Treatment

Tics do not always need to be treated if they're mild, but treatments are available if they're severe or are interfering with everyday life.

Many tics will eventually go away or improve significantly after a few years. But, if untreated, more severe tics can cause issues such as difficulties at school or social problems.

Self-help tips

There are some simple things you can do that may help to improve your or your child's tics.

• avoid stress, anxiety and boredom – for example, try to find a relaxing and enjoyable activity to do (such as sport or a hobby). Read more advice about 10 stress busters, anxiety in children and anxiety, fear and panic
• avoid becoming too tired – try to get a good night's sleep whenever possible. Read about ways to fight tiredness and the Royal College of Psychiatrists' advice on sleeping well
• try to ignore your child's tic and not talk about it too much – drawing attention to it may make it worse
• do not tell a child off when their tic occurs
• reassure your child that everything's OK and there's no reason for them to feel embarrassed
• let other people you're in regular contact with know about tics, so they're aware of them and know not to react when they occur

If your child is finding school difficult, talk to their teacher about ways of dealing with this. For example, it may help if they're allowed to leave the classroom if their tics are particularly bad.

Similarly, if you have a tic that's making things difficult for you at work, speak to your employer to find out if any help and support is available.

Find support on the Tourettes Action website.

Behavioural therapies

Behavioural therapy is often recommended as one of the first treatments for tics.

You may be referred to a specialist psychological treatment service if a doctor feels therapy might help.

One of the main types of therapy for tics is habit reversal therapy. This aims to:

• teach you about your condition
• make you more aware of when your tics occur and identify any urges you feel at the time
• teach you a new response to do when you feel the urge to tic – for example, if your tic involves shrugging your shoulders, you may be taught to stretch your arms until the urge to tic passes

Comprehensive behavioural intervention for tics (CBiT) may also be used. This involves learning a set of behavioural techniques to help reduce tics.

A technique called exposure and response prevention (ERP) is also sometimes used. This aims to help you learn to suppress the feeling you need to tic until it subsides.

These techniques usually require several sessions with a therapist. They work best if you continue using them yourself after treatment finishes.

Medicine

There are several medicines that can help control tics. Some of the medicines used are outlined below.

Neuroleptics

Neuroleptics, also called antipsychotics, are the main medicines for tics. They work by altering the effects of the chemicals in the brain that help control body movements.

Examples include risperidone, pimozide and aripiprazole.

Side effects of neuroleptics can include:

• weight gain
• blurred vision
• constipation
• dry mouth

Some neuroleptics can have additional effects such as drowsiness, shaking and twitches.

Other medicines

There are also a range of other medicines that may be used to reduce tics and treat associated conditions.

These include:

• clonidine – a medicine that can help reduce tics and treat symptoms of attention deficit hyperactivity disorder (ADHD) at the same time
• tetrabenazine – a medicine that can reduce tics in people with an underlying condition that causes rapid, repetitive movements, such as Huntington's disease
• botulinum toxin injections – these can be given into particular muscles to relax them and prevent tics, although the effect usually only lasts up to 3 months

These treatments each carry a risk of side effects. Speak to a doctor about this if you have any concerns.

Surgery

A type of surgery called deep brain stimulation has been used in a few cases of severe Tourette's syndrome.

It involves placing 1 or more electrodes (small metallic discs) in an area of your brain associated with tics.

The electrodes are placed using fine needles passed through small holes in your skull. This is done while you're asleep (under general anaesthetic).

Thin wires run from the electrodes to a pulse generator (a device similar to a pacemaker), which is placed under the skin of your chest. This gives out an electric current to help regulate the signals in your brain and control your tics.

There are still uncertainties about how effective and safe it is, so it is only considered in a small number of adults who have severe tics that have not responded to other treatments.