Tourette's Syndrome treatment - do vitamins, herbs, supplements help? Review of symptoms by Ray Sahelian, M.D.
Feb 7 2014

Tourette's disorder is a neuropsychiatric disorder characterized by motor and vocal tics, which may be associated with obsessive-compulsive disorder (OCD), certain learning difficulties, and attention-deficit hyperactivity disorder (ADHD). Boys are more commonly affected than girls. Tourette syndrome is a neurological disorder that develops in childhood or adolescence in which patients have involuntary tics involving sudden movements or vocalizations that are rapidly repeated. The symptoms usually occur several times a day, every day or intermittently and are usually mild, but can be severe. The condition is believed be to associated with many genetic and environmental factors, including stress.

I am not aware of an effective natural or alternative treatment with with vitamins and herbs at this time.

Pediatrics. 2012. A double-blind, placebo-controlled trial of ω-3 fatty acids in Tourette's disorder. NYU Child Study Center, NYU School of Medicine, New York, New York, USA.  Clinical observations have suggested therapeutic effects for omega-3 fatty acids in Tourette's disorder (TD). Thirty-three children and adolescents (ages 6-18) with TD were randomly assigned, double-blind, to O3FA or placebo for 20 weeks. O3FA consisted of combined eicosapentaenoic acid and docosahexaenoic acid. Placebo was olive oil.  At end point, subjects treated with O3FA did not have significantly higher response rates. However, significantly more subjects on O3FA were considered responders on the YGTSS-Global measure. Obsessive-compulsive, anxiety, and depressive symptoms were not significantly affected by O3FA. Longitudinal analysis did not yield group differences on any of the measures. O3FA did not reduce tic scores, but it may be beneficial in reduction of tic-related impairment for some children and adolescents with TD.

Tourette's Syndrome treatment
Although the neurochemistry of Tourette's disorder is not well known, there are some effective therapies for tics, OCD and ADHD. However, these are not devoid of adverse effects. Tics only require treatment when they interfere with the functioning of the patient. If therapy is needed, monotherapy at the minimal effective dose is desirable, but some patients may require two or more drugs. The most frequently used drugs for tics are antipsychotics (mainly pimozide and haloperidol) and clonidine. The pathophysiology of TS mainly involves dysfunction of basal ganglia-related circuits and hyperactive dopaminergic innervations.
   Additional drugs that may be looked at include atypical antipsychotic drugs (risperidone, olanzapine, clozapine, ziprasidone) and other dopaminergic drugs (fluphenazine, sulpiride, tiapride, metoclopramide, piquindone, tetrabenazine), clonazepam, calcium channel antagonists, botulinum toxin, dopamine agonists, selegiline, and other drugs. The drugs of choice for OCD in patients with Tourette's disorder are the selective serotonin reuptake inhibitors (SSRIs), although the tricyclic antidepressant clomiplamine, which inhibits both serotonin and noradrenaline uptake, has also been found to be useful. ADHD can be treated with some psychostimulants, mainly methylphenidate, although these drugs must be used with caution. Other potentially useful drugs for the treatment of ADHD in patients with Tourette's disorder are clonidine, guanfacine, selegiline, some tricyclic antidepressants, sertraline, pimozide and clonazepam.

More research is needed on nonpharmacological therapies (hypnotherapy, biofeedback, conductual therapies, electroconvulsive therapy, acupuncture and surgery).

J Clin Psychiatry. 2013. A multicenter, randomized, double-blind, placebo-controlled study of aripiprazole in children and adolescents with Tourette's disorder. In comparison with placebo, aripiprazole was efficacious, generally tolerated and safe in the short-term treatment of children and adolescents with Tourette's disorder.

Symptoms
The most common Tourette's syndrome symptoms are motor tics such as forceful eye blinking. Vocal tics, which are repetitive involuntary stereotyped vocalizations, are usually unintelligible sounds, such as sniffing, grunting or throat clearing, but they can also be complex, such as uttering whole phrases. Complex motor tics can occur, such as bending over and touching the ground.
   Many people have come across in a public situation where they noticed someone swearing in an inappropriate way that seemed to be out of their control. This is called coprolalia. Other involuntary motor or vocal tics include copropraxia (involuntary obscene gestures), echolalia (involuntary repetition of speech of others), and echopraxia (involuntary imitation of the actions of others).

A Cause of Tourette's syndrome
This condition is most likely due to genetic causes but other factors may have an influence. Women who smoke during pregnancy appear to have a higher risk of having a child with severe symptoms of Tourette's syndrome and the risk of having obsessive-compulsive disorder is also increased in these children. Reductions in oxygen in the womb, a known effect of smoking, could increase the risk of developing Tourette's syndrome in those with a genetic susceptibility.

Q. I was searching to see if there was a link between common allergies and Tourette's syndrome, when I read a statement about smoking during pregnancy and Tourette's syndrome. With all due respect and as the mother of a child who has Tourette's syndrome, I have to say I strongly disagree with this statement. I realize that the statement said that it was an increased risk, which does not infer that only women who smoke during pregnancy have children with Tourette's syndrome. My concern is that there really is not enough that is known about this disorder and every day myself and my child have to face daily challenges from his disorder that others who come in contact with us have. I just think that this statement re-enforces stereo-type thinking, which I think we can both agree does more harm than good. Please consider this email, from a mother of a child with Tourette's syndrome and one who did everything right before, during and after my pregnancy with my son.
   A. Having had a family member with a chronic diseases and having grown up in such a household, I can fully empathize with the difficulties involved in raising a child with Tourette's syndrome. However, I do not place information on my website out of thin air. This information is based on a study published in the American Journal of Psychiatry, June 2006. A person can have a heart attack even on an ideal diet and not ever having smoked, yet smoking can raise the risk for a heart attack.

Book on the topic
Hi Dr Sahelian, I frequently refer to your very helpful website. Congratulations on all you've accomplished! I saw the exchange on Tourette Syndrome and thought you might like my book, Natural Treatment for Tics and Tourette's: ticsandtourettes dot com. Best wishes, Sheila Rogers, Director, Association for Comprehensive NeuroTherapy.

Studies
Nutritional supplements and complementary/alternative medicine in Tourette syndrome.
J Child Adolesc Psychopharmacol. 2004.
Tourette syndrome (TS) is a neuropsychiatric disorder associated with motor and vocal tics. Some people with TS have reported using alternative or complementary medicine (CAM), including nutritional supplements to control their tics. In a recent national survey, approximately 40% of people reported having used CAM in the prior year. We attempted to explore the use of supplements and other CAM among TS patients. We developed a survey instrument based on anecdotal accounts of CAM use and distributed it to the mailing list of the New York Chapter of the Tourette Syndrome Association (n=500) and the subscription list of Latitudes, a newsletter exploring CAM treatments for neurological conditions (n=750). Responses were entered in a database and analyzed using SPSS version 10. Of 115 respondents, 87% reported using 1 or more of 29 nutritional supplements to control symptoms. Many also reported using other CAM. Most supplement users reported an improvement in tics. Although these results are not generalizable, they provide no evidence that use of supplements and other CAM is rarer among TS patients than in the general population. Given that most of our respondents were also using conventional medication, further study of the use of supplements and other CAM therapies by people with Tourette Syndrome, the safety and efficacy of such therapies in this population, and possible interactions of such therapies with conventional treatment seems warranted.

Cannabinoids reduce symptoms of Tourette's syndrome.
Expert Opin Pharmacother. 2003.
Currently, the treatment of Tourette's syndrome is unsatisfactory. Therefore, there is expanding interest in new therapeutical strategies. Anecdotal reports suggested that the use of cannabis might improve not only tics, but also behavioural problems in patients with Tourette Syndrome. A single-dose, cross-over study in 12 patients, as well as a 6-week, randomised trial in 24 patients, demonstrated that Delta9-tetrahydrocannabinol (THC), the most psychoactive ingredient of cannabis, reduces tics in Tourette Syndrome patients. No serious adverse effects occurred and no impairment on neuropsychological performance was observed. If well-established drugs either fail to improve tics or cause significant adverse effects, in adult patients, therapy with Delta9-THC should be tried. At present, it remains unclear whether herbal cannabis, different natural or synthetic cannabinoid CB1-receptor agonists or agents that interfere with the inactivation of endocannabinoids, may have the best adverse effect profile in Tourette Syndrome.

Questions
Q. I have a grandson that just turned 10 years old. About two years ago, he started this uncontrollable eye blinking from time to time. His mom & dad thought it was just from him playing video games on the computer too much. Since then, about a year ago he started making throat clearing and grunting sounds from time to time. His dad did some research and talked to some people and they suggested that he had tics, or tourettes syndrome. Since school has started (two months ago) he has wet his pants at school on a regular basis and not having any idea he's doing this. I feel reasonably certain he has tourettes also and it seems to me that it's getting worse. I have read that serotonin and dopamine deficiencies may contribute to this disease. Can you tell me what I need to get for this little boy to see if we can increase his serotonin and dopamine levels and also if you may be able to tell me if sugar and a diet high in carbohydrates can affect this. He eats sugar and bread like it's going out of style and is skinny and has too much energy. I, like his dad, am very worried about him. Many of the doctors nowadays want to cripple people with the psychiatric and psychotic drugs and I don't want that for this boy. Can you help me?
     A. We don't have much experience with Tourette's syndrome and natural supplements at this point to make any recommendations.

Q. I wanted to share my experience with Tourette's Syndrome. At 5, our son began displaying typical Tourette's Syndrome symptoms - head bobbing, licking, smelling everything, throat noises, humming, etc. Of course we were devastated, but didn't want to rush into drugs, as the options were not good. My husband started to remember incidents from his childhood, and came to realize that he and his brother had displayed many of the same symptoms, but no longer did. We began to notice that our son's symptoms became worse at particular times of year, and suspected that seasonal allergies played a role. We discussed this with our wonderful pediatrician, who advised us that Tourette's Syndrome is a description of a collection of symptoms, not a disease, and that allergies was as good an explanation as any. We treated the allergies, and the symptoms all but disappeared. As a teen, he still has small compulsions - jumping up and touching the ceiling, bouncing his leg - but nothing seriously detracting from his life. We've sense discovered that other doctors aren't nearly so imaginative or open minded.

Q. Does 5-htp or tryptophan treat Tourette's Syndrome?
  A. I don't have any experience with these supplements in this context.

Q. I recently read where carnitine may help Tourette Syndrome children. Do you know anything about this? Any data at all? Would it be just carnitine or the acetyl-carnitine supplement?
   A. We did a Medline search in 2011 and did not find any research regarding carnitine or acetyl-l carnitine.

Q. My son was cured of Tourette's nearly two years ago. He was severely affected, having motor tics from head to toe, echolalia, screams, barks, throat sounds, squeaks, you name it. He became symptomatic at age 6. He is now 8 1/2. He was treated with nystatin and diet change. We attribute the explosion of symptoms to repeated long term antibiotic use as well as use of steroid medication around the same time. He again became symptomatic during treatment with antibiotics one year later, but symptoms resolved with nystatin treatment entirely. Here is a full report:
   My son is not the only child to be successfully treated this way. Another mom in Canada had a son with Tourette's syndrome who recovered without other meds. Another mom in NY has just started nystatin on her son, as well as diet, and for the first time in years he has gone days at a time with few or no tics. He has only been on treatment for less than one week! Here is my son's full history:

CM, now 8 years of age, had initial onset of motor tics in June, 2004. He was being aggressively treated for chronic allergic sinusitis and tonsillitis (since age 2) with repeated courses of antibiotics as well as steroid medications including prednisone. Motor tics included severe and painful trunk-twisting and shoulder shrugging. Motor tics gradually subsided within three weeks. Cory's second onset of motor tics was in April, 2005 when he was dealing with severe allergies and tonsillitis again. For months previous to this, he was treated aggressively with antibiotics and steroid medications. Motor tics began in his face, then spread to shoulders, torso, and legs. About four weeks after motor tics began, vocal tics began. Vocal tics included throat noises, squeaks, barks, screams. Echolalia was severe. Cory had developed comorbid symptoms including severe rage attacks, severe OCD, and extreme anxiety. Cory had a lifelong history of sinusitis, ear infections, tonsillitis, eczema, unexplained rashes, unexplained very high fevers. He also had a lifelong history of night sweats. By July, 2005 Cory had been diagnosed with Tourette's syndrome and we were informed that due to the severity of motor and vocal tics he would require medication in order to function at school. His tics and OCD were so severe that he was a danger to himself out in public, as he would impulsively jump into traffic if walking near a street or in a parking lot. His screams prevented him from socializing at all. We were advised to look for an alternative educational setting for Cory to attend third grade. On July 1, 2005 we took Cory to Bruce Semon, M.D. who has a private practice in Wisconsin. Dr. Bruce Semon confirmed what I suspected since my son was two years old, namely that he had yeast overgrowth from constant antibiotic use. Dr. Semon prescribed nystatin, provided a careful dosing schedule, and instructed us to begin a yeast elimination diet. This diet involved removing all products containing malt, all products of fermentation, certain fruits, white bread and cheddar cheese. His complete diet is outlined in a book he published titled Feast Without Yeast and his dietary recommendations are based on his own research as well as other published research. This research and references are published in his first book, An Extraordinary Power to Heal. We feel that dietary changes were crucial to beating this, but also feel that nystatin made it possible. Cory's motor tics are described as:
repetitive eye movements that resembled looking to the side of the head and then upward
cranking head back and sideways simultaneously
lifting shoulders one at a time to ears, or together
repetitive touching of opposite shoulders with the hands (every 3 seconds)
twisting the torso in one direction while shrugging shoulder
repeatedly arching his back
repeatedly stepping backward with one foot, or hopping backward with both feet while walking (every four to ten steps taken)
Vocal tics are described as:
loud bark or scream lasting 1/4 second, in one pitch (every minute or less)
repeated words that were heard on t.v. or heard in a crowd (every few seconds)
repeated throat clearing or grunting noise (every few seconds)
repeated humming sound that would rise in pitch and drop again ( every four seconds)

Treatment and outcome:
Cory was treated with oral nystatin starting in mid July, 2005. Elimination diet was started immediately. Within two weeks many of Cory's vocal tics were gone, having gradually subsided in volume and frequency. Within four weeks most of Cory's motor tics had subsided. By the middle of August Cory had motor tics that were barely noticeable and no vocal tics. Cory was enrolled in the public school we intended to send him to before his illness, and by the start of school September 7th all symptoms had resolved. A few related conditions took a bit longer to clear up, namely constipation and encopresis, anxiety, and some signs of OCD. By December, 2005 he had none of anxiety or OCD seen before. Related chronic illnesses that also resolved simultaneously:
tonsillitis (became life threatening at one point) but they advised against surgical removal
chronic sinus infection
eczema
frequent stomach pain and nausea (after nearly every meal!)
night sweats (these he had without a break from the age of about two years)
night terrors (almost nightly, since the age of three years)
Recent episode: in April, 2006 following a course of broad spectrum antibiotics, some mild motor tics started up again oral nystatin was started immediately all symptoms resolved after about four weeks of nystatin and dietary restriction of sugar and complex carbohydrates treatment was continued as precaution for another few weeks no symptoms since treatment
   A. Very interesting, I find it difficult to believe that nystatin would cure Tourette's, but I will await other reports.

Q. What is the genetic likelihood of Tourette's syndrome being passed from father to child?
   A. This is not a topic I have studied in any great detail.

Q. I am having trouble finding anything about the problems with reading, test taking etc. for people with tourrette's. My daughter Shannon will be 18 in January 2009 and her case is mild at this time. When her grades starting dropping when she was a sophomore I had no idea this was linked to tourrette's and we never talked to her doctor about it until the end of her junior year. Everything I read about Tourette's syndrome never talk about this. I am not ever sure if it is the tourrette's or AHD which many children have who have Tourrette's. This has affected her test taking including the SAT test but I do not have any proof of this when we speak with admissions offices on her college search.
   A. I am not familiar enough with Tourette's syndrome in relation to academic achievement to know how it effects learning and reading.

Q. Is there any research on the effectiveness of inositol for people with Tourette's or other tic disorders?
   A. Inositol Tourette's keyword search in Medline did not reveal any human studies, as of Feb 2010.