Prognosis

The natural history of TS follows a relatively predictable course, characterized by onset of motor tics between ages 3 and 8 years, followed by vocal tics.[2] The tics typically wax and wane and vary with different day-to-day environmental factors. Tics typically peak in late childhood before puberty, and usually attenuate or remit during and after adolescence.[3] A prospective longitudinal study of 46 children followed until 14 years of age showed that the most severe period of tics occurs at 10 years of age, and that the severity of tics tends to decrease during adolescence.[3] In these patients, the highest severity of OCD symptoms occurred 2 years after the most severe period of tics. ADHD was not associated with the presence or severity of tics or OCD in TS. Of further prognostic interest is that late childhood tic severity is modestly predictive of severity later in life.[127]

Other predictors of tic severity in adulthood have been described, including female sex, smaller caudate volumes, and poorer fine-motor control.[128][129]

In another study, whereas 81% of patients less than 18 years of age required medication, only 41% of patients over 18 years of age were still taking medication.[130] Patients with ADHD may have higher rates of other behavioral disorders, which may be associated with more functional impairment.[2] In a more recent study comparing older adolescents with TS with healthy adolescents in the community, TS patients were found to have higher rates of overall psychiatric comorbidity, OCD, and ADHD.[131] However, independent of ADHD, the TS adolescents had higher rates of major depression. The presence of depression has been related to suicidal ideation[132][133] and poorer quality of life in patients with TS.[134] Whether this is a neurobiological risk factor, a result of living with a chronic disease, or both, requires further study.[131] However, the overall picture is favorable and, by early adulthood, only approximately 20% of patients will still have moderately debilitating tics; most will have mild tics and some will have remission of their symptoms.[135]

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