Table 3

A practical guide to the main strategies of the management of the motor and vocal/phonic tics of Tourette syndrome in young people, showing the current evidence (modified from Robertson5 and Scahill et al9)7

Treatment modalityEmpirical support; A=good =2–3 DBT; B=adequate =1 DBT+series total >150 patients; C=fair=1 DBT only or open label or series/case reports (<150 patients); D=minimal–only case reports; small seriesReferencesComments
Haloperidol (antipsychotic)A=good = 2-3 DBTsScahill et al113 Robertson5Three DBTs show haloperidol better than placebo; used worldwide and in many countries is the only drug licensed for GTS but has many adverse side effects
Risperidone (antipsychotic)AScahill et al113 Robertson5Four RCTs in adults and children; subsequently reports of serious adverse effects=increase in weight and glucose abnormalities (diabetes); widely used worldwide
Pimozide (antipsychotic)AScahill et al115 Robertson5Four DBTs show that pimozide and haloperidol have equal efficacy, pimozide less adverse side effects than haloperidol but some reports of prolongated QTC interval with pimozide; widely used
Sulpiride (antipsychotic)B=adequate=1DBT+other evidence>150 patientsRobertson5One DBT showed that sulpiride was superior to placebo; one small case series and two large case series encompassing 249 patients showed that Sulpiride improved motor and vocal tics and had few side effects; widely used in UK; unavailable in USA, Canada
Tiapride (antipsychotic)B=fair=two small DBT only or open label or larger case reports (>100 patients)Chouza et al131 Eggers et al132DBT versus placebo; not stated how many patients; 800 mg per day. Tiapride>placebo; 10 patients in DBT; widely used in Europe (most common in Russia and Germany); unavailable in UK, USA, Canada
Aripiprazole (antipsychotic)C=1 small DBT only or open label or larger case studiesRobertson5Becoming first-line treatment in many dedicated GTS clinics in UK and Europe; appears useful and safe, with transient minimal side effects and successful reports totalling 222 patients have been published
ClonidineARobertson5Six DBTs involving tablets and transdermal patch showed that clonidine was superior to placebo
Botulinum toxinBRobertson5A DBT showed decreased tics, decreased urges, pts not satisfied; a series of 30, open label, showed decreased tics, decreased urges, increased QoL; hypophonia in 80%: other case series and reports=successful
AtomoxetineBRobertson5Two DBTs show tics and ADHD reduce
TetrabenazineDRobertson5Two studies encompassing 86 patients have documented success with this agent; used mainly by neurologists; depression common; no DBTs
Habit reversal trainingARobertson5RCTs>psychotherapy: WL=to other behavioural methods
Exposure and response preventionVerdellen et al118–121Somewhat more evidence for habit reversal training than exposure and response prevention
  • Modified from Robertson.5

  • ADHD, attention deficit hyperactivity disorder; DBTs, double blind randomised; GTS, Gilles de la Tourette syndrome; QoL, quality of life; RCTs, randomised controlled trials; WL, waiting list.