Tic disorders are usually only treated with medication if they cause pain, sleep problems, reduced performance or psychological stress. Unfortunately, there is no causal treatment, but there are drugs that achieve symptomatic improvement. This leads to an alleviation of the symptoms, which reduces the stress. However, a complete suppression of the tics is usually not possible. The principle of therapy is based on dopamine blockers, which balance the excess of dopamine in the basal ganglia.
Typical drugs would be
- Tiapride (Delpral®), sulpiride
- Haloperidol (Haldol®)
- risperidone (Risperdal®)
- tetrabenazine, topiramate, THC
The substance class of dopamine blockers can often cause hormonal disturbances, which can manifest themselves, for example, in loss of menstruation, orgasmic disturbances, breast pain and breast swelling, breast growth in men (gynecomastia), milk production and potency disorders. These side effects are usually reversible after discontinuation.
Furthermore, Parkinson's-like symptoms may occur, such as hand tremors, muscle stiffness, lack of movement, and increased salivation.
Other side effects include.
- drowsiness, listlessness, lack of strength
- restlessness, insomnia
- confusion, hallucinations
- dizziness, headache
Irrespective of drug treatment, psychoeducation of those affected and their relatives is particularly important. Through counseling and education, the disease can be better understood and thus the psychological and social burden can be reduced. Often, this measure alone can lead to sufficient coping with the disease. In more severe cases, additional behavioral therapy methods can be used. Habit Reversal Training" (HRT) strengthens the early recognition of tics so that they can be counteracted, for example, by muscle tension. Exposure and Response Prevention Training" (ERPT), i.e. reaction avoidance training, attempts to break through the tic reaction to the unpleasant pre-existing sensation.
Other approaches rely on relaxation techniques. In Jakobsen's progressive muscle relaxation, for example, various muscle groups are tensed and then relaxed again, ultimately relaxing the person psychologically. For all psychotherapeutic methods, it is important to consider the age of the person affected. Especially when the disease begins in childhood, it can happen that the children are still too young to implement the therapeutic approaches.
In very rare cases, neurosurgical treatment by deep brain stimulation can be used.
It is also important to treat comorbidities, or co-occurring disorders. These include ADHD or obsessive-compulsive disorder, both of which can be treated using various psychotherapeutic approaches. Psychostimulant drugs are also available for ADHD symptoms, such as methylphenidate (Ritalin®, Concerta®). Antidepressants are used for obsessive-compulsive disorders.