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Tourette's Syndrome Treatment
Tourette's syndrome is a chronic familial disorder with a fluctuating course; the long-term outcome is generally favorable. Although the exact underlying pathology has yet to be determined, evidence indicates a disorder localized to the frontal-subcortical neural pathways. Up to 20 percent of children have at least a transient tic disorder at some point. Once believed to be rare, Tourette's syndrome is now known to be a more common disorder that represents the most complex and severe manifestation of the spectrum of tic disorders.
What are the treatment options for curing Tourette's syndrome?
Many children won't need any medicine, but some may. The important thing is to get the right diagnosis for your child. This makes it easier to understand your child's behavior.
If you or your child has Tourette's plus comorbid or associated conditions, then you will also need to prioritize to determine what to treat for: is it the tics that are really the most significant problem, or is it any ADHD or OCD or mood disorder? The medications you would use for tics are not necessarily what you would use for another condition and treating one condition might make symptoms of another condition worse. You will also want to learn about research-validated alternatives to medication.
Medication for Tourette's syndrome(TS)
The available TS medications are only able to help reduce specific symptoms. In the U. S., the most frequently prescribed medications are
- clonidine hydrochloride (Catapres®) and
- guanfacine (Tenex®), two alpha 2-adrenergic agonists.
- Clonidine ( an antihypertensive drug ) is actually a blood pressure medication that was found to ameliorate tics.
Clonidine and guanfacine can generally be taken by individuals who have normal blood pressure. Clonidine is available in tablet and sustained-release (transdermal) patch form. At the present time, guanfacine is not available in patch form.
Some clinicians and investigators have been exploring the value of nicotine patches or mecamylamine (Inversine®), a medication that blocks nicotine receptors in the brain. Over all, however, it seems that the nicotine patch's promise is as a supplement to tic medication, and not as a sole treatment.
Jankovic and Beach (1997) report that tetrabenazine (TBZ), a medication that blocks dopamine receptors, produced significant tic amelioration in over half the patients they followed for over two years. TBZ is not currently approved by the FDA as a treatment for tics.
Other types of therapy for Tourette's syndrome
Other types of therapy may also be helpful.
- Psychotherapy - Although psychological problems do not cause TS, psychotherapy may help the person better cope with the disorder and deal with the secondary social and emotional problems that sometimes occur. Psychotherapy does not help suppress the patient's tics. Family counseling and psychotherapy may be useful to help cope with adjustment problems associated with the social stigma common in more severe cases.
- Relaxation techniques and biofeedback may be useful in alleviating stress that can lead to an increase in tic symptoms.
- Education and support - A person with Tourette's, along with family members, should be taught about the natural course of the disorder. Tics most likely will decrease in intensity and frequency as time passes. With proper treatment, tics need not impair life at school, at work or in relationships. Self-help groups can provide support and education.
There is no cure for TS; however, the condition in many individuals improves as they mature. Individuals with TS can expect to live a normal life span. Although the disorder is generally lifelong and chronic, it is not a degenerative condition.
Management of Tourette's syndrome should include timely and accurate diagnosis, education, and behavior or pharmacologic interventions. Use of neuroleptic medications and dopamine D 2 antagonist drugs can be effective but may be associated with significant side effects.
What else should I know about Tourette's syndrome treatment?
Many children with Tourette's syndrome also have attention-deficit hyperactivity disorder (also called ADHD). Children with Tourette's syndrome may also have learning disabilities or obsessive-compulsive disorder (thoughts or behaviors that are repeated over and over). Your doctor can help you find out if your child has any of these other conditions.
Tics may affect more than one person in a family. Tics and Tourette's syndrome should be considered as a possible cause if a child with a family member who has Tourette's syndrome has learning or behavior.