Simple vocal tics can include hissing, coughing or barking. Complex vocal tics can involve phrases that interfere with normal speech, sudden slurring of speech, an accent, or inappropriate emphasis on a word. The most distressing symptom of Tourette syndrome is coprolalia, where foul or “dirty” words are used during normal speech. The language may include sexual or racial insults, which are not intended to offend but appear suddenly in speech. Although coprolalia affects fewer than 15% of people with Tourette syndrome, a common misconception is that all sufferers display this symptom.

Some people may also have a tendency to mimic another person’s actions or repeat their own speech or sounds involuntarily. The frequency of tics varies greatly. Some people are able to suppress their symptoms while at school or work, but this often means that the tics will then occur at a distressing level once the person reaches home. If the tics are multiple and severe, they may occur constantly while the person is awake. Besides the problems caused by the physical movements, problems such as social isolation may also arise. The symptoms can cause social embarrassment and vocational or academic failure.

In some people Tourette syndrome may be accompanied by behavioral problems, such as: obsessive-compulsive behavior; manic depressive disorders; schizoid behavior; phobic disorders; autism and Asperger’s syndrome; sexual disorders; learning disorders and dyslexia; alcoholism; or eating disorders.

How is Tourette syndrome treated?
Most people with Tourette syndrome are able to manage without medication. If there are accompanying behavioral problems, one-to-one teaching, counseling and other forms of individual help are all beneficial. If non-drug treatment is not successful and the symptoms of Tourette syndrome are disabling, then medication may be advised. Neuroleptic drugs such as haloperidol or pimozide (Orap) may be prescribed. In some patients other types of medicine such as clonidine (Kapvay) and tetrabenazine (Xenazine) are effective. In patients with obsessive-compulsive symptoms treatment with drugs such as fluoxetine (Prozac), clomipramine (Anafranil), or sertraline (Zoloft) may be helpful. Furthermore, tricyclic antidepressants may be utilized in addition to the following stimulants: methylphenidate (Ritalin) or dextroamphetamine (Dexedrine). The medication should be given in the lowest possible dose needed to suppress the worst of the symptoms. The person may have to tolerate less disabling symptoms—for example, an eye tic is more tolerable than coprolalia. Symptoms may vary over time and if they diminish, the medication should also be altered accordingly. For severe tics, a long-acting (depot) injection of haloperidol (Haldol Decanoate Injection) may be prescribed.

Further information
National Tourette Syndrome Association: www.tsa-usa.org

Last Reviewed: June 2013