Tourette syndrome and other tic disorders. Diagnosis, pathophysiology, and treatment

• Published in: Medicine (Baltimore) 1991-01, Vol.70 (1), p.15-32
• Main Authors: Singer, H S, Walkup, J T
• Format: Article
• Language: English
• Subjects: Behavior; Humans; Neurology - trends; Tic Disorders - diagnosis; Tic Disorders - physiopathology; Tic Disorders - therapy; Tourette Syndrome - diagnosis; Tourette Syndrome - physiopathology; Tourette Syndrome - therapy
• ISSN: 0025-7974
• DOI: 10.1097/00005792-199101000-00002

In this report, we discuss the definition, characteristics, pathophysiology, and treatment of tic disorders with a major emphasis on Tourette syndrome. Although the diagnosis of a tic disorder depends on the presence of motor and/or phonic tic(s), patients with these problems also have a variety of co-morbid features including obsessive-compulsive symptoms, attention-deficit hyperactivity disorder, behavioral difficulties, and learning disabilities. Conservative estimates for Tourette syndrome suggest a prevalence rate of 0.1-1.0 per 1000. This syndrome is inherited in a sex-influenced autosomal dominant pattern with either chronic multiple tic disorder or obsessive-compulsive disorder as alternative phenotypes of the putative gene. Current evidence continues to support a pathophysiologic mechanism involving synaptic neurotransmission, with the dopaminergic system as a primary candidate. Therapeutically, it is essential to clarify whether a patient's problems are related to tics or associated behavioral difficulties. Pharmacotherapy for motor and phonic tics is strictly symptomatic and should be reserved for those with functionally disabling symptoms. A comprehensive individualized treatment program is often required in the care of individuals with tic disorders.