Tourette Syndrome

Tourette syndrome is a neurological disorder that causes sudden, repetitive, rapid, and unwanted movements or vocal sounds called tics.

Overview

Tourette syndrome is a neurological disorder that may cause sudden unwanted and uncontrolled rapid and repeated movements or vocal sounds called tics. Tics come and go over time. They can vary in type and severity, as well as how often and where they happen.

In children, the first symptoms usually occur between ages 5 and 10, usually in the head and neck. These symptoms may expand to include muscles in the torso, arms, and legs. Movement-related tics usually occur before vocal tics.

Tourette syndrome affects more boys than girls. Most people with the disorder experience their worst tic symptoms in their early teens, but tics typically become less frequent and controllable by the late teens to early 20s. For some people, Tourette syndrome can be a chronic condition with symptoms that last into adulthood. In some cases, tics may worsen in adulthood.

Tourette syndrome is not a degenerative condition (one that continues to get worse). People with the disorder have a normal life expectancy. Many people do not need treatment if their symptoms do not interfere with daily life. Some may become tic-free or no longer need medicine to control their tics.

Related Terms: Tourette syndrome is one of this group of disorders of the developing nervous system, called tic disorders.

Signs and Symptoms

Tourette syndrome tics are sudden, unwanted, and uncontrolled rapid and repeated movements or vocal sounds. They can vary in type and severity, as well as how often and where they happen. For the most part, tics are mild.

Tics can be classified as simple or complex. Simple tics often precede complex tics. Simple tics are sudden, brief, repetitive movements that involve only a few muscles. Complex tics are specific, coordinated patterns of movement involving many muscles. Simple tics are more common than complex tics.

Simple Tics

Simple motor tics include:

Eye blinking and other eye movements
Facial grimacing
Shoulder shrugging
Head or shoulder jerking

Simple vocal tics include:

Repetitive throat clearing
Sniffing
Barking
Grunting sounds

Complex Tics

Complex motor tics may include:

Facial grimacing combined with a head twist and a shoulder shrug
Sniffing or touching objects
Hopping, jumping, bending, or twisting

Complex vocal tics may include:

Repeating your own words or phrases
Repeating others’ words or phrases
Using vulgar, obscene, or swear words (this occurs more rarely)

Some of the most dramatic and disabling tics may include motor movements that result in self-harm, such as punching oneself in the face, or vocal tics such as repeating others’ words or phrases or swearing.

Premonitory Urge

Sometimes, an urge or sensation in the affected muscle group comes right before a tic. This is called a premonitory urge. Some people with Tourette syndrome describe a need to complete a tic in a certain way or a certain number of times to relieve the urge or decrease the sensation.

Tic Triggers

Tics can become worse with excitement or anxiety and better during calm, focused activities. Certain physical experiences can trigger or worsen tics. For example, tight collars may trigger neck tics. Hearing another person sniff or clear their throat may trigger similar sounds.

Tics go away completely during deep sleep. They do not go away during light sleep but are often significantly reduced.

Tourette syndrome tics happen without a person’s control. But some people can hold tics back or manage them for a while. However, people with Tourette syndrome often feel tense when trying to hold back their tics, to the point where they feel the tic must be expressed against their will. Tics in response to an environmental trigger can appear voluntary or purposeful but are not.

Many people with Tourette syndrome have other co-occurring conditions. The most common ones include:

Attention deficit hyperactivity disorder (ADHD): A mental health condition that causes difficulty with concentration, hyperactivity, and impulsivity
Obsessive compulsive disorder or behaviors (OCD/OCB): A mental health condition that leads to repetitive, unwanted thoughts, ideas, or sensations (obsessions) that make a person feel the need to perform certain behaviors repeatedly or in a certain way (compulsions). Repetitive behaviors can include handwashing, checking things, and cleaning, and can significantly interfere with daily life
Anxiety: Fear, unease, or apprehension about a situation or event that may have an uncertain ending
Learning disabilities: Problems with reading, writing, and math that are not related to intellectual ability
Behavioral or conduct issues: Common issues include aggression, anger management problems, and problems adjusting emotionally and socially
Sleep disturbances: Difficulties falling or staying asleep and excessive sleepiness during the day
Social skills and social functioning difficulties: Trouble with social skills and maintaining social relationships
Sensory processing issues: Difficulty organizing and responding to sensory information related to touch, taste, smells, sounds, or movement

Educational Impact

Although children and teens with Tourette syndrome often function well in school, ADHD, learning disabilities, obsessive-compulsive symptoms, and frequent tics can interfere with school performance and social skills. Children who need support may benefit from tutoring, smaller or special classes, private study areas, exams outside the regular classroom, other individual performance accommodations, and in some cases special schools.

Causes and Risk Factors

What causes Tourette syndrome is still unknown. But it likely involves both genetic and environmental factors (things outside the body that can affect health).

Research points to differences in:

Certain brain regions, including the basal ganglia, frontal lobes, and cortex
The brain circuits connecting the brain regions involved in Tourette syndrome
The brain chemicals that are responsible for communication between nerve cells, which include dopamine, serotonin, and norepinephrine

Research suggests that Tourette syndrome can run in families. It may involve several genes, along with environmental factors. Specific genes thought to be involved include:

The SLITRK1 gene, which affects how neurons grow and connect with one another
The NRXN1 and CNTN6 genes, which control the formation of nerve connections

Males who inherit gene mutations are more likely to have tics. Females are more likely to have obsessive-compulsive symptoms. But it is important to know that having certain genes does not guarantee that a person will get Tourette syndrome.

Research suggests that some forms of ADHD, OCD, and Tourette syndrome stem from issues with the same genes. This is not true for the other conditions that commonly co-occur in people with Tourette syndrome.

Diagnosis

To diagnose Tourette syndrome, a doctor or healthcare provider looks for:

Motor and vocal tics that occur several times a day, every day, or intermittently for at least one year
Tics that happen before age 18
Tics not caused by medicines, other substances, or medical conditions

Common tics can often be diagnosed by a primary care provider, pediatrician, or mental healthcare specialist. Other medical expertise may be required for diagnosing less common symptoms and symptoms that begin in adulthood.

Tourette syndrome is not diagnosed by blood, laboratory, or imaging tests. In rare cases, imaging tests such as magnetic resonance imaging (MRI) or computerized tomography (CT), electroencephalogram (EEG) studies, or certain blood tests may be used to check for other conditions that might have similar symptoms to Tourette syndrome.

It can take time to get a clear diagnosis of Tourette syndrome. Families and doctors unfamiliar with this condition might think mild and even moderate tic symptoms are not important, part of normal child development, or caused by something else. For example, some parents may think that eye blinking is caused by vision problems or that sniffing is caused by seasonal allergies.

Treatment and Management

If symptoms are mild, some people with Tourette syndrome may not need treatment. For those whose symptoms interfere with daily life, effective treatments are available to help people manage their symptoms.

Medicines

No one medicine is helpful to all people with Tourette syndrome, nor does any treatment get rid of all symptoms. Like most medicines, some may have side effects and should be monitored by a doctor or other healthcare provider. Medicines can include:

Haloperidol and pimozide, dopamine-blocking medicines commonly used to treat tics
Clonidine and guanfacine, alpha-2 agonists that are also used to treat tics
Methylphenidate and dextroamphetamine, stimulant medicines used to treat attention-deficit hyperactivity disorder (ADHD). Short-term use may help some children with Tourette syndrome who also have ADHD
Antidepressants called serotonin reuptake inhibitors, such as clomipramine, fluoxetine, fluvoxamine, paroxetine, and sertraline, can be used to help control symptoms of depression, obsessive-compulsive disorder (OCD), and anxiety

Other Therapies and Treatments

Behavioral treatments can help reduce tics. One example is learning to move on purpose in response to a premonitory urge to prevent tics.
Counseling can help people cope with the disorder and deal with other health problems such as ADHD, depression, anxiety, and OCD.
Biofeedback and supportive therapy can help a person with Tourette syndrome better cope with the disorder and manage social and emotional problems.

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. Find clinical trials on Tourette syndrome.

Find Treatment

If you are unsure of where to get help, a doctor or healthcare provider is a good place to start. They can refer you to specialists and help you figure out the next steps.

Community Support

The following organizations provide information and support for people with Tourette syndrome and their families:

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH.

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.

NIH supports research relevant to Tourette syndrome at NIH laboratories and through grants to research institutions across the country. Current and ongoing research areas include:

How genes affect Tourette syndrome and its treatment
Testing the effectiveness and safety of deep brain stimulation (DBS) for treating tics and other conditions that commonly occur with it, such as obsessive-compulsive behaviors
New imaging techniques are being used to identify brain regions, how brain areas are connected, and biological factors linked to Tourette syndrome and related conditions such as ADHD and OCD
Testing use of stimulant medicines with people who have ADHD and Tourette syndrome.
Testing behavioral treatments for tics in children and adults.
Developing medicines to change how nerve cells communicate in the brain.
Non-surgical techniques that deliver magnetic signals are also being tested in children and adults with Tourette syndrome
Studying how and why multiple conditions are common in people with Tourette syndrome, including brain injury linked to some infections

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies. 