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Treatment of Non-motor Symptoms in Tourette Syndrome

  • Jorge L. JuncosEmail author
  • Jagan Chilakamarri
Chapter
Part of the Current Clinical Neurology book series (CCNEU)

Abstract

We present two cases that highlight the importance of non-motor symptoms in the management of tics in Tourette syndrome (TS). Attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) are frequent comorbidities in TS. Their presentation in TS can be significantly different from that in the general population. Failure to recognize these differences can lead to missed opportunities for effective management and to unnecessary suffering on the part of TS patients. In children, tic severity is influenced by developmental issues that may be more subtle in adults. In children and adults, tic severity is highly variable but heavily influenced by the above and other possible comorbidities of TS. These include anxiety, mood disorders, learning disabilities, and acquired maladaptive behaviors used to cope with the stress brought on by TS. Tics are also heavily influenced by external factors such as self esteem issues stemming from being repeatedly taunted by peers early on and by well-meant disciplinary strategies used by parents and teachers that may end up enabling tics over time (e.g., blaming everything on the tics, using tics to avoid expectations and responsibilities, and in school, placing unrealistic expectations and little support with tic control). We hope these cases and the suggested reading allow the reader to better recognize, prioritize, and orchestrate the various treatment paths to controlling tics in TS.

Keywords

Tourette Syndrome Tics Attention deficit hyperactivity disorder (ADHD) Obsessive-compulsive disorder (OCD) Generalized anxiety disorder (GAD) Premonitory urges “Cognitive urges” “Churning” Rage attacks Generalized anxiety disorder Selective serotonin reuptake inhibitors (SSRIs) Fluphenazine Stimulants Atypical antipsychotics Deep brain stimulation (DBS) 

Suggested Reading

  1. Allen AJ, Kurlan RM, Coffey BJ, et al. Atomoxetine treatment of children with ADHD and comorbid tic disorders. Neurology. 2005;65:1941–9.CrossRefGoogle Scholar
  2. Banaschewski T, Neale BM, Rothenberger A, Roessner V. Comorbidity of tic disorders and ADHD – conceptual and methodologic considerations. Eur Child Adolesc Psychiatry. 2007;16(Suppl 1):I/5–14.CrossRefGoogle Scholar
  3. Bloch MH, Peterson BS, Scahill L, et al. Adulthood outcome of tic and obsessive-compulsive symptom severity in children with Tourette syndrome. Arch Pediatr Adolesc Med. 2006;160:65–9.CrossRefGoogle Scholar
  4. Budman CL, Rockmore L, Stokes J, Sossing M. Clinical phenomenology of episodic rage in children with Tourette syndrome. J Psychosom Res. 2003;55:59–65.CrossRefGoogle Scholar
  5. Carter AS, Pauls DL, Leckman JF, Cohen DJ. A prospective longitudinal study of Gilles de la Tourette’s syndrome. J Am Acad Child Adolesc Psychiatry. 1996;33:377–85.CrossRefGoogle Scholar
  6. Cath DC, Spinhoven P, Hoogduind CAL, Landman AD, CAM van Woerkom T, van de Wetering BJM, Ross RAC, Rooijmans HGM. Repetitive behaviors in Tourette’s syndrome and OCD with and without tics: what are the differences? Psychiatry Res. 2001;101:171–85.CrossRefGoogle Scholar
  7. Diniz JB, Rosario-Campos MC, Hounie AG, Curi M, Shavitt RG, Lopes AC, Miguel EC. Chronic tics and Tourette syndrome in patients with obsessive–compulsive disorder. J Psychiatr Res. 2006;40:487–93.CrossRefGoogle Scholar
  8. Hoekstra PJ, Steenhuis MP, Troost PW, Korf J, Kallenberg CG. Relative contribution of attention-deficit hyperactivity disorder, obsessive-compulsive disorder, and tic severity to social and behavioral problems in tic disorders. J Dev Behav Pediatr. 2004;25(4):272–9.CrossRefGoogle Scholar
  9. Kano Y, Kono T, Shishikura K, Konno C, Kuwabara H, Ohta M, do Rosario MC. Obsessive compulsive Symptom dimensions in Japanese Tourette Syndrome subjects. CNS Spectr. 2010;15(5):296–303.CrossRefGoogle Scholar
  10. Kirov R, Banaschewski T, Uebel H, et al. REM-sleep alterations in children with tic disorder and ADHD comorbidity – impact of hypermotor symptoms. Eur Child Adolesc Psychiatry. 2007;16(Suppl 1):I/45–50.CrossRefGoogle Scholar
  11. Leckman JF, Bloch MH, King RA. Symptom dimensions and subtypes of obsessive-compulsive disorders: a developmental perspective. Dialogues Clin Neurosci. 2009;11(1):21–33.PubMedPubMedCentralGoogle Scholar
  12. Lee JC, Prado HS, Diniz JB, et al. Perfectionism and sensory phenomena: phenotypic components of obsessive-compulsive disorders. Compr Psychiatry. 2009;50(5):431–6.CrossRefGoogle Scholar
  13. Martino D, Lechkman JF. Tourette Syndrome eds. Oxford/New York: Oxford University Press; 2013.Google Scholar
  14. McDougle CJ, Goodman WK, Leckman FF, et al. Haloperidol addition in fluvoxamine-refractory obsessive-compulsive disorder: a double-blind, placebo-controlled in patients with and without tics. Arch Gen Psychiatry. 1994;51:303–8.Google Scholar
  15. Stephens RJ, Sandor P. Aggressive behavior in children with Tourette syndrome and comorbid attention-deficit hyperactivity disorder and obsessive-compulsive disorder. Can J Psychiatry. 1999;44:1036–42.CrossRefGoogle Scholar
  16. Sukhodolsky DG, Scahill L, Shan H, et al. Disruptive behavior in children with Tourette’s syndrome: association with ADHD comorbidity, tic severity and functional impairment. J Am Acad Child Adolesc Psychiatry. 2003;412:98–105.CrossRefGoogle Scholar
  17. Wong SS, Wilens TE. Medical cannabinoids in children and adolescents: a systematic review. Pediatrics. 3027;240(5):1–17.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Emory University School of Medicine, Department of Neurology and Movement Disorders ProgramAtlantaUSA
  2. 2.Atlanta Psychiatric InstituteAtlantaUSA

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