Skip to main content Accessibility help
Hostname: page-component-55597f9d44-mm7gn Total loading time: 0.659 Render date: 2022-08-16T02:45:39.563Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true } hasContentIssue true

Gilles de la Tourette syndrome as a paradigmatic neuropsychiatric disorder

Published online by Cambridge University Press:  21 May 2018

Andrea E. Cavanna*
Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, UK Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and University College London, London, UK School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, UK
*Address for correspondence: Prof. Andrea E. Cavanna, MD, PhD, FRCP, FANPA, Department of Neuropsychiatry, The National Centre for Mental Health, 25 Vincent Drive, Birmingham B15 2FG, United Kingdom. (Email:


Gilles de la Tourette syndrome is a chronic and complex tic disorder accompanied by specific behavioral problems in the majority of patients. With its multifaceted interplay between motion and emotion, this condition is a paradigmatic example of the science and art of clinical neuropsychiatry. This review article encompasses the clinical phenomenology of motor and vocal tics and associated sensory experiences (premonitory urges), as well as the behavioral spectrum of the most common comorbidities, including obsessive-compulsive disorder, attention-deficit and hyperactivity disorder, affective symptoms, and impulsivity. Knowledge of the contributions of both tics and behavioral problems to patients’ health-related quality of life across the lifespan should assist treating clinicians in formulating a targeted management plan. Although the exact pathophysiology of Gilles de la Tourette syndrome remains elusive, research into therapeutic interventions has expanded the range of available interventions across multiple domains. A thorough understanding of the neurology and psychiatry of this condition is of key importance to meet the needs of this patient population, from the formulation of an accurate diagnosis to the implementation of effective treatment strategies.

