The colorful spectrum of Tourette syndrome and its medical, surgical and behavioral therapies.

Tourette syndrome (TS) is a common neuropsychiatric disorder, more common in males than females, with onset before age 18. TS is characterized by multiple motor tics and one or more vocal/phonic tics, persisting for more than a year. Tics are unvoluntary, abrupt, rapid, repetitive, but non-rhythmic movements or sounds (vocalizations). They are preceded by an inner urge. Tics can be temporarily suppressed, but this leads to a powerful re-emergence. The performance of tics results in immediate but transient relief. Motor and vocal tics are classified as simple or complex. Tics emerge many times during the day and display spontaneous fluctuations in frequency, type, severity and complexity. Tics improve during concentration, worsen during relaxation or when under stress and occasionally are persistent in sleep. Psychiatric comorbidities such as attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD) and others frequently are present. Patients, families and teachers benefit from receiving instruction regarding the character of TS and its specific symptoms and from receiving counseling. Pharmacological treatment is not always necessary. Atypical antipsychotics (e.g. risperidone, ziprasidone, olanzapine, aripiprazole) are often the first-line treatment; typical antipsychotics (e.g. haloperidol, pimozide, fluphenazine), benzodiazepines (clonazepam) and tetrabenazine are employed less frequently. Alpha adrenergic agonists (clonidine, guanfacine), the selective noradrenaline re-uptake inhibitor, atomoxetine, and the amphetamine-like stimulant, methylphenidate, are useful in patients with tics and ADHD; selective serotonin re-uptake inhibitors can be useful in individuals with tics and OCD. Botulinum toxin can be effective in focal tics. In severe, treatment-resistant TS, deep brain stimulation may be beneficial.