Comprehensive systematic review summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders

Tamara Pringsheim, Yolanda Holler-Managan, Michael S Okun, Joseph Jankovic, John Piacentini, Andrea E Cavanna, Davide Martino, Kirsten Müller-Vahl, Douglas W Woods, Michael Robinson, Elizabeth Jarvie, Veit Roessner, Maryam Oskoui

Research output: Contribution to journalArticlepeer-review

50 Citations (Scopus)


OBJECTIVE: To systematically evaluate the efficacy of treatments for tics and the risks associated with their use.

METHODS: This project followed the methodologies outlined in the 2011 edition of the American Academy of Neurology's guideline development process manual. We included systematic reviews and randomized controlled trials on the treatment of tics that included at least 20 participants (10 participants if a crossover trial), except for neurostimulation trials, for which no minimum sample size was required. To obtain additional information on drug safety, we included cohort studies or case series that specifically evaluated adverse drug effects in individuals with tics.

RESULTS: There was high confidence that the Comprehensive Behavioral Intervention for Tics was more likely than psychoeducation and supportive therapy to reduce tics. There was moderate confidence that haloperidol, risperidone, aripiprazole, tiapride, clonidine, onabotulinumtoxinA injections, 5-ling granule, Ningdong granule, and deep brain stimulation of the globus pallidus were probably more likely than placebo to reduce tics. There was low confidence that pimozide, ziprasidone, metoclopramide, guanfacine, topiramate, and tetrahydrocannabinol were possibly more likely than placebo to reduce tics. Evidence of harm associated with various treatments was also demonstrated, including weight gain, drug-induced movement disorders, elevated prolactin levels, sedation, and effects on heart rate, blood pressure, and ECGs.

CONCLUSIONS: There is evidence to support the efficacy of various medical, behavioral, and neurostimulation interventions for the treatment of tics. Both the efficacy and harms associated with interventions must be considered in making treatment recommendations.

Original languageEnglish
Pages (from-to)907-915
Number of pages9
Issue number19
Publication statusPublished - 7 May 2019


  • Antipsychotic Agents/therapeutic use
  • Behavior Therapy/methods
  • Deep Brain Stimulation
  • Humans
  • Tic Disorders/drug therapy
  • Tics/drug therapy
  • Tourette Syndrome/drug therapy


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