Review Articles
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


1. Cavanna, AE, Seri, S. Tourette’s syndrome. BMJ. 2013; 347: f4964.CrossRefGoogle ScholarPubMed
2. Hallett, M. Tourette syndrome: update. Brain Dev. 2015; 37(7): 651655.CrossRefGoogle ScholarPubMed
3. Ganos, C, Martino, D. Tics and Tourette syndrome. Neurol Clin. 2015; 33(1): 115136.CrossRefGoogle ScholarPubMed
4. Rickards, H, Cavanna, AE. Gilles de la Tourette: the man behind the syndrome. J Psychosom Res. 2009; 67(6): 469474.CrossRefGoogle ScholarPubMed
5. McNaught, KS, Mink, JW. Advances in understanding and treatment of Tourette syndrome. Nat Rev Neurol. 2011; 7(12): 667676.CrossRefGoogle ScholarPubMed
6. Robertson, MM, Eapen, V, Cavanna, AE. The international prevalence, epidemiology and clinical phenomenology of Tourette syndrome: a cross-cultural perspective. J Psychosom Res. 2009; 67(6): 475483.CrossRefGoogle ScholarPubMed
7. Scharf, JM, Miller, LL, Gauvin, CA, Alabiso, J, Mathews, CA, Ben-Shlomo, Y. Population prevalence of Tourette syndrome: a systematic review and meta-analysis. Mov Disord. 2015; 30(2): 221228.CrossRefGoogle ScholarPubMed
8. Cohen, SC, Leckman, JF, Bloch, MH. Clinical assessment of Tourette syndrome and tic disorders. Neurosci Biobehav Rev. 2013; 37(6): 9971007.CrossRefGoogle ScholarPubMed
9. Ganos, C, Ogrzal, T, Schnitzler, A, Münchau, A. The pathophysiology of echopraxia/echolalia: relevance to Gilles de la Tourette syndrome. Mov Disord. 2012; 27(10): 12221229.CrossRefGoogle ScholarPubMed
10. Eddy, CM, Cavanna, AE. “It’s a curse!”: coprolalia in Tourette syndrome. Eur J Neurol. 2013; 20(11): 14671470.Google ScholarPubMed
11. Freeman, RD, Zinner, SH, Müller-Vahl, KR, et al. Coprophenomena in Tourette syndrome. Dev Med Child Neurol. 2009; 51(3): 218227.CrossRefGoogle ScholarPubMed
12. Ganos, C, Edwards, MJ, Müller-Vahl, K. “I swear it is Tourette’s!”: on functional coprolalia and other tic-like vocalizations. Psychiatry Res. 2016; 246: 821826.CrossRefGoogle ScholarPubMed
13. Afshangian, F, Nami, M, Abolhasani Foroughi, A, et al. BLAS2T (Bilingual Aphasia in Stroke-Study Team). Coprolalia in aphasic patients with stroke: a longitudinal observation from the BLAS2T database. Neurocase. 2017; 23(5–6): 249262.CrossRefGoogle ScholarPubMed
14. Kwak, C, Dat Vuong, K, Jankovic, J. Premonitory sensory phenomenon in Tourette’s syndrome. Mov Disord. 2003; 18(12): 15301533.CrossRefGoogle ScholarPubMed
15. Leckman, JF, Bloch, MH, Scahill, L, King, RA. Tourette syndrome: the self under siege. J Child Neurol. 2006; 21(8): 642649.CrossRefGoogle ScholarPubMed
16. Crossley, E, Cavanna, AE. Sensory phenomena: clinical correlates and impact on quality of life in adult patients with Tourette syndrome. Psychiatry Res. 2013; 209(3): 705710.CrossRefGoogle ScholarPubMed
17. Ganos, C, Garrido, A, Navalpotro-Gómez, I, et al. Premonitory urge to tic in Tourette’s is associated with interoceptive awareness. Mov Disord. 2015; 30(9): 11981202.CrossRefGoogle ScholarPubMed
18. Bloch, MH, Leckman, JF. Clinical course of Tourette syndrome. J Psychosom Res. 2009; 67(6): 497501.CrossRefGoogle ScholarPubMed
19. Hassan, N, Cavanna, AE. The prognosis of Tourette syndrome: implications for clinical practice. Funct Neurol. 2012; 27(1): 2327.Google ScholarPubMed
20. Groth, C, Mol Debes, N, Rask, CU, Lange, T, Skov, L. Course of Tourette syndrome and comorbidities in a large prospective clinical study. J Am Acad Child Adolesc Psychiatry. 2017; 56(4): 304312.CrossRefGoogle Scholar
21. Eddy, CM, Cavanna, AE. Altered social cognition in Tourette syndrome: nature and implications. Behav Neurol. 2013; 27(1): 1522.CrossRefGoogle ScholarPubMed
22. Pauls, DL, Fernandez, TV, Mathews, CA, State, MW, Scharf, JM. The inheritance of Tourette disorder: A review. J Obsessive Compuls Relat Disord. 2014; 3(4): 380385.CrossRefGoogle ScholarPubMed
