Tourette syndrome (TS) is an inherited neurological disorder that begins in childhood or adolescence, characterized by the presence of multiple physical (motor) tics and at least one vocal (phonic) tic.

The eponym was bestowed by Jean-Martin Charcot (1825–1893) on behalf of his intern, Georges Albert Édouard Brutus Gilles de la Tourette (1859–1904), a French physician and neurologist, who published an account of nine patients with Tourette's in 1885. The possibility that movement disorders, including Tourette syndrome, might have an organic origin was raised when an encephalitis epidemic from 1918 to 1926 led to a subsequent epidemic of tic disorders. Research in 1972 advanced the argument that Tourette's is a neurological, rather than psychological, disorder; since the 1990s, a more neutral view of Tourette's has emerged, in which biological vulnerability and adverse environmental events are seen to interact.

Findings since 1999 have advanced TS science in the areas of genetics, neuroimaging, neurophysiology, and neuropathology. Questions remain regarding how best to classify Tourette syndrome, and how closely Tourette's is related to other movement disorders or psychiatric disorders. Good epidemiologic data is still lacking, and available treatments are not risk-free and not always well tolerated.

Fifteenth century The first presentation of Tourette syndrome is thought to be in the 15th-century book Malleus Maleficarum (Hammer of Witches), which describes a priest whose tics were "believed to be related to possession by the devil". As reported in Finger S (1994). "Some movement disorders." Origins of neuroscience: the history of explorations into brain function. New York: Oxford University Press. pp. 220–39.

Nineteenth century

A French doctor, Jean Marc Gaspard Itard, reported the first case of Tourette syndrome in 1825, From describing Mme de D (the Marquise de Dampierre)Walusinski (2019), pp. 167–69. an important woman of nobility in her time, whose episodes later understood to be coprolalia "were obviously in stark contrast to the lady's background, intellect, and refined manners".

Jean-Martin Charcot, an influential French physician, assigned his studentWalusinski (2019), pp. xvii–xviii, 23. and intern Georges Gilles de la Tourette, to study patients with movement disorders at the Salpêtrière Hospital, with the goal of defining a condition distinct from hysteria and chorea. Charcot and Gilles de la Tourette believed that the "tic illness" they had observed was an untreatable, chronic, and progressive hereditary condition.Black, KJ. Tourette Syndrome and Other Tic Disorders. eMedicine (March 22, 2006). Retrieved on June 27, 2006. History is unclear on whether Charcot had examined the Marquise de Dampierre, but his publications mention having met her socially and overhearing her most common utterances of " and (which translates literally as filthy pig but the truer colloquial meaning is 'fucking pig')".

In 1885, Gilles de la Tourette published an account of nine patients, Study of a Nervous Affliction, concluding that a new clinical category should be defined.Gilles de la Tourette G, Goetz CG, Llawans HL, trans. Étude sur une affection nerveuse caractérisée par de l'incoordination motrice accompagnée d'echolalie et de coprolalie. In: Friedhoff AJ, Chase TN, eds. Advances in Neurology: Volume 35. Gilles de la Tourette syndrome. New York: Raven Press; 1982;1–16. Discussed at Black, KJ. Tourette Syndrome and Other Tic Disorders. eMedicine (March 22, 2006). Retrieved on June 27, 2006. His description included accounts of Marquise de Dampierre, previously described by Itard, as a reclusive aristocratic lady who "ticked and blasphemed" from the age of seven until her death at the age of 80 years. Gilles de la Tourette describes the common feature of involuntary movements or tics in all nine patients. The eponym was bestowed by Charcot after and on behalf of Gilles de la Tourette, who later became Charcot's senior resident.Walusinski (2019), pp. xi, 398. "Interne: House physician or house officer. The internes lived at the hospital and had diagnostic and therapeutic responsibilities. Chef de Clinique: Senior house officer or resident. In 1889, when Gilles de la Tourette was Chef de Clinique under Charcot ... "Who Named It? Georges Albert Édouard Brutus Gilles de la Tourette. Retrieved on June 28, 2006.

Little progress was made over the next century in explaining or treating tics. With limited clinical experience, involving typically one or two patients, authors advanced different ideas, including brain lesions similar to those resulting from rheumatic chorea or encephalitis lethargica as a cause of tics, faulty mechanisms of normal habit formation, and treatment with Freudian psychoanalysis. The psychogenic view prevailed well into the 20th century.

Twentieth century The possibility that movement disorders, including Tourette syndrome, might have an organic origin was raised when an encephalitis epidemic from 1918 to 1926 led to a subsequent epidemic of tic disorders. The psychoanalytic theory was so dominant that it was claimed that an organic component alone would not be sufficient to produce Tourette syndrome. At the time, psychiatrists believed patients with tics must also have unresolved psychological disturbances or psychosexual conflicts, and psychiatric intervention was the preferred method of treatment. Patients and their families were told that their own psychological maladjustments were to blame for their symptoms, adding to the burden carried by the patients and their families. Until the early 1970s, psychoanalysis was the preferred intervention for Tourette syndrome.Pagewise, Inc. Tourette syndrome. Retrieved on June 29, 2006.

