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Tic ManagementAka: Tourette's Syndrome Management

Behavioral Management
1. Positive reinforcement
2. Target behaviors
  1. Skill deficiencies
  2. Behavior excesses
Indications for medical management
1. Significant tic interfering with daily function
Precautions to medical management
1. Often treatment worse than disease
2. Observe for extrapyramidal effects of Neuroleptics
Goal for medication management
1. Lowest medication dose to adequately improve function
Mild to moderate Tic Disorder medications
1. Clonidine (Catapres) 0.05 mg PO bid to 0.1 mg PO qid
2. Guanfacine (Tenex) 0.5 to 1.5 mg PO bid
Severe Tic Disorder medications: Neuroleptic Preparations
1. Haloperidol (Haldol) 0.5 to 4 mg PO qhs
2. Pimozide (Orap) 1 to 8 mg PO qhs
3. Risperidone (Risperdal)
Other Preparations for Tic Disorder
1. Clonazepam (Klonopin) 0.25 mg PO bid to 1 mg PO tid
2. Agents for concurrent obsessive compulsive features
  1. Clomipramine (Anafranil)
  2. Fluvoxamine (Luvox)
  3. Fluoxetine (Prozac)
Maintenance of medications
1. Tourette's Syndrome requires treatment for upto 2 years
2. Try slowly tapering medication when stable for 6 months
References
1. Jankovic (2001) N Engl J Med 345:1184

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This page was written by Scott Moses, MD, and was last revised 3/10/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.