Tourette’s syndrome

Tics are common. Usually, the clinician can reassure the family and child and with time, observation and support, the tics go away without intervention. If they become more complex with both motor and vocal components and continue over 12 months, then there is concern of Tourette’s syndrome. What treatment should be offered initially once a diagnosis is made in children and young adults? The guidelines are inconsistent. Farhat et al [The Lancet Child & Adolescent Health 2023;7 (2):112–126. https://doi.org/10.1016/S2352-4642(22)00316-9] have completed a systematic review and metanalysis to examine the tolerability and efficacy, along with the acceptability of the pharmacological options. Out of an initial 12 088 records they identified 39 double-blind randomised controlled trials which included 4578 subjects and 23 individual medications (six drug classes) in children and adolescents (aged≥4 years and≤18 years), adults (>18 years), or both, diagnosed with Tourette’s syndrome. The bottom line is that the first generation and second generation antipsychotic drugs and α−2 agonists were more efficacious than placebo as a monotherapy but the antipsychotics were superior to α−2 agonists, with moderate certainty of evidence. Although antipsychotic medications did not differ from each other, aripiprazole and risperidone were superior to clonidine. …