Background: Tourette Syndrome (TS) is a neurodevelopmental disorder characterized
by multiple repetitive motor and vocal tics. In most patients, its clinical course has a waxing and
waning nature and most patients, usually children, will benefit from tolerant environmental and
psychoeducation. Patients with more complicated tics, in particular, those with significant comorbidities
will require drug therapy.
Objective: The present paper is a mini-review of the current therapeutic arsenal for TS with reference
to drug and non-drug management approach.
Methods: A systematic survey of medical literature regarding the treatment decision making and the
reported clinical trials or accumulating experience with different medications or other therapeutic
modalities which were proven beneficial over the years.
Results: Reviewing the literature indicates that dopamine antagonists, such as haloperidol and pimozoide,
are the most reliable agents in terms of treatment response. Due to numerous adverse
effects, newer atypical anti-psychotic drugs have been shown effective. Other widely accepted
medications include alpha-2 adrenergic agonists, benzamides, dopamine depleting agents, benzodiazepines
and dopamine depleting agents. In more selective and intractable cases botulinum toxin,
dopamine agonists and cannabinoids should be also considered. Non-pharmacologic therapies reported
beneficial effects, which include on the one hand, non-invasive behavioral techniques, such
as comprehensive behavior therapy for tics. While on the other hand, in cases with particular protracted
pharmaco-resistant tics electric stimulation techniques, such as deep brain stimulation, have
been shown to be successful.
Conclusion: Currently, there are numerous multifarious options for treatment of tics and other comorbid
symptoms of TS. Nevertheless, treatment options and decision-making algorithms are still a
Area Covered: A step by step decision-making and various drugs and non-pharmacologic modalities
appropriate for the management of TS.