While there is no cure for Tourette syndrome today, there are a number of treatments that can be offered to patients to alleviate the tics and associated symptoms, and help people affected by this syndrome to live better with it on a daily basis.
Patient care is multidisciplinary, involving a team of specialists who approach the disease from different angles. The team generally comprises neurologists, psychiatrists, neuropsychologists, clinical psychologists, speech therapists and psychomotor therapists. It also includes social workers whose role is to adapt the school or work environment and minimise the psychosocial consequences of the disease, as well as the repercussions at school, such as repeating a year or dropping out, or redundancies.
Multidisciplinary treatment will enable people suffering from Tourette syndrome to benefit from complementary strategies, in addition to medication, to alleviate all the difficulties encountered on a day-to-day basis.
Firstly, cognitive-behavioural therapies enable patients to reduce their tics considerably or make them disappear by means of exercises practised very regularly over a short period. The aim of these exercises is to deconstruct the association between the sensation that precedes the onset of the tic (premonitory sensation) and the occurrence of the tic, so that the urge to tic eventually disappears. To date, there are two scientifically validated techniques. The first, which has been widely used in the English-speaking world for over thirty years, consists of implementing a movement that is incompatible with the tic as soon as the person feels the urge to tick: this is a habit reversal. The second, developed more recently in Europe, has the same objective, using so-called third-wave methods: relaxation, acceptance and mental imagery. The results obtained with this second technique seem even more promising, although the number of scientific publications is smaller. Unfortunately, these techniques are still not widely known by professionals in France. One of the centre’s aims is to disseminate them to a wide network of professionals through regular training courses.
In addition, psychological support is often very beneficial for these patients, particularly given their young age, to boost their self-esteem and the coping strategies that enable them to live better with the symptoms of the disease.
In the case of associated learning difficulties, speech therapy and/or psychomotor therapy are essential to provide patients with the best possible support in their schooling and optimise their chances of success.
Finally, the contribution of the social worker is essential for many patients, giving them access to crucial information about school or work arrangements, the help available if they find it difficult to work, and support in accessing treatment.
If behavioural and cognitive therapy is not effective enough, it can be supplemented by serotonin reuptake inhibitors.
At the Pitié-Salpêtrière hospital, the Gilles de la Tourette syndrome reference centre, coordinated by Dr HARTMANN, neurologist at the Pitié-Salpêtrière hospital and researcher at the Institut du Cerveau offers patients appropriate, multidisciplinary care.
“Since the creation of the reference centre, our efforts have focused on three methodological areas: behaviour and cognition, brain imaging and genetics. We are also trying to combine these approaches in the hope of gaining a better understanding of the aetiology (causes) and pathophysiology (mechanisms) of GTS, and ultimately proposing new treatments. Among these, we are working to develop behavioural therapies in France for the treatment of tics, such as exposure with response prevention (ERP) and habit reversal. We have also been running an ambitious programme of deep brain stimulation for over a decade. We regularly invite our patients and their families to take part in this research. We are an active member of the European Society for the Study of Tourette Syndrome (ESSTS), which was set up in 2008. Several collaborative and federative projects have emerged as a result, partly funded by the EU. At a global level, we are participating in consortia in genetics and neurosurgery.
If you are interested in taking part in research protocols, either as a patient or as a healthy volunteer, please contact our clinical research officer, Ms Prasanthi JEGATHEESAN: prasanthi.jegatheesan@aphp.fr
Personalised, multidisciplinary treatment
In addition to medication, multidisciplinary treatment is essential for patients suffering from Tourette syndrome. Psychological support is very important, so that patients can discuss the difficulties they face on a daily basis, particularly because of their young age, and try to find solutions. People with Tourette syndrome can also benefit from relaxation techniques. Follow-up speech therapy is also part of the treatment, and can have a real impact on sound tics and learning difficulties.
Deep brain stimulation (DBS) offers considerable therapeutic promise in the treatment of drug-resistant tics. The indication for surgery is established by a multidisciplinary team on the basis of international and national consensus criteria, which are constantly evolving.
Researchers and clinicians at the Institut du Cerveau have pioneered the use of deep brain stimulation in Tourette syndrome.
At the Paris Brain Institute
- 3 research teams are working with the hospital’s centre of reference on deep stimulation projects for Tourette’s syndrome:
“Mov’It: Movement, Investigations, Therapy. Normal and abnormal movement: physiopathology and experimental therapy”, directed by Profs Marie VIDAILHET and Stéphane LEHERICY.
“Experimental neurosurgery” led by Dr Carine KARACHI and Dr Brian LAU
“Neurophysiology of Repetitive Behaviour, led by Eric BURGUIERE.
The results of these teams’ research showed a beneficial effect of stimulation of the anterior part of the internal globus pallidus, a structure of the basal ganglia, in 16 patients suffering from Tourette’s syndrome who were resistant to treatment. A second study, this time involving data from 185 patients treated with deep brain stimulation for Tourette’s syndrome, provided further positive evidence for the use of this technique after one year, despite the variability of results. The challenge now is to observe the effects over the longer term.