Modern tactics of diagnosis and treatment of tic disorders

Tic disorders are a heterogeneous group of pathological conditions that typically manifest in childhood and are characterized by sudden, rapid, recurrent, non-rhythmic motor movements or vocalizations. Their prevalence is estimated at 0.5–1 % in the general population, with a marked male predominance. A substantial proportion of patients present with comorbidities, particularly attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, anxiety, and mood disorders, significantly affecting quality of life and adaptive functioning. The article presents the classification of tic disorders according to the International Classification of Diseases, 11th revision (ICD-11), the full transition to its use in medical practice in Ukraine is planned from January 1, 2027. The pathophysiology of tic disorders involves dysfunction of cortico-striato-thalamo-cortical circuits and neurotransmitter imbalance. Dopaminergic system plays a central role, alongside GABAergic, glutamatergic, serotonergic, and cholinergic mechanisms. Neuroimaging studies demonstrate structural and functional abnormalities within the basal ganglia, especially the striatum, as well as the supplementary motor area. Genetic contribution is substantial, with heritability estimates ranging from 0.58 to 0.77 and polygenic involvement of variants such as SLITRK1, HDC, CNTNAP2, and NRXN1. Epigenetic mechanisms and environmental risk factors, including perinatal complications and infections, also contribute to disease development. Diagnosis is based on clinical criteria from DSM-5-TR and ICD-11, considering tic duration, type, and combination. Standardized rating scales are recommended, with the Yale Global Tic Severity Scale recognized as the gold standard. Ancillary investigations such as electroencephalography and magnetic resonance imaging are used primarily for differential diagnosis. Management requires a multimodal, individualized approach. Behavioral therapy constitutes first-line treatment. Pharmacotherapy is indicated when symptoms are severe or refractory and includes dopamine receptor antagonists (e.g., aripiprazole, risperidone), 2-adrenergic agonists (clonidine, guanfacine), and alternative agents such as topiramate in resistant cases. An individualized approach allows you to optimize symptom control and improve patients’ quality of life.