Current Drug Therapy

At the back of the mind of a layperson as well as those in the medical profession, a youngster who tics and swears is immediately tagged with the title of Tourette Syndrome (TS). This sort-of reflex association may turn out to be correct in some youngsters, however, this youngster may have tics due to other conditions rather than Tourette syndrome. Moreover, children (and adults) without TS often swear or use obscene phrases as youngster do nowadays. During the last 50 years, it became evident that TS is a unique chronic neuropsychiatric complex disorder with early childhood onset and an evolving course which is often characterized by additional comorbidities such as Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive-Compulsive Disorder (OCD), a combination suggesting a possible involvement of the corpus striatum outflow tracts. Indeed, the beneficial effect of Haloperidol, a dopamine D2 receptor antagonist first synthetized by Bert Hermans at the Janssen Pharmaceutica in 1958 [1], and the successful trial of this newly introduced butyrophenone in several patients with TS in 1961 [2, 3], laid the basis for extensive research on the pathophysiology of the syndrome which with the advanced modern functional neuroimaging extended our knowledge on the close link between certain neuro-functional circuits, movements and behaviors. Interestingly, the emphasis on tics and their rich repertoire is the rule in many publications dedicated to the syndrome, while the behavioral and psychiatric features are frequently “neglected “. Tics are also the main issue discussed in recent publications dedicated to the pathophysiology of TS, while quite rare publications dealt in-depth with sleep abnormalities frequently experienced by the patients. It is obvious that for successful therapeutic intervention(s), it is crucial that the treating team will include specialists for each of the "many faces” of the syndrome. For the readers of this journal, the main field of interest of which is therapeutics, the present thematic mini issue of Current Drug Therapy authored by multidisciplinary experts on TS provides a short clinical description of the back-bone of TS symptomatology, and detailed up-to-date reviews of the neurophysiology, and sleep characteristics of the syndrome. Familiarity with the “many faces” of the syndrome is necessary for sound therapeutic considerations, therefore, the last chapter is dedicated to past and present drug therapy for TS. We believe that this multidisciplinary format dedicated to TS will help in developing the concept that successful treatment of tics is not enough because tics may have a lesser impact on the quality of life than the associated comorbidities. Since comorbidities may not be evident when tics appear at a relatively young age, those should be evaluated routinely and treated timely by a multidisciplinary team.