Treating tics

Treatment for tics is not always necessary, although different treatments are available.

If your tic is mild and doesn’t usually interfere with your school, work or everyday life, you may decide it doesn’t need treating. The tic may improve without treatment as you get older.

If your tic needs treatment, you can try behavioural therapy, often recommended as the first approach, or there are a number of medicines you can chose from. When deciding whether you need treatment, you should bear in mind that tics tend to be better or worse at different times and often improve during later teenage years or early adulthood.

Self help

There are a number of simple things you can do that may help improve your tics, such as avoiding things which make them worse. This may involve reducing stress and trying not to become too tired or over-excited, or being aware that you may experience more tics at these times and being prepared for this.

Also, try to make time for activities that are relaxing and enjoyable.

If your child develops a tic, there are several things you can do that may help them. For example:

• don’t tell them off about their tic
• don’t try to stop them making repetitive movements or sounds because this may cause them to become stressed, which may make the tic worse
• try to ignore the tic because drawing attention to it may make it worse
• reassure your child that they are well and there’s no reason for them to feel ashamed
• make a point of educating other children about tics so they’re aware of your child’s condition; encourage them to react naturally

Most importantly, you should try to reduce the levels of stress and anxiety around you and your child.

Behavioural therapy

Behavioural therapies are often recommended as one of the first treatments for tics. Behavioural therapy is a type of psychotherapy designed to change the pattern of your behaviour.

The type of therapy most suitable for you will depend on the nature and severity of your tics. Often several different techniques are used together.

You may be referred to a specialist psychological treatment service where staff can advise about an appropriate treatment plan.

One of the main types of behavioural therapy used to treat tics is called habit reversal therapy (HRT). HRT aims to:

• educate you about your condition and how it is treated
• make you more aware of when you tic and identify the urges you feel
• teach you a new response to carry out when you feel the urge to tic – for example, if your tic usually involves shrugging your shoulders, you may be taught to stretch out your arms if you feel the urge to tic, until the urge subsides

Behavioural therapy for tics may also include a technique called exposure and response prevention (ERP). ERP aims to help you learn to suppress the growing feeling that you need to tic (premonitory urge) until this feeling subsides.

The idea is that over time you will get used to the feeling of this premonitory urge (habituation) and the need to tic in response will lessen. 

Studies have shown that both HRT and ERP can improve tics in around half the people using them. These techniques are more likely to be successful if practiced regularly.

Medication

If you decide to use medicines to treat your tics, the choice of medicine will initially depend on several things, including:

• the type of symptoms that are most problematic
• the severity of your symptoms
• how important treatment is to you
• the risk of possible side effects

In clinical studies, a variety of medicines have been shown to be effective in treating tics, although they can have unpleasant side effects. Some of these are described below.

Neuroleptics

Neuroleptics, also known as antipsychotic medicines, are a type of medicine used to treat psychosis. In much lower doses, they have also been shown to be effective at treating tics.

Neuroleptics work by altering the effects of dopamine on the brain. Dopamine is a naturally occurring chemical in the brain that helps to control and co-ordinate your body’s movements.

Examples of neuroleptics include haloperidol, pimozide and risperidone. However, haloperidol is rarely prescribed nowadays due to the potential side effects (see below).

Neuroleptics can be divided into two main groups:

• typical neuroleptics – the first generation of neuroleptics, developed in the 1950s
• atypical neuroleptics – a newer generation of neuroleptics, developed in the 1990s

The newer, atypical neuroleptics tend to have milder side effects.

Side effects of both typical and atypical neuroleptics include:

• weight gain
• blurred vision
• constipation
• a dry mouth

However, typical neuroleptics can also cause:

• drowsiness
• shaking
• trembling
• muscle twitches
• spasms

Studies have found that neuroleptics can improve tics in about seven out of every 10 people.

Alpha2-adrenergic agonists

Alpha2-adrenergic agonists, such as clonidine, have been shown to be effective in suppressing tics, as well as treating the symptoms of attention deficit hyperactivity disorder (ADHD).

Alpha2-adrenergic agonists have relatively mild side effects, including:

• drowsiness
• constipation
• dry mouth
• feeling sick

Studies have shown that alpha2-adrenergic agonists can reduce the frequency of tics in about half the people who are prescribed them.

Benzodiazepines

Benzodiazepines, such as clonazepam, have been shown to reduce the severity of tics in some people. They work by altering the way certain chemicals transmit messages in the brain.

Benzodiazepines aren’t as effective as neuroleptics in suppressing tics and it’s possible to become addicted to them if they’re used for a long time. However, they can be useful for the short-term treatment of tics.

Tetrabenazine

Tetrabenazine is a medicine used to treat conditions that affect movement. Some studies have found that tetrabenazine improved tics in eight out of every 10 people and some people experienced a long term improvement in their symptoms.

It can cause side effects, such as drowsiness, feeling sick and depression. However, it’s less likely to cause weight gain than some of the other medicines.

Botulinum toxin

Botulinum toxin type A is a powerful poison that’s safe when used in small doses. A tiny amount of botulinum toxin can be injected into the muscles involved in a particular tic to relax them. For example, it can be injected into the muscles of your voice box to treat vocal tics.

As well as reducing tics, botulinum toxin can reduce the feeling of building tension that often comes before a tic.

However, the effect of botulinum toxin injections only lasts about three months, so further injections may be necessary. It can also cause a temporarily weak or soft voice when used to treat vocal tics. 

Deep brain stimulation

Deep brain stimulation is a type of surgery that’s been used to treat severe cases of Tourette’s syndrome. It’s a relatively new treatment for the condition, so it’s still being studied.

Deep brain stimulation involves placing one or more electrodes (small metallic discs) in an area of your brain associated with tics. The electrodes are placed in the brain by inserting fine needles through small holes in your skull. This is done under general anaesthetic.

Thin wires run from the electrodes to a pulse generator (a device similar to a pacemaker), which is implanted under the skin somewhere in your chest. The generator gives out an electric current to help regulate your brainwaves and control your tics.

Some studies have reported good results from deep brain stimulation, with tics being reduced by at least a fifth or, in some cases, almost disappearing.

Due to the uncertainty surrounding this treatment for tics, deep brain stimulation is currently only recommended for adults who have severe tics that have not responded to other treatment.