During the 1990s, a more neutral view of Tourette's emerged, in which a genetic predisposition is seen to interact with non-genetic and environmental factors.Kushner HI (2000), pp. 142, 143, 187, 204, 208–12. As the beneficial effects of haloperidol (Haldol) on tics became known, the psychoanalytic approach to Tourette syndrome was questioned. The first description of haloperidol in the treatment of Tourette's was published by Seignot in 1961. The turning point came in 1965, when Arthur K. Shapiro—described as "the father of modern tic disorder research"—treated a Tourette's patient with haloperidol. Shapiro and his wife, Elaine Shapiro, reported the treatment in a 1968 article, and severely criticized the psychoanalytic approach.

The Shapiros, working with the patient families who founded in 1972 the Tourette Syndrome Association (TSA, renamed to Tourette Association of America, TAA, in 2015), advanced the argument that Tourette's is a neurological, rather than psychological, disorder, and worked to persuade the media to promote information about Tourette's. Although the original case reports of TS were by French neurologists, the "focus moved to New York in the 1970s" and "the centre for the most committed progress in TS continued to be the USA, facilitated by the success of the Tourette Syndrome Association". In 1975, The New York Times headlined an article with "Bizarre outbursts of Tourette's disease victims linked to chemical disorder in brain", and Shapiro said: "The bizarre symptoms of this illness are rivaled only by the bizarre treatments used to treat it."

The U.S. National Institutes of Health (NIH) turned down a 1972 grant proposal from the TAA (then known as the TSA) because "the reviewers believed there were probably no more than 100 cases of TS in the entire nation",Cohen DJ, Jankovic J, Goetz CG, (eds). Advances in Neurology, Vol. 85, Tourette syndrome. Lippincott, Williams & Wilkins, Philadelphia, PA, 2001, p. xviii. and a 1973 registry reported only 485 cases worldwide. Subsequent articles on Tourette's in Good Housekeeping, The New York Times and Ann Landers produced an "enormous response, proving that there were many undiagnosed cases of TS across the United States". TS was listed as a rare disorder in the United States Orphan Drug Act of 1983, a law enacted to increase development of medications for conditions which affect small numbers of people.Orphan Drug Act of 1983 .| US Food and Drug Administration. 1983. Retrieved on October 27, 2015. In 1985 pimozide was approved by the U.S. Food and Drug Administration for the treatment of the condition.

Twenty-first century Research since 1999 has advanced knowledge of Tourette's in the areas of genetics, neuroimaging, neurophysiology, and neuropathology, but questions remain about how best to classify it and how closely it is related to other movement or psychiatric disorders. Good epidemiologic data is still lacking, and available treatments are not risk-free and not always well tolerated. The TAA supports a clinical database that may help identify genes involved in Tourette syndrome, and the TSA (TAA) International Genetic Consortium has collected a database on large extended families for future studies. Novel neuroimaging studies are being employed to study tic expression and functional or cognitive deficits in TS patients. Studies of Tourette's neurophysiology and neuropathology are attempting to link deficits in Tourette's to specific brain mechanisms, and have taken advantage of a brain bank sponsored by the TAA. Clinical trials have focused on understanding tic suppression, comorbid conditions, novel treatment approaches such as botulinum toxin, and targeted behavioral therapies. Controversy remains in the areas of deep brain stimulation and PANDAS.Walkup, JT, Mink, JW, Hollenback, PJ, (eds). Advances in Neurology, Vol. 99, Tourette syndrome. Lippincott, Williams & Wilkins, Philadelphia, PA, 2006. pp. xvi–xviii.

Multiple studies published since 2000 have consistently demonstrated that the prevalence of TS and tic disorders is much higher than previously thought.Scahill, L. "Epidemiology of Tic Disorders". Medical Letter: 2004 Retrospective Summary of TS Literature. Tourette Syndrome Association. The first page (PDF), is available without subscription. Retrieved on June 11, 2007.* * * * Fernandez, State and Pittenger wrote in 2018 that the rate of Tourette's in the general population is between 0.5 and 0.7%, and Robertson (2011) suggested 1%. A prevalence range of 0.1% to 1% yields an estimate of 53,000 to 530,000 school-age children with Tourette's in the United States, using 2000 census data. In the United Kingdom, a prevalence estimate of 1.0% based on the 2001 census meant that about half a million people aged five or older would have Tourette's, although symptoms in older individuals would be almost unrecognizable.

Increasing episodes of tic-like behavior affecting teenagers were reported in several countries during the COVID-19 pandemic. Researchers linked their occurrence to followers of certain TikTok or YouTube artists. Described in 2006 as psychogenic, abrupt-onset movements resembling tics are referred to as a functional movement disorder or functional tic-like movements. While mass psychogenic illness is more common in developing countries, an "epidemic of leg twitching" was reported in the US as early as 1939. Psychogenic or functional tic-like movements can be difficult to distinguish from tics that have an organic (rather than psychological) cause.

Evolution of diagnostic criteria