education and reassurance for the family and school
- Comprehensive behavioral intervention for tics (CBIT)
- Guanfacine or clonidine, especially with ADHD
- Aripiprazole for severe, impairing tics
- Treat ADHD and OCD when present
Red flags
- Self-injurious tics or tics causing injury
- Severe depression or suicidal thoughts
- Sudden onset of tics with new neurological signs
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.