Synopsis
Identify motor and vocal tics from their urge, stereotypy and suppressibility, diagnose Tourette syndrome longitudinally, assess comorbid ADHD and obsessive-compulsive symptoms, and reserve treatment for meaningful distress or impairment.
- A tic is a sudden, rapid, recurrent, non-rhythmic motor movement or vocalisation that is stereotyped for the individual and often temporarily suppressible at the cost of mounting inner tension.
- Many people describe a premonitory urge relieved briefly by performing the tic; young children may not recognise or verbalise this sensation.
- Tics wax and wane, change anatomical site and complexity, and commonly increase with fatigue, excitement, anxiety or attention drawn to them; fluctuation does not imply deliberate behaviour.
Key red flags
Acute chorea, fixed dystonic posture, rhythmic tremor, seizures, progressive focal signs or a new adult-onset movement without childhood history should not be forced into a tic diagnosis.
Investigation priorities
Confirm onset, duration, changing motor and vocal phenotypes and the diagnostic time criterion.
Management branches
Recurrent movements or sounds are reported in a child or adult.
- 1. Ask the person to describe urge, relief, suppressibility, rebound, triggers and whether the movement or sound is recognisably the same each time.
- 2. Reconstruct all previous motor and vocal tics and duration, using home video and collateral information with consent.
Key medicines
ClonidineA specialist may begin with a low evening oral dose and titrate slowly in divided doses, especially when tics coexist with ADHD; follow current BNF and local age-specific guidance.
AripiprazoleUse a specialist-selected low once-daily starting dose with gradual increments towards the minimum that meets the agreed tic or behavioural goal.