Medications
Tics are rarely eradicated entirely; the goal of medication is to achieve maximal control with minimal side effects.
Dopamine receptor blockers-
They work by blocking the effects of dopamine on the brain. Dopamine is a chemical in the brain thought to be associated with tics.
e.g., haloperidol, pimozide, fluphenazine and other typical neuroleptics.
Central α 2-adrenergic receptor blockers-
It is thought to stabilise levels of a brain chemical called norepinephrine which decreases the risk of the basal ganglia misfiring and triggering tics.
e.g. clonidine
Presynaptic catecholamine-depleting agents
e.g., reserpine, tetrabenazine
SURGERY
Preoperative and postoperative assessment tools
- video recordings
- The Yale Global Tourette Severity Scale(YGTSS, a validated standardized instrument)
- A tic diary incorporating the Tourette Syndrome Symptom Scale
- Two quality of-life instruments (a visual analog scale and the Short Form Health Survey [SF-36]), and Neuropsychological battery.
Deep Brain Stimulation
DBS involves the stereotactic implantation of stimulating electrodes that are positioned within specific targets in deep forebrain structures. These electrodes are connected to an implantable pulse generator that delivers a continuous high-frequency train of electrical square waves to the target.
Some authors have targeted the thalamus, whereas others have approached the globus pallidus pars interna (GPi). The precise thalamic target has not yet been established. The most effective location for stimulation is the VL thalamus. The electrode tip (contact 0) is placed on average, 4.3 mm lateral, 4.5 mm posterior and 0.1 mm inferior to the midpoint of a line between the anterior and posterior commissures, and the trajectory at 34 degrees in the lateral plane and 26 degrees anterior in the sagittal plane. In successful cases, the reduction in tic frequency has been in the 70% to 100% range. Another target for deep brain stimulation is the Globus Pallidus internus- Gpi. Results have been comparable to those of thalamic stimulation.
Prognosis
The overall prognosis is positive. Regardless of the symptom severity, individuals with Tourette’s have a normal life span.