Tourette syndrome
You feel an urgent need to blink your eyes, move your head, or make a certain sound.
Sometimes you can suppress these movements or sounds for a while, but the tension builds up until you have to perform the tic anyway.
For people with Tourette syndromethese involuntary movements and sounds can have a major impact on daily life.
Tics can vary in frequency and intensity. They may increase during times of stress or fatigue and decrease when you are highly focused on an activity.
In addition to tics, concentration problems, impulsivity, anxiety, sleep issues, and obsessive thoughts or behaviors are also common.
Tourette syndrome is a neurodevelopmental disorder in which brain networks involved in movement, impulse control, and behavioral regulation function differently.
Scientific research shows that the interaction between the cerebral cortex, basal ganglia, and thalamus plays a particularly important role in the development of tics.
These insights provide an interesting starting point for neuromodulation.
At BRAI3N, we use targeted neuromodulation to influence the activity of brain networks involved in the development and regulation of tics.
With this, we aim to reduce the severity of the tics and their impact on daily life.
What is it?
What is Tourette syndrome?
Tourette syndrome, often referred to simply as Tourette's, is a neurodevelopmental disorder that usually begins during childhood.
The condition is characterized by the presence of multiple motor tics and at least one vocal tic over a period of more than a year.
AnA tic is a sudden, repetitive movement or sound that is difficult to keep under complete control.
Tics are usually divided into two groups:
Motor tics
These are involuntary movements, such as:
- Frequent eye blinking.
- Making grimaces.
- Shaking the head.
- Shrugging the shoulders.
- Sudden movements of the arms or legs.
- More complex movements involving multiple muscle groups.
Vocal tics
These are sudden sounds or vocalizations, such as:
- Throat clearing.
- Coughing.
- Sniffing.
- Grunting or making other noises.
- Repeating certain sounds, words, or phrases.
Tourette's is sometimes associated with uncontrollable swearing or the utterance of inappropriate words.
This phenomenon is coprolalia and occurs in only a minority of people with Tourette's.
Most patients have other, often less noticeable, motor and vocal tics.
Why are tics so hard to suppress?
Many people with Tourette's experience an unpleasant physical sensation just before a tic.
This can feel like tension, pressure, itching, or a strong inner urge to perform a specific movement.
This sensation is called a premonitory urge : a preceding impulse.
Performing the tic can provide temporary relief.
Some people can consciously suppress a tic for a short time. However, this often requires a great deal of concentration and effort.
Moreover, the preceding tension can remain present while suppressing it.
This explains why it can be particularly difficult for someone with Tourette's to constantly hold back tics, even when they want to.
What other symptoms can occur?
Tourette's is not always limited to motor and vocal tics.
Many patients experience additional neurological or psychological symptoms.
Attention and concentration problems
People with Tourette's are more likely than average to also have attention deficit hyperactivity disorder (ADHD).
This can lead to concentration problems, impulsivity, restlessness, and difficulties with planning or organizing activities.
Read more aboutattention and concentration disorders.
Obsessive thoughts and behaviors
Some patients experience recurring thoughts or actions that are difficult to suppress.
This can range from repeatedly performing certain actions to obsessive-compulsive disorder (OCD).
Tourette's and OCD share partial similarities in the brain networks involved in behavioral control and habit formation.
Anxiety and emotional tension
Anxiety symptoms and increased sensitivity to stress occur regularly.
Stress can intensify certain tics. Conversely, the tics themselves can cause insecurity or social anxiety.
Sleep problems and fatigue
Some patients have difficulty falling asleep, staying asleep, or maintaining a regular sleep schedule.
Constantly trying to control tics can also be mentally exhausting.
You can find more information on our page about sleep disorders.
The presence and severity of these additional symptoms vary greatly from person to person.
How does Tourette's develop in the brain?
Tourette's is currently considered a condition in which various brain networks involved in movement and behavioral control interact differently.
An important system is the cortico-striato-thalamo-cortical network (CSTC network).
This network connects various areas of the cerebral cortex with the basal ganglia and the thalamus.
It helps our brains select movements, suppress unwanted reactions, and organize goal-directed behavior.
In Tourette's, changes in these circuits can contribute to the development of tics.
The basal ganglia: selecting and regulating movements
The basal ganglia are a group of deep-seated brain nuclei.
Among other things, they play a role in selecting, initiating, and suppressing movements.
Normally, these systems help determine which movements are performed and which movements are inhibited.
In Tourette's, disruptions in these processes can contribute to the sudden onset of unwanted movements or sounds.
The supplementary motor area: preparation of movements
The supplementary motor area (SMA) is an area on the inner side of the frontal cerebral cortex.
This area plays an important role in preparing, organizing, and executing movements.
Research shows that SMA activity in people with Tourette's can change in the period just before a tic occurs.
The functional connections between the SMA, the basal ganglia, and other motor brain areas are also important in this regard.
The SMA therefore represents an interesting target for focused neuromodulation.
The prefrontal cortex: impulse control
The prefrontal cortex supports functions such as attention, planning, and behavioral regulation.
This area helps suppress reactions when they are inappropriate.
In Tourette syndrome, changes in the interaction between prefrontal and motor networks can affect the control of tics and other impulses.
The right inferior frontal gyrus is also of interest due to its role in suppressing automatic or unwanted responses.
The prefrontal cortex is easily accessible via targeted neuromodulation, making it a promising target for treatments.
The insula and anterior cingulate cortex: physical urges and tension
The insula plays a key role in perceiving and processing signals from the body.
This area is involved in research into the premonitory urges that many patients experience before a tic occurs.
The anterior cingulate cortex (ACC) also plays a role in motivation, behavioral control, and processing conflicts between different potential responses.
These brain regions work in tandem with motor and prefrontal networks.
As a result, movements, physical sensations, attention, and emotional processes can influence one another.
The anterior cingulate cortex (ACC) can be reached with deeper targeted neuromodulation and is a promising target for treatments.
What role do neurotransmitters play?
Communication between nerve cells occurs via various chemical messengers, known as neurotransmitters.
In Tourette syndrome, dopamine plays a particularly important role.
Dopamine influences, among other things, the functioning of the basal ganglia and the selection and execution of movements.
Scientific research suggests that changes in dopamine regulation may contribute to the development of tics.
However, dopamine is not the only neurotransmitter involved.
Gamma-aminobutyric acid (GABA), glutamate, serotonin, and other signaling systems also play a role.
GABA is a major inhibitory neurotransmitter, while glutamate is primarily involved in excitatory signals between nerve cells.
The balance between these systems helps determine how easily certain brain networks are activated.
Changes in this balance can contribute to the dysregulation of motor and behavioral processes in Tourette syndrome.
Tourette as a disorder of brain networks
Recent neurophysiological research shows that tics do not arise solely from abnormal activity in a single brain region.
It involves changes in the interaction between different brain circuits.
For example, researchers have found that functional connections between the thalamus and frontal brain regions can change in the period leading up to a tic.
This suggests that the timing and coordination of brain activity are important in the development of tics.
These insights offer starting points for neuromodulation, where the function of specific brain networks can be targeted and influenced.
Does Tourette change with age?
Tourette syndrome usually begins during childhood.
In many children, tics increase in intensity around the age of eight to twelve.
During adolescence, tics become gradually less pronounced in a significant portion of patients.
For some people, they disappear almost completely. For others, they remain present into adulthood.
Furthermore, the severity of symptoms can fluctuate significantly over time.
That is why it is important to tailor treatment to current symptoms and their impact on daily functioning.
How to treat
Personalized treatment for Tourette
Treatment for Tourette depends on the severity of the tics, any co-occurring symptoms, and the impact on daily life.
Not every patient requires the same treatment.
When tics cause little disruption, education about the condition and support for the patient and their environment may be sufficient.
For more pronounced symptoms, behavioral therapy and medication can be important.
A commonly used behavioral therapy method isComprehensive Behavioral Intervention for Tics(CBIT), which includesHabit Reversal Trainingas a core component.
In this approach, patients learn to recognize the premonitory urge and adopt a different, less disruptive response.
Certain medications can also help reduce tics.
These medications influence dopamine regulation, among other things, but can cause side effects such as fatigue, weight gain, or other neurological and metabolic effects.
Neuromodulation offers an additional treatment approach in which we aim to specifically influence the brain networks involved in tics and impulse control.
Neuromodulation: influencing the brain networks involved
Neuromodulation uses electrical or magnetic stimulation to alter the activity of nerves and brain networks.
In Tourette's, treatment and scientific research focus primarily on the motor and prefrontal circuits involved in the generation and suