Treatment

Tics don't 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 more severe tics can cause issues such asdifficulties at school or social problems if untreated.

Treatments include:

Self-help tips

Behavioural therapies

Medication

Surgery

These treatments are outlined below. You can also read a summary of the pros and cons of the treatments for tics that allows you to compare the options.

Self-help tips

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

• Avoid stress, anxiety and boredom for example, try to find a relaxing and enjoyable activity to do(such as sport or a hobby). Read moreadvice about reducing stress , ways to reduce anxiety and helping an anxious child .
• Avoid becoming too tired try to get agood night's sleep whenever possible. Read some good sleep tips and ways to beat fatigue .
• Try to ignore your child's tic and not talk about it too much drawing attention to it may make it worse.
• Don't 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 outif any help and support is available.

The Tourettes Action website has more information about tips to help you managetics (PDF, 514kb) .

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 your doctor feels therapy might help.

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

• teach you aboutyourcondition
• make you more aware of when your tics occur and identifyany 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

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

The idea is that, over time, you'll get used to this feeling and the need to tic in response will reduce.

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

Medication

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 ofthe 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 too, 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 reducetics andtreat symptoms of attention deficit hyperactivity disorder (ADHD) at the same time
• clonazepam a medicine thatcan help reduce the severity of tics in some people by altering the way that certain chemicals in the brain work
• 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 three months

These treatments eachcarry a risk of side effects. Speak to your 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 .

Itinvolves placing one or more electrodes (small metallic discs) in an area of your brain associated with tics.

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

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.

Researchinto deep brain stimulation for tics has had promising results so far, but the treatment is still fairly new and there haven't been many large studies looking at it.

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