Movement Disorders: Tics and Tourette's Disorder

Tourette's disorder (TD) is a complex neuropsychiatric disorder with a heterogeneous phenotype characterized by core disinhibition mediated by the cortico-striato-thalamo-cortical tracts. TD is genetically determined in most cases. There is a growing appreciation and understanding of the role of psychiatric comorbidity in the diverse clinical presentation and impact on quality of life in those affected. Treatment strategies should be multimodal in nature, and include pharmacotherapy and, where indicated, behavior, individual, and family intervention and educational monitoring. Prospective longitudinal studies and randomized clinical trials have advanced our understanding of several models of pathogenesis and the evidence base regarding novel treatment options. However, further investigation is needed to better understand the phenomenology, developmental psychopathology, and treatment of this complex disorder. This chapter reviews the following: classification and clinical phenomenology, clinical course, psychiatric comorbidity, genetic findings, etiology, and pathophysiology, pediatric autoimmune neuropsychiatric disorders associated with Streptococcus (PANDAS), differential diagnosis, clinical evaluation, and treatment of Tourette's disorder.