Recognition and management of Tourette's syndrome and tic disorders

Tic disorders and Tourette's syndrome are conditions that primary care phys icians are likely to encounter. Up to 20 percent of children have at least a transient tic disorder at some point. Once believed to be rare, Tourette' s syndrome is now known to be a more common disorder that represents the mo st complex and severe manifestation of the spectrum of tic disorders. Toure tte's syndrome is a chronic familial disorder with a fluctuating course; th e long-term outcome is generally favorable. Although the exact underlying p athology has yet to be determined, evidence indicates a disorder localized to the frontal-subcortical neural pathways. Tourette's syndrome is commonly associated with attention-deficit/hyperactivity disorder, obsessive-compul sive disorder, behavior problems and learning disabilities. These comorbid conditions make the management of Tourette's syndrome more challenging. Man agement of Tourette's syndrome should include timely and accurate diagnosis , education, and behavior or pharmacologic interventions. Use of neurolepti c medications and dopamine D-2 antagonist drugs can be effective but may be associated with significant side effects.