Nasal Airway Respiration Anti-tic (NARA) method in pediatric Tourette syndrome: a retrospective case series.

BACKGROUND: Tourette syndrome (TS) often impairs social and academic functioning in children due to disruptive motor and vocal tics. Minimally invasive and patient-driven interventions are desirable, yet existing treatments do not always provide rapid or sustained relief. This study evaluates the clinical outcomes of the Nasal Airway Respiration Anti-tic (NARA) method—a non-invasive, lip-closed nasal breathing technique—for children with TS. METHODS: In this uncontrolled retrospective case series, we identified all 8 consecutive pediatric patients (5 boys, 3 girls; ages 6–10) meeting DSM-5 criteria for TS who presented with habitual mouth breathing between 2019 and 2021. All patients were free of tic-suppressing medications at baseline. Patients had a chronic disease course (mean duration of illness: 2.5 years). No eligible patients were excluded. Patients were instructed to practice the NARA method (3–5 s nasal inhalation, 2s breath-holding, and 6–10 s exhalation with firm lip closure) for 2 min, 3 times daily. Tic severity was assessed using the Yale Global Tic Severity Scale (YGTSS) and a modified Rush Video Rating Scale (mRVRS) at baseline and follow-up (mean 18.4 months). RESULTS: At the initial visit, a 120-second trial of the NARA method significantly reduced tic frequency (p = 0.038) and severity (p = 0.025). Long-term follow-up demonstrated notable improvements in YGTSS motor and vocal subscales (14.4 ± 1.7 to 2.4 ± 1.2; 13.6 ± 2.3 to 3.6 ± 1.3, respectively). Three children who had refused school attendance due to severe tics returned to regular classes. Crucially, video analysis confirmed a “carry-over effect,” showing sustained tic reduction even during natural, resting respiration (without the maneuver) at the final assessment. CONCLUSIONS: The NARA method was associated with substantial tic reduction in this small cohort. We hypothesize that the intense physiological sensory input from nasal respiration may function as a “primary reward” that activates the thalamic centromedian nucleus to overshadow the urge-to-tic cycle. Clinically, the method’s success relied on active parental support. While placebo effects cannot be entirely ruled out in this uncontrolled study, the immediate “On/Off” reversibility of tics upon lip release implies a specific physiological antagonism distinct from simple distraction. Future prospective controlled trials are warranted to validate these preliminary findings.