23. Mathews, CA, Scharf, JM, Miller, LL, Macdonald-Wallis, C, Lawlor, DA, Ben-Shlomo, Y. Association between pre- and perinatal exposures and Tourette syndrome or chronic tic disorder in the ALSPAC cohort. Br J Psychiatry. 2014; 204(1): 4045.CrossRefGoogle ScholarPubMed
24. Martino, D, Zis, P, Buttiglione, M. The role of immune mechanisms in Tourette syndrome. Brain Res.. 2015; 1617: 126143.CrossRefGoogle ScholarPubMed
25. Leckman, JF, Bloch, MH, Smith, ME, Larabi, D, Hampson, M. Neurobiological substrates of Tourette’s disorder. J Child Adolesc Psychopharmacol. 2010; 20(4): 237247.CrossRefGoogle ScholarPubMed
26. Yael, D, Vinner, E, Bar-Gad, I. Pathophysiology of tic disorders. Mov Disord. 2015; 30(9): 11711178.CrossRefGoogle ScholarPubMed
27. Cavanna, AE, Black, KJ, Hallett, M, Voon, V. Neurobiology of the premonitory urge in Tourette’s syndrome: pathophysiology and treatment implications. J Neuropsychiatry Clin Neurosci. 2017; 29(2): 95104.CrossRefGoogle ScholarPubMed
28. Cavanna, AE, Rickards, H. The psychopathological spectrum of Gilles de la Tourette syndrome. Neurosci Biobehav Rev. 2013; 37(6): 10081015.CrossRefGoogle ScholarPubMed
29. Martino, D, Ganos, C, Pringsheim, TM. Tourette syndrome and chronic tic disorders: the clinical spectrum beyond tics. Int Rev Neurobiol. 2017; 134: 14611490.CrossRefGoogle ScholarPubMed
30. Lombroso, PJ, Scahill, L. Tourette syndrome and obsessive-compulsive disorder. Brain Dev. 2008; 30(4): 231237.CrossRefGoogle ScholarPubMed
31. Eddy, CM, Cavanna, AE. Tourette syndrome and obsessive compulsive disorder: compulsivity along the continuum. J Obsessive Compuls Relat Disord. 2014; 3(4): 363371.CrossRefGoogle Scholar
32. Mansueto, CS, Keuler, DJ. Tic or compulsion? It’s Tourettic OCD. Behav Modif. 2005; 29(5): 784799.CrossRefGoogle ScholarPubMed
33. Ganos, C, Martino, D, Pringsheim, T. Tics in the pediatric population: pragmatic management. Mov Disord Clin Pract. 2017; 4(2): 160172.CrossRefGoogle ScholarPubMed
34. Coffey, BJ. Complexities for assessment and treatment of co-occurring ADHD and tics. Curr Dev Disord Rep. 2015; 2(4): 293299.CrossRefGoogle Scholar
35. Robertson, MM. Mood disorders and Gilles de la Tourette’s syndrome: an update on prevalence, etiology, comorbidity, clinical associations, and implications. J Psychosom Res. 2006; 61(3): 349358.CrossRefGoogle ScholarPubMed
36. Frank, MC, Piedad, J, Rickards, H, Cavanna, AE. The role of impulse control disorders in Tourette syndrome: an exploratory study. J Neurol Sci. 2011; 310(1–2): 276278.CrossRefGoogle Scholar
37. Kompoliti, K, Goetz, CG, Morrissey, M, Leurgans, S. Gilles de la Tourette syndrome: patient’s knowledge and concern of adverse effects. Mov Disord. 2006; 21(2): 248252.CrossRefGoogle ScholarPubMed
38. Kern, JK, Geier, DA, King, PG, Sykes, LK, Mehta, JA, Geier, MR. Shared brain connectivity issues, symptoms, and comorbidities in autism spectrum disorder, attention deficit/hyperactivity disorder, and Tourette syndrome. Brain Connect. 2015; 5(6): 321335.CrossRefGoogle ScholarPubMed
39. Trillini, MO, Müller-Vahl, KR. Patients with Gilles de la Tourette syndrome have widespread personality differences. Psychiatry Res. 2015; 228(3): 765773.CrossRefGoogle ScholarPubMed
40. Darrow, SM, Hirschtritt, ME, Davis, LK, et al. Tourette Syndrome Association International Consortium for Genetics. Identification of two heritable cross-disorder endophenotypes for Tourette syndrome. Am J Psychiatry. 2017; 174(4): 387396.CrossRefGoogle ScholarPubMed
41. Eddy, CM, Cavanna, AE, Gulisano, M, Calì, P, Robertson, MM, Rizzo, R. The effects of comorbid obsessive-compulsive disorder and attention-deficit hyperactivity disorder on quality of life in Tourette syndrome. J Neuropsychiatry Clin Neurosci. 2012; 24(4): 458462.CrossRefGoogle ScholarPubMed
42. Cavanna, AE, Schrag, A, Morley, D, et al. The Gilles de la Tourette Syndrome-Quality of Life scale (GTS-QOL): development and validation. Neurology. 2008; 71(18): 14101416.CrossRefGoogle ScholarPubMed
43. Su, MT, McFarlane, F, Cavanna, AE, et al. The English version of the Gilles de la Tourette Syndrome-Quality of Life Scale for children and adolescents (C&A-GTS-QOL): a validation study in the United Kingdom. J Child Neurol. 2017; 32(1): 7683.CrossRefGoogle Scholar
44. Cavanna, AE, David, K, Bandera, V, et al. Health-related quality of life in Gilles de la Tourette syndrome: a decade of research. Behav Neurol. 2013; 27(1): 8393.CrossRefGoogle Scholar
45. Kurlan, RM. Treatment of Tourette syndrome. Neurotherapeutics. 2014; 11(1): 161165.CrossRefGoogle ScholarPubMed
46. Frank, M, Cavanna, AE. Behavioural treatments for Tourette syndrome: an evidence-based review. Behav Neurol. 2013; 27(1): 105117.CrossRefGoogle Scholar
47. Wile, DJ, Pringsheim, TM. Behavior therapy for Tourette syndrome: a systematic review and meta-analysis. Curr Treat Options Neurol. 2013; 15(4): 385395.CrossRefGoogle ScholarPubMed
48. Fründt, O, Woods, D, Ganos, C. Behavioral therapy for Tourette syndrome and chronic tic disorders. Neurol Clin Pract. 2017; 7(2): 148156.CrossRefGoogle ScholarPubMed
49. Piacentini, J, Woods, DW, Scahill, L, et al. Behavior therapy for children with Tourette disorder: a randomized controlled trial. JAMA. 2010; 303(19): 19291937.CrossRefGoogle ScholarPubMed
50. Wilhelm, S, Peterson, AL, Piacentini, J, et al. Randomized trial of behavior therapy for adults with Tourette syndrome. Arch Gen Psychiatry. 2012; 69(8): 795803.CrossRefGoogle ScholarPubMed
51. Dutta, N, Cavanna, AE. Effectiveness of habit reversal therapy in the treatment of Tourette syndrome and other chronic tic disorders: a systematic review. Funct Neurol. 2013; 28(1): 712.Google ScholarPubMed
52. Waldon, K, Hill, S, Termine, C, Balottin, U, Cavanna, AE. Trials of pharmacological interventions for Tourette syndrome: a systematic review. Behav Neurol. 2013; 26(4): 265273.CrossRefGoogle ScholarPubMed
53. Tourette’s Syndrome Study Group. Treatment of ADHD in children with tics: a randomized controlled trial. Neurology. 2002; 58(4): 527536.CrossRefGoogle Scholar
54. Jankovic, J, Jimenez-Shahed, J, Brown, LW. A randomised, double-blind, placebo-controlled study of topiramate in the treatment of Tourette syndrome. J Neurol Neurosurg Psychiatry. 2010; 81(1): 7073.CrossRefGoogle ScholarPubMed
55. Masi, G, Pfanner, C, Brovedani, P. Antipsychotic augmentation of selective serotonin reuptake inhibitors in resistant tic-related obsessive-compulsive disorder in children and adolescents: a naturalistic comparative study. J Psych Res. 2013; 47(8): 10071012.CrossRefGoogle ScholarPubMed
56. Erenberg, G. The relationship between Tourette syndrome, attention deficit hyperactivity disorder, and stimulant medication: a critical review. Semin Pediatr Neurol. 2005; 12(4): 217221.CrossRefGoogle ScholarPubMed
57. Cohen, SC, Mulqueen, JM, Ferracioli-Oda, E, et al. Meta-analysis: risk of tics associated with psychostimulant use in randomized, placebo-controlled trials. J Am Acad Child Adolesc Psychiatry. 2015; 54(9): 728736.CrossRefGoogle ScholarPubMed
58. Baldermann, JC, Schüller, T, Huys, D, et al. Deep brain stimulation for Tourette syndrome: A systematic review and meta-analysis. Brain Stimul. 2016; 9(2): 296304.CrossRefGoogle ScholarPubMed
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Gilles de la Tourette syndrome as a paradigmatic neuropsychiatric disorder
Available formats

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Gilles de la Tourette syndrome as a paradigmatic neuropsychiatric disorder
Available formats

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Gilles de la Tourette syndrome as a paradigmatic neuropsychiatric disorder
Available formats

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *