Tourette syndrome.

Abstract

Tourette syndrome is characterized by the presence of motor and phonic tics. Individuals with Tourette syndrome can have a spectrum of related behaviours including attention deficit hyperactivity features, obsessions, compulsions, impulsions and complex tics. The pathophysiology of Tourette syndrome is thought to reflect genetic influences on the development and function of cortical-striatal-thalamic-cortical and broader cortical-subcortical circuitry implicated in motor and inhibitory control and interoceptive processing, which may contribute to the characteristic 'urge-tic-relief' cycles. Shared genetic risks resulting in pleiotropy and overlapping neurocircuitry could explain some of the psychiatric comorbidities of Tourette syndrome. Management typically includes education, psychosocial support and behavioural therapy alongside pharmacotherapy for those with more severe tics or those unresponsive to behavioural therapy. Deep brain stimulation is used in severe, incapacitating and treatment-refractory cases persisting into adult life. Approaches aimed at improving quality of life and management of psychiatric comorbidities are also critically important. Future research should include considering refining the diagnostic criteria and delineating functional tic disorders, as well as the tic-related obsessive-compulsive behaviours, as this may have implications for treatment, understanding the underlying neurobiology, and the development of personalized interventions focusing on core tic-related features, psychiatric comorbidities and improving quality of life.