Current treatment modalities for tic disorders in children and adolescents

Objectives: Tic disorders are characterized by the presence of involuntary contractions of muscle groups, either resulting in motor movements, or in verbal utterances and sounds. Tic disorders are neuropsychiatric disorders with higher prevalence rates than previously thought, of up to 3–4% for chronic motor or vocal tic disorders and 1% (range 0.05–3%) for Tourette syndrome, which is the combination of chronic motor and vocal tics persisting for at least one year. In some cases tics highly effect the quality of life and demand behavioral treatment, pharmacotherapy or combined treatments. It is difficult to develop guidelines for pharmacological treatment of tic disorders for a number of reasons. But in this presentation it was aimed to make a summary of the current consensus on pharmacological treatment options and indications for tic disorders and to brieşy review the evidence-based behavioral interventions and other treatment options.

Method: Latest original articles, reviews and guidelines about the treatment of tic disorders were searched on PubMed published after year 2008. Current treatment modalities were summarized based on especially two recent guidelines (European Guidelines and Canadian Guidelines) about the pharmacotherapy, behavioral interventions and other treatment options for tic disorders

Results: Many children and adolescents with tic disorders do not require treatment for their tics, since their tics do not interfere with daily life or recreational activities. Many patients do well with a watch and wait strategy after psychoeducation and reassurance. Psychoeducation which aims to improve the tolerance for symptoms and to support stress reduction is the first step in the treatment of tics. Although education, reassurance, and a watch-and-wait approach are often the primary treatment modality, drug treatment is the most common active intervention. Haloperidol, pimozide, atypical antipsychotics (e.g., risperidone) and alpha-2 adrenergic agonists such as clonidine and guanfacine are generally considered to be the most effective medications for the treatment of tic disorders. Beside pharmacotherapy, several different behavioral therapies have been examined for treatment of tics, each showing varying levels of efficacy. The data suggest that behavioral interventions, particularly habit reversal training (HRT) and exposure and response prevention (ERP), are effective in the treatment of tic disorders. Deep brain stimulation (DBS) is a surgical treatment reserved for severe cases of Tourette syndrome that have not responded to other behavioral or pharmacological treatments. Majority of the studies on DBS show significant tic reduction, but not complete symptom remission. Although some studies describe successful outcomes with DBS in adolescents patients, due to lacking of randomized controlled studies, at present time DBS is recommended only in adult, treatment resistant, and severely affected patients.

Conclusion: All pharmacological treatment options are symptomatic that alleviate, but do not cure the tics. And the evidence of the effect that pharmacological treatment has on the prognosis of the disorder is still lacking. Behavioral interventions like habit reversal training (HRT) and exposure and response prevention (ERP) seems to be effective treatment methods for tic disorders.