Tourette syndrome and tic disorders: a decade of progress.
OBJECTIVE
This is a review of progress made in the understanding of Tourette syndrome (TS) during the past decade including models of pathogenesis, state-of-the-art assessment techniques, and treatment.


METHODS
Computerized literature searches were conducted under the key words "Tourette syndrome," "Tourette disorder," and "tics." Only references from 1996-2006 were included.


RESULTS
Studies have documented the natural history of TS and the finding that tics usually improve by the end of the second decade of life. It has also become clear that TS frequently co-occurs with attention-deficit/hyperactivity disorder), obsessive-compulsive disorder, and a range of other mood and anxiety disorders. These comorbid conditions are often the major source of impairment for the affected child. Advances have also been made in understanding the underlying neurobiology of TS using in vivo neuroimaging and neurophysiology techniques. Progress on the genetic front has been less rapid. Proper diagnosis and education (involving the affected child and his or her parents, teachers, and peers) are essential prerequisites to the successful management of children with TS. When necessary, modestly effective antitic medications are available, although intervening to treat the comorbid attention-deficit/hyperactivity disorder and/or obsessive-compulsive disorder is usually the place to start.


CONCLUSIONS
Prospective longitudinal studies and randomized clinical trials have led to the refinement of several models of pathogenesis and advanced our evidence base regarding treatment options. However, fully explanatory models are needed that would allow for more accurate prognosis and the development of targeted and efficacious treatments.
Drs. Swain, Scahill, Lombroso, King, and Leckman are with the Child Study Center of Yale University, New Haven, CT; and Dr. Scahill is also with the School of Nursing at Yale University.. Electronic address: james.leckman@yale.edu.
James E
JE
Swain
Drs. Swain, Scahill, Lombroso, King, and Leckman are with the Child Study Center of Yale University, New Haven, CT; and Dr. Scahill is also with the School of Nursing at Yale University.
Lawrence
L
Scahill
Drs. Swain, Scahill, Lombroso, King, and Leckman are with the Child Study Center of Yale University, New Haven, CT; and Dr. Scahill is also with the School of Nursing at Yale University.
Paul J
PJ
Lombroso
Drs. Swain, Scahill, Lombroso, King, and Leckman are with the Child Study Center of Yale University, New Haven, CT; and Dr. Scahill is also with the School of Nursing at Yale University.
Robert A
RA
King
Drs. Swain, Scahill, Lombroso, King, and Leckman are with the Child Study Center of Yale University, New Haven, CT; and Dr. Scahill is also with the School of Nursing at Yale University.
James F
JF
Leckman
D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology; D015897:Comorbidity; D003937:Diagnosis, Differential; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000453:epidemiology; D006801:Humans; D013981:Tic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D005879:Tourette Syndrome / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology