New AAN guideline for treating Tourette syndrome

For people with Tourette syndrome and other chronic tic disorders, effective treatments are available that may help improve symptoms, according to a new AAN guideline [1]. The guideline is endorsed by the Child Neurology Society and the EAN.

The authors emphasised that treatment should be individualised, and be a collaborative decision of the patient, caregiver, and clinician. Treatment options include watchful waiting, the Comprehensive Behavioral Intervention for Tics (CBIT), and medication. Recommendations on how to offer and monitor these therapies have been provided. “It is important that doctors let patients know that tics may improve with time,” said guideline lead author Dr Tamara Pringsheim (University of Calgary, Canada). “Treatments can help decrease tic frequency and severity, but they rarely eliminate all tics.”

Some of the recommendations include:

• Clinicians should inform patients and caregivers that watchful waiting is an acceptable approach in people who do not experience functional impairment from their tics.
• Clinicians may prescribe CBIT as an initial treatment option relative to watchful waiting, for people with tics who do not experience functional impairment, if they are motivated to attempt treatment. CBIT combines relaxation training, habit-reversal training, and behavioural therapy to help reduce tic symptoms.
• In patients with tics, clinicians should assess for comorbid attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, mood, and disruptive behaviour disorders.
• Clinicians should direct patients with Tourette syndrome who self-medicate with cannabis to medical supervision where they can be monitored for efficacy and adverse events. Depending on local laws, clinicians may consider treatment with cannabis in treatment-resistant patients.
• Deep brain stimulation (DBS) may be considered in adults with severe Tourette syndrome who are resistant to medical and behavioural therapy.

1. Pringsheim T, et al. Neurology. 2019;92(19):896-906.



Posted on 30 July 20196 September 2023