Treatment of TS

The majority of people with TS are not significantly disabled by their tics or resulting symptoms and therefore do not require medication. However, there are medications to help control symptoms when they interfere with functioning.

The dosage necessary to achieve maximum control of symptoms varies for each patient and must be gauged carefully by a clinician. Usually, the medication is administered in small doses with gradual increases to the point where there is a maximum alleviation of symptoms with minimal side effects. Some of the undesirable reactions to medications are fatigue, motor restlessness, weight gain and social withdrawal. Side effects such as depression and cognitive impairment can sometimes be alleviated with dosage regulation or a change of medication.

Other types of therapy may also be helpful. Sometimes psychotherapy can assist a person with TS and help his/her family cope with the psycho-social problems associated with TS. The use of relaxation techniques and/or biofeedback may help during prolonged periods of high stress. There have been case reports of acupuncture, yoga, hypnosis and other alternative therapies to show benefits, but rigorous research is lacking. Proven treatments for tics include Cognitive Behavioural Intervention for Tics (CBIT) and medications prescribed by a physician. The point is to find what is best for your individual needs with the decision for the best treatment modality being left to the individual and their clinician.

Cognitive Behavioural Intervention For Tics

Comprehensive Behavioural Intervention for Tics (CBIT), is a treatment for tics (such as those seen in Tourette Syndrome). It is a more selective treatment than medications (i.e. specific tics can be targeted), lasts over time, and available research suggests that it is highly effective–perhaps moreso than medication for some.

CBIT is a way of significantly reducing or even completely eliminating targeted tic symptoms. It involves a combination of psychoeducation, relaxation techniques, symptom analysis, competing response training, and social support.

Here’s how it works: each time an individual with TS does a tic it makes that tic stronger, and each time they hold back from doing a tic they make it weaker. So if they can find some way of preventing themselves from doing a particular tic, this will extinguish it over time.

Because it is unfair to expect individuals with TS to simply suppress (or ‘hold in’) tics, using CBIT they instead pick a competing response to prevent the expression of the tic. Each time they do a competing response in place of the tic this makes the tic weaker. This means it's important to do the competing response a lot more than they are doing the original tic.

There are three important times to do the competing response: when the individual feels the original tic coming, if they ‘slip up’ and just do the tic, and when they are in a situation where they typically do the tic a lot. Conducting a thorough symptom analysis prior to starting helps them to determine when and where to use the competing response most effectively.

Some important components of CBIT are:

Pick a tic
Choose one that is actually causing problems for the individual with tics. Many tics may be unwanted, but not all of them are painful or causing damage or humiliating. They may have more than one tic to get rid of, but it is important to only start work on one at a time–it is too difficult to fight them all at once!

Choosing the competing response
A good competing response follows certain rules. It is something that can be done for extended periods. It is less noticeable/painful/problematic than the tic. Most importantly, it is something that is impossible to do at the same time as the tic!

Relaxation techniques
When an individual with TS prevents a tic from coming out, this makes them feel stressed out.  The more things they do right then to calm themselves, the weaker the urge to tic becomes.

Get some cheerleaders
It is important that adults (and even friends, if one is comfortable with this) know that an individual with TS is targeting a tic, and know what their competing response is. That way, the cheerleaders can give credit for the effort the individual is putting in, and help cheer them on!

Early Treatment

Is it important to treat TS early? Yes, if the symptoms are disruptive or frightening. The symptoms portrayed may provoke ridicule and rejection by peers, neighbours, teachers and even casual observers. Parents may be overwhelmed by the strangeness of their child's behaviour. The child may be threatened, excluded from family activities and prevented from enjoying normal interpersonal relationships. These difficulties may become greater during adolescence, an especially trying period for young people and even more so for a person coping with a neurological disorder. Early diagnosis and treatment is advisable to avoid psychological harm.
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