Abstract
Objective To make recommendations on the assessment and management of tics in people with Tourette syndrome and chronic tic disorders.
Methods A multidisciplinary panel consisting of 9 physicians, 2 psychologists, and 2 patient representatives developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine–compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence.
Results Forty-six recommendations were made regarding the assessment and management of tics in individuals with Tourette syndrome and chronic tic disorders. These include counseling recommendations on the natural history of tic disorders, psychoeducation for teachers and peers, assessment for comorbid disorders, and periodic reassessment of the need for ongoing therapy. Treatment options should be individualized, and the choice should be the result of a collaborative decision among patient, caregiver, and clinician, during which the benefits and harms of individual treatments as well as the presence of comorbid disorders are considered. Treatment options include watchful waiting, the Comprehensive Behavioral Intervention for Tics, and medication; recommendations are provided on how to offer and monitor these therapies. Recommendations on the assessment for and use of deep brain stimulation in adults with severe, treatment-refractory tics are provided as well as suggestions for future research.
Glossary
- AAN=
- American Academy of Neurology;
- ADHD=
- attention-deficit/hyperactivity disorder;
- CBD=
- cannabidiol;
- CBIT=
- Comprehensive Behavioral Intervention for Tics;
- CBT=
- cognitive behavioral therapy;
- DBS=
- deep brain stimulation;
- DSM-5=
- Diagnostic and Statistical Manual of Mental Disorders, 5th edition;
- EVID=
- evidence-based conclusions from the systematic review;
- HRT=
- habit reversal training;
- INFER=
- deductive inferences from other premises;
- OCD=
- obsessive-compulsive disorder;
- PRIN=
- generally accepted principles of care;
- RELA=
- strong evidence from related conditions;
- THC=
- δ-9-tetrahydrocannabinol;
- TS=
- Tourette syndrome;
- VMAT2=
- vesicular monoamine transporter type 2
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Approved by the Guideline Development, Dissemination, and Implementation Subcommittee on July 29, 2017; by the AAN Practice Committee on October 15, 2018; and by the AAN Institute Board of Directors on February 12, 2019.
This guideline was endorsed by the Child Neurology Society on September 4, 2018, and the European Academy of Neurology on September 5, 2018.
See page 907
Podcast: NPub.org/q4jl9p
- Received June 15, 2018.
- Accepted in final form November 21, 2018.
- © 2019 American Academy of Neurology
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