Objective: To describe five cases of adults with Tourette Syndrome (TS) who experienced exacerbations of their tics.

Background: Tourette Syndrome is a life-long disorder, but is characterized by childhood onset with the most severe symptoms occurring at age 10-12. By young adulthood 1/3 to 1/2 of patients have minimal to no tics, but few studies have examined long-term outcome in these individuals. It is unknown to what extent people who have had improvement in their tics by young adulthood remain prone to periodic exacerbations as they age. In this series we begin to address this knowledge gap by describing 5 adult patients with TS who experienced tic exacerbations after many years of minimal or no tics.

Methods: Case series.

Results: Case 1 is a 40-year old male with a family history of tics who presented with a re-occurrence of his tics. He had never taken medications for tics and had been free of tics since his teenage years. Case 2 is a 66-year old woman with good tic control on pimozide since her early 30s who developed marked worsening of motor tics at age 66. An increase in pimozide proved effective. Case 3 is a 62-year old man with OCD treated successfully with pimozide for 20 years. At age 61 he experienced a tics flare. Pimozide was switched to haloperidol with improvement, however he developed drug-induced parkinsonism. Case 4 is a 69-year old man who experienced significant tics reduction in his 30s until he suffered an exacerbation at age 66. Case 5 is a 47-year old woman with OCD whose tics were under good control until age 41. Clonidine was effective for OCD but not tics. Three patients reported a concomitant increase in anxiety, depression, or stress levels during exacerbations. No unique life stressors or mood changes were identified in two patients.

Conclusions: Patients with TS can experience either recurrence or exacerbation of their tics at any age, with or without an identifiable stressor. Pimozide can be used successfully in the long-term to treat adult tics. Further study is needed to better understand TS in all age groups.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/tics-exacerbations-in-middle-aged-and-older-adults-with-tourette-syndrome-a-case-series/