What are the treatments for Gilles de la Tourette syndrome?

Treatments for Gilles de la Tourette Syndrome

If the Gilles de la Tourette syndrome is not cured today, many treatments can be offered to patients to alleviate the tics and symptoms associated with it, and to help people affected by this syndrome to live it better on a daily basis.

Patient management is multidisciplinary, involving a team of specialists who approach the disease from different angles. In general, the team consists of neurologists, psychiatrists, neuropsychologists, clinical psychologists, speech therapists, motor psychologists. It also includes social workers whose role is to adjust the school or work environment and to minimise the psychosocial consequences of the illness, such as school repetitions or dropouts, or redundancies.

Multidisciplinary care will enable people with Gilles de la Tourette syndrome to benefit from complementary strategies, beyond medication, to alleviate all the difficulties encountered in their daily lives.

First, cognitive-behavioural therapies allow patients to significantly reduce or eliminate tics by exercising very regularly over a short period of time. The practice of these exercises aims to deconstruct the association between the sensation that precedes the onset of the tic (premonitory sensation) and the realization of the tic, so that eventually the urge to label disappears. To date, there are two scientifically validated techniques. The first, which has been widely used in the Anglo-Saxon world for more than 30 years, is to set up a movement incompatible with the realization of the tic as soon as the person feels the urge to label: it is a reversal of habit. The second, developed in Europe more recently, aims at the same goal using so-called third-wave methods, namely relaxation, acceptance and mental imagery. The results obtained with this second technique seem even more promising, although the number of scientific publications is smaller. These techniques are unfortunately still not well known by professionals in France. One of the Centre's objectives is to disseminate them to a wide network of professionals through regular training.

In addition, psychological support is often very beneficial for these patients, particularly in view of their young age, in order to strengthen their self-esteem and coping strategies that enable them to live better with the symptoms of the disease.

In the case of learning disorders associated with speech therapy and/or psychomotor therapy, it is essential to provide patients with the best possible support in their education and to optimise their chances of success.

Finally, the contribution of the social worker is essential for many patients, enabling them to access crucial information concerning school or vocational facilities, existing aids in the event of difficulties in working, or support in accessing care.

If behavioural and cognitive therapy is not effective enough, it can be supplemented with serotonin reuptake inhibitors.

At the Pitié-Salpêtrière hospital, the reference centre for the Gilles de la Tourette syndrome, coordinated by Dr HARTMANN, a neurologist at the Pitié-Salpêtrière hospital and researcher at Paris Brain Institute, offers patients adapted and multidisciplinary management.

“Since the establishment of the reference center, our efforts have focused on three methodological areas: behavior and cognition, brain imaging, and genetics. In addition, we are attempting to combine these approaches in the hope of gaining a better understanding of the etiology (causes) and pathophysiology (mechanisms) of SGT, and ultimately proposing new treatments. Among these, we are working on the development in France of behavioural therapies for the treatment of tics such as exposure with response prevention (ERP) and reversal of habits. In addition, for more than a decade we have been running an ambitious programme in the field of deep brain stimulation. We regularly ask our patients and their families to participate in this research. We actively participate in the European network created in 2008, the European Society for the Study of Tourette Syndrome (ESSTS). Several collaborative and unifying projects have emerged, partly funded by the EU. At the global level, we participate in consortia in genetics and neurosurgery.

If you wish to participate in research protocols, either as a patient or as a healthy volunteer, do not hesitate to contact our Clinical Research Associate, Ms Prasanthi JEGATHEESAN: prasanthi.jegatheesan@aphp.fr

Personalized multidisciplinary treatment

In addition to medication, multidisciplinary management is essential for patients with Gilles de la Tourette syndrome. Psychological support is very important in discussing the difficulties faced by patients on a daily basis, particularly in view of their young age, and in trying to find solutions. Relaxation techniques can also benefit people with Gilles de la Tourette syndrome. Speech therapy is also part of the care, and can have a real benefit on sound tics and learning disabilities.

Deep brain stimulation (DBS) offers considerable therapeutic promise in the treatment of drug-resistant tics. The surgical indication is submitted by a multidisciplinary team on the basis of international and national consensus criteria, which are constantly evolving.

Paris Brain Institute researchers and clinicians have pioneered the use of deep brain stimulation in Gilles de la Tourette syndrome.