The most common first symptom is a tic of the face. Other tics may follow. A tic is a sudden, fast, repeated movement or sound.
Symptoms of Tourette syndrome can range from tiny, minor movements (such as grunts, sniffling, or coughing) to constant movements and sounds that cannot be controlled.
Tics can include:
Repeated throat clearing or sniffing
Tics may occur many times a day, but they tend to improve or get worse at different times. The tics may change with time. Symptoms usually get worse before the mid-teen years.
Contrary to popular belief, only a small number of patients use curse words or other inappropriate words or phrases (coprolalia).
Tourette syndrome is different from OCD. People with OCD feel as though they have to do the behaviors. Sometimes a person can have both Tourette syndrome and OCD.
Many people with Tourette syndrome can stop doing the tic for periods of time. But they find that the tic is stronger for a few minutes after they allow it to start again. Often the tic slows or stops during sleep.
Signs and tests
There are no lab tests to diagnose Tourette syndrome. A health care provider will likely do an examination to rule out other causes of the symptoms.
To be diagnosed with Tourette syndrome, a person must:
Have had many motor tics and one or more vocal tics, although these tics may not have occurred at the same time
Have tics that occur many times a day, nearly every day or on and off, for a period of more than 1 year. During this period, there must not have been a tic-free period of more than 3 months in a row.
Have started the tics before age 18
Have no other brain problem that could be a likely cause of the symptoms
Persons who have very minor symptoms are not treated. This is because the side effects of the medicines may be worse than the symptoms of Tourette syndrome.
Different medicines are available to treat Tourette syndrome. The exact medicine that is used depends on the symptoms and any other medical problems.
Deep brain stimulation has shown promise for treating both the main symptoms of Tourette syndrome and the obsessive-compulsive behaviors, but not when these symptoms occur in the same person.
Symptoms are usually worst during the teenage years and then improve in early adulthood. In some persons symptoms go away entirely for a few years and then return. In a few persons, symptoms do not return at all.
Conditions that may occur in people who have Tourette syndrome include:
These conditions need to be diagnosed and treated.
Calling your health care provider
Make an appointment with your health care provider if you have tics that are severe or persistent, or if they interfere with your daily life.
There is no known prevention.
Cohen S, Leckman JF, Bloch MH. Clinical assessment of Tourette syndrome and tic disorders. Neurosci Biobehav Rev. http://dx.doi.org/10.1016/j.neubiorev.2012.11.013.
Kurlan R. Clinical practice Tourette's Syndrome. N Engl J Med. 2010;363:2332-2338.
Ryan CA, Gosselin GJ, DeMaso DR. Habit and tic disorders. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 22.
Luc Jasmin, MD, PhD, Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles and Department of Anatomy, University of California, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.