When needed, medications are used at the lowest doses possible. During pregnancy, neuroleptic medications are avoided when possible because of the risk of pregnancy complications. When needed, olanzapine, risperidone and quetiapine are most often used as they have not been shown to cause fetal abnormalities. One report found that haloperidol could be used during pregnancy, to minimize the side effects in the mother, including low blood pressure, and anticholinergic effects, although it may cross the placenta.If severe tics might interfere with administration of local anesthesia, other anesthesia options are considered. Neuroleptics in low doses may not affect the breastfed infant, but most medications are avoided. Clonidine and amphetamines may be present in breast milk. Prognosis
Tourette syndrome is a spectrum disorder—its severity ranges from mild to severe. Symptoms typically subside as children pass through adolescence. In a group of ten children at the average age of highest tic severity (around ten or eleven), almost four will see complete remission by adulthood. Another four will have minimal or mild tics in adulthood, but not complete remission. The remaining two will have moderate or severe tics as adults, but only rarely will their symptoms in adulthood be more severe than in childhood.Regardless of symptom severity, individuals with Tourettes have a normal life span. Symptoms may be lifelong and chronic for some, but the condition is not degenerative or life-threatening. Intelligence among those with pure TS follows a normal curve, although there may be small differences in intelligence in those with comorbid conditions.
The fourth revision of the DSM (DSM-IV) in 1994 added a diagnostic requirement for "marked distress or significant impairment in social, occupational, or other important areas of functioning", which led to an outcry from TS experts and researchers, who noted that many people were not even aware they had TS, nor were they distressed by their tics; clinicians and researchers resorted to using the older criteria in research and practice. In 2000, the American Psychiatric Association revised its diagnostic criteria in the fourth text revision of the DSM (DSM-IV-TR) to remove the impairment requirement, recognizing that clinicians often see people who have Tourettes without distress or impairment. Society and culture
Not everyone with Tourettes wants treatment or a cure, especially if that means they may lose something else in the process. The researchers Leckman and Cohen believe that there may be latent advantages associated with an individuals genetic vulnerability to developing Tourette syndrome that may have adaptive value, such as heightened awareness and increased attention to detail and surroundings.Accomplished musicians, athletes, public speakers and professionals from all walks of life are found among people with Tourettes.