INTRODUCTION:
Tourette’s syndrome is a neurodevelopmental disorder commonly presenting
in young males below 18 years of age and persisting for more than one
year with multiple motor and vocal tics [1]. Tics are sudden, rapid,
recurrent, and non-rhythmic motor movements or vocalizations commonly
preceded by an urge [2]. Most cases of Tourette syndrome show
significant improvement or resolve entirely by adulthood [3].
Patients whose tics persist into adulthood suffer from higher anxiety,
low self-esteem, socioeconomic status, and poor quality of life [4].
Tourette syndrome is frequently associated with other common childhood
disorders such as attention deficit hyperactivity disorder (ADHD)
(60-80%), obsessive compulsive disorder (OCD) (11-80%), anxiety,
depression (13-76%), migraine (25%) and self-injurious behaviour
[5,6].
According to the American Academy of Neurology’s practice guidelines,
Tourette syndrome can be managed with behavioural, pharmacological, and
surgical modalities [7]. Behavioural therapy includes exposure and
response prevention therapy (ERP), habit reversal therapy (HRT), and
comprehensive behavioural intervention for tics (CBiT), which is
considered the safest and first line of treatment [4,7].
CBiT is typically a behavioural intervention that includes
psycho-education, HRT, functional analysis, and relaxation training and
improves the patient’s recognition of the initial urge by providing a
competing response or motor movement incompatible with the corresponding
tic [8,9].