The pharmacology of Tourette syndrome

Tourette syndrome (TS) is a chronic neuropsychiatric disorder characterised by multiple motor and vocal tics, plus associated behavioural symptoms. Tics are defined as sudden, rapid, repetitive non-rhythmic movements (motor tics) or vocalisations (vocal tics). Tics are distressing symptoms and can lead to considerable disruption to social functioning and quality of life. Converging evidence from different lines of research suggests that the pathophysiology of TS involves altered dopaminergic transmission in the cortico-striatal-thalamo-cortical circuits, along with other neurotransmitter systems. Pharmacotherapy is currently the treatment of choice in patients with moderate-to-severe tics, particularly when associated with deterioration in social, occupational or academic performance. This review will focus on the recent evidence base supporting the use of different medication classes for the treatment of tics in TS. The recent publication of the European and Canadian guidelines on the management of TS are based on experts' consensus and highlight the need for randomised controlled trials, especially with regards to newly developed pharmacological agents.