Tourette’s syndrome

Synonyms:

Gilles de la Tourette’s syndrome

Diagnosis:

Clinical criteria:

  • Onset < 21 y.o.
  • Lasts >1 year.
  • Multiple motor tics. At least 1 vocal tick. Fluctuating course.
  • Corprolalia is not necessary for diagnosis
  • Consider associated:
    • Attention deficit hyperactivity disorder ADHD
    • Obsessive compulsive disorder OCD

Treatment:

Educate patient, family members, teachers.
Decide on if treatment is warranted
Social: Extra breaks at school & additional test taking time.
Motor Tics:

  • 1st line: Fluphenazine
  • Pimozide, [Metanalysis].
  • Haloperidol, trifluoperazine
  • Consider: botulinum toxin injection

If attention deficit is present: treat it

  • Clonidine orally, then patch
  • Haloperidol

If obsessive compulsive:

  • Clomipramine P.O. or others

If impulsive:

  • Carbamazepine CBZ or lithium.

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