Determining if Treatment is Needed
In cases where symptoms are mild, treatment for TS is usually limited to education. Medical treatment is considered when symptoms cause psychological distress or physical pain, or interfere with social, academic or professional functioning. While there is no cure for TS, behavioural therapy or medication can help with symptom management.
Cognitive or Comprehensive Behavioural Intervention for Tics (CBIT)
CBIT (pronounced see-bit) combines six strategic therapeutic components in the form of a clinically-proven comprehensive non-medication therapy to help a child (person) with Tourette Syndrome manage their tics. CBIT employs techniques used in Cognitive Behavioural Therapy (CBT) along with traditional Habit Reversal techniques (HRT)
That a behavioural treatment helps reduce tic severity is a step forward and reflects modern understanding of how the brain, through brain plasticity, can be shaped by the environment. CBIT focuses on increasing a person’s awareness of their tics, understanding and managing the environmental factors that influence their tics, and teaching them how to perform a competing response that effectively blocks the tic when they sense that the tic is about to happen. Strong evidence suggests that this form of treatment is effective that can be an option to consider as a way to help manage tic symptoms.
CBIT is not a cure, and does not eradicate tics, but rather allows the individual to gain better control over symptoms by managing factors that cause tics. This treatment requires active participation from the patient and tolerance of distress, so it may not be suitable for everyone. It also requires the patient to be aware of their tics, so it may be ineffective for children younger than age nine.
Tourette Canada along with other Tourette advocacy groups are providing training for qualified medical practitioners to provide CBIT for their patients. Information about training, or currently trained practitioners can be obtained by contacting Tourette Canada.
It is hoped that in the near future, other means of delivering CBIT may become available for individuals who don’t have access to a locally trained practitioner.
There are a number of different medications that may be prescribed to an individual with TS. Not every medication is effective for everyone and it may take some time to find the right medication and dosage. To learn about possible medication side effects or whether a medication is recommended for tics, see the Canadian Guidelines for the Evidence-based Treatment of Tourette Syndrome. You can download a free PDF copy from our website.
Botulinum Toxin Injection (Botox)
Botox injections have been used to treat both vocal and motor tics. There is anecdotal evidence that this treatment is effective, however it has only been the subject of a few well-designed studies. As a result, Botox injections are given a weak recommendation in the current Canadian treatment guidelines for TS. Botox can only treat tics in a specific area of the body rather than all of an individual’s tics because of technical and dose limitations. The effects of the injection(s) wear off over time, in approximately three to six months. Other limitations include the cost of the treatment and availability of individuals with the expertise needed to administer it properly.
Transcranial Magnetic Stimulation (TMS)
Repetitive Transcranial Magnetic Stimulation (TMS) is a new experimental procedure being tested as a potential treatment for TS. Doctors place an electromagnet on the scalp over the supplementary motor area and activate the magnet for short periods, sending pulses of magnetic waves into the brain. The goal is to help to reduce tics by altering the rhythms in the brain. While the treatment is noninvasive, a risk of seizures exists, particularly if someone has had seizures in the past. This treatment is costly and not widely available. According to the Canadian Guidelines for the Evidence-based Treatment of Tourette Syndrome, there is currently no good evidence to support the use of TMS in the treatment of TS.
Deep Brain Stimulation
For a small number of people with TS, their tics are extremely severe, significantly and negatively impact their quality of life and are resistant to medication. For these individuals, a relatively new surgical approach, called Deep Brain Stimulation (DBS), could be a potential treatment. DBS refers to the direct delivery of an electric pulse to the brain to help moderate abnormal signals associated with TS. The electric pulse comes from an electrode that is implanted in the brain and connected to a pulse generator via a cable or lead. The lead and generator are also surgically implanted in the body, with the lead running down the neck and skull, and over the collarbone with the pulse generator sitting in the upper chest. DBS is controversial partly because it’s so new (not a lot of studies or cases exist) and partly due to questions about side effects and effectiveness. The Canadian Guidelines for the Evidence-based Treatment of Tourette Syndrome rates DBS as having insufficient evidence to make a formal recommendation for adults and is not recommended for children.
Dental Appliance (Occlusal Splint)
There is some anecdotal evidence that a removable mouthpiece or dental appliance helps to reduce tic severity. While no published studies exist supporting the use of this device for TS, its effectiveness in reducing tic severity in children is currently being studied.
Massage therapies, chiropractic therapy and acupuncture have been used to help relieve pain or soreness resulting from tics. Little research or studies are available on the efficacy of these treatments in treating TS symptoms.
Some evidence suggests that exercise can help reduce tic symptoms. Relaxation exercises and meditation may have similar beneficial effects as stress often exacerbates tics.
Some individuals modify their diets or take supplements to help manage their symptoms. Very little research has been done on in this area, and any individual considering taking supplements for this purpose is advised to consult their doctor first.