Editorials

Tic disorders

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.d7659 (Published 05 January 2012) Cite this as: BMJ 2012;344:d7659
  1. James F Leckman, Neison Harris professor
  1. 1Child Study Center, Yale University, New Haven, CT 06520-7900, USA
  1. james.leckman{at}yale.edu

New European guidelines highlight best practice in diagnosis and management

The European clinical guidelines for Tourette’s syndrome and other tic disorders were recently compiled and published by the European Society for the Study of Tourette Syndrome.1 2 3 4 5 The take home message of the guidelines is that tic disorders are common and complex neuropsychiatric conditions. Practising clinicians need to work together with medical specialists, parents, teachers, peers, and advocacy groups to disseminate knowledge and implement effective interventions.2 3 In addition, despite recent scientific advances, more effort is needed to understand and treat these neurodevelopmental disorders.

Tic disorders start in childhood and are characterised by multiple sudden, rapid, recurrent, and non-rhythmic movements (motor tics) or utterances (vocal tics), or both. The best studied chronic tic disorder is Tourette’s syndrome, which has a prevalence of 0.3-1% in the general paediatric population. The syndrome is characterised by multiple motor tics as well as one or more vocal tics over a period of more than one year.6

The phenomenology and natural course of tic disorders are complex. Although some practitioners try to reassure families that their child will “outgrow” their tics, the long term course is variable. Tics may improve, but usually the tics are just one part of a larger neuropsychiatric syndrome. Specifically, the guidelines note that children with Tourette’s syndrome often function poorly across numerous psychosocial domains and have high rates of hyperkinetic disorder: attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, mood and anxiety disorders, learning disorders, and autism spectrum disorders.2 Tics and their associated neuropsychiatric symptoms can negatively affect patients’ quality of life, social and academic functioning, and lifetime achievements. Tics and related symptoms can be extremely troubling to the patient’s family, and the entire family often needs care and counselling. At the time of evaluation, the child …

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