More than one in every ten schoolchildren suffers from a transient tic disorder, and 1% have a particular type of tic disorder known as Tourette syndrome. In this issue of Deutsches Ärzteblatt International, Andrea G. Ludolph of the Universitätsklinikum Ulm and her coauthors report on the available modes of diagnosis and treatment for these disorders (Dtsch Arztebl Int 2012; 109(48): 821).
Tic disorders usually take a benign course; in about 90% of patients, the tics regress spontaneously in adolescence. Specific treatment is indicated only if the tics are severe or cause evident psychosocial stress. On the other hand, 80% to 90% of all patients with Tourette syndrome have comorbid disorders such as attention deficit--hyperactivity disorder, depression, anxiety, or obsessive-compulsive disorder. These comorbidities often impair patients' quality of life more than the tics themselves do, and their treatment is, therefore, a priority.
At present, tics cannot be cured, nor is there any treatment aimed at their cause, which remains unknown. Moreover, there is no available treatment that can improve all of the potential symptoms of Tourette syndrome simultaneously while also treating all of its comorbidities. Atypical neuroleptic drugs are the agents of first choice in the treatment of tics, but, before any drug treatment is begun, all patients should first undergo a trial of behavior therapy, whose beneficial effect has been documented by sound scientific evidence. The state of the evidence regarding pharmacotherapy for Tourette syndrome is still poor.