The current concepts of Tourette syndrome, including research diagnostic criteria formulated by a workshop sponsored by the Tourette Syndrome Association, are reviewed from the Department of Neurology, University of Rochester School of Medicine, Rochester, NY. The author concludes that Tourette syndrome is a common, hereditary, neurobehavioral disorder with heterogeneous clinical manifestations. Chronic multiple motor or phonic tic disorder and transient tic disorder represent milder variants of the same illness. Behavioral disorders such as obsessive compulsive disorder and attention deficit disorder with hyperactivity occur in 50% of patients and may represent the predominant or only clinical manifestation of the illness. Diagnostic criteria for Tourette syndrome in the DSM-IIIR include 1) multiple motor tics, 2) one or more vocal tics, 3) onset before 21 years of age, and 4)duration more than one year. The Tourette Syndrome Association Workshop participants divided tic disorders into 11 categories: 1) definite Tourette syndrome, 2) Tourette syndrome by history, 3) definite chronic multiple motor or phonic tic disorder, 4) chronic multiple motor or phonic tic disorder by history, 5) chronic single motor or phonic tic disorder by history, 6) definite transient tic disorder, 7) transient tic disorder by history, 8) definite nonspecific tic disorder, 9) nonspecific tic disorder by history, 10) definite tic disorder diagnosis deferred until followed for one year, 11) probable Tourette syndrome. Causes of associated school problems in Tourette syndrome are as follows: 1) primary Tourette syndrome symptoms, 2) obsessive compulsive behaviors, 3) attention deficit hyperactivity disorder, 4) general behavioral disturbances, 5) associated learning disabilities, 6) poor socialization, 7) low self-esteem, and 8) medication side effects. Genetic factors in etiology are recognized and striatal dopamine receptor supersensitivity is suggested as the likely mechanism for tics. Pharmacotherapy should be considered only when symptoms of Tourette syndrome are functionally disabling and not remediable by nondrug interventions. Most patients with Tourette syndrome can probably be managed well without drug therapy and by educating the patients, family members, and school personnel concerning the nature of Tourette syndrome, restructuring the school environment (one on one tutoring) and supportive therapy. Haloperidol is the most commonly prescribed medication for Tourette syndrome but the “reflex” prescribing of this medication at diagnosis of Tourette syndrome should be avoided. [1]

COMMENT. The author correctly notes that the accurate assessment of drug effectiveness in Tourette syndrome is hampered by the natural waxing and waning course of tics and the strong placebo effect of medications. The author's condoning of a combination of haloperidol and methylphenidate in selected patients with attention deficit disorder complicated by tics, a view shared by his colleague from the same institution [2] may not receive universal acceptance.