Tourette syndrome: clinical spectrum, mechanisms and personalized treatments.

PURPOSE OF REVIEW: To describe recent advances regarding the disease spectrum in Tourette syndrome, offer new mechanistic insights into tic generation and provide clues for personalized treatments in this disorder.

RECENT FINDINGS: Apart from tics, which define Tourette syndrome, comorbidities are the rule and not the exception. They significantly define clinical presentation, disease severity and quality of life. Recent studies have highlighted the importance of screening for depression, anxiety and autism spectrum disorders in Tourette syndrome. Regarding the mechanisms of tic generation, computational models begin to emerge and provide important clues regarding the cerebral regions and networks involved, as well as information on the nature of neurotransmitter signaling, for instance phasic versus tonic dopamine release. Also, these models may inform on generation or termination of premonitory urges which underlie tic generation. Finally, personalized treatments in Tourette syndrome are both necessary because of the width of the clinical spectrum, making every patient unique from a symptom-oriented perspective; yet, difficult to achieve because of the lack of large prospective cohorts which may inform on prognostic factors and disease-modifying interventions. However, interesting developments, especially in the fields of behavioral therapy and deep brain stimulation, deserve mention and pave the way for tailored treatments in Tourette syndrome.

SUMMARY: The recent literature offers interesting clues that sharpen our understanding of comorbidities in Tourette disorder and thereby its clinical spectrum, offers insights into the cerebral networks underlying tic generation and cautiously announces personalized interventions for Tourette disorder patients based on their symptom profile.