Tourette Syndrome is a neurological condition characterized by tics, which are sudden, repetitive movements or sounds an individual cannot easily control. While often identified in childhood, tics can emerge or persist into adulthood. A diagnosis of Tourette Syndrome or another chronic tic disorder may be made later in life, though adult-onset tics often involve different considerations than those beginning in childhood.
Typical Onset of Tourette Syndrome
Tourette Syndrome is a developmental disorder, with tics typically appearing between ages 5 and 10 years. Most cases (90-95%) show tic onset between 4 and 13 years. Simple motor tics, such as eye blinking, nose twitching, or facial grimaces, are often the first to emerge.
Tic severity often peaks in early to mid-adolescence, around ages 10 to 12 years. Many individuals then experience a decrease in tic severity during late adolescence and adulthood. About half to two-thirds of children with Tourette Syndrome show significant improvement or even remission of their tic symptoms by adulthood.
Understanding Adult-Onset Tics
While tics can appear for the first time in adults, adult-onset Tourette Syndrome, where diagnostic criteria are met without a known cause, is rare compared to childhood onset. When tics develop in adulthood, it is important to distinguish between adult-onset Tourette Syndrome and secondary tics.
Secondary tics develop in adulthood due to underlying medical conditions, certain medications, or neurological disorders. Neurological conditions like stroke, Huntington’s disease, or Parkinson’s disease can lead to tics. Infections, including post-streptococcal infections or various types of encephalitis, may also cause them.
Certain medications can induce tics in adults. Stimulants, some antipsychotics, and antidepressants are associated with their appearance or worsening. Head trauma is another potential cause, with tics sometimes developing weeks or up to a year after a brain injury.
Other psychiatric conditions, such as functional neurological disorder (FND), can manifest with tic-like movements. Functional tics often have a sudden onset, commonly appearing in mid-teens or young adulthood, and are observed more frequently in females. These movements can be more elaborate and noticeable, often without the premonitory urges typical of Tourette Syndrome tics.
Diagnosis and Management in Adults
Diagnosing tics in adults requires a comprehensive evaluation due to varied causes. A thorough medical history and neurological examination are performed to identify or rule out secondary causes. This often involves additional tests, such as neuroimaging (e.g., MRI) or blood tests, to investigate potential underlying conditions.
A diagnosis of adult-onset Tourette Syndrome is made only after other possible medical conditions or substance-induced causes for tics have been excluded. Management approaches are tailored to the individual and the underlying cause. If secondary tics are identified, addressing the primary condition or adjusting medications is a primary step.
For tics causing significant impairment, various management strategies are available. Education and counseling help individuals understand their condition and coping mechanisms. Behavioral therapies, such as Comprehensive Behavioral Intervention for Tics (CBIT), are effective for adults, involving training in tic awareness, competing responses, and managing triggers. Medications may be considered if behavioral therapies are insufficient. These include alpha-2 adrenergic agonists (e.g., clonidine, guanfacine) or, in some cases, antipsychotics (e.g., risperidone, aripiprazole), used cautiously due to potential side effects. Botox injections can also be used for specific, localized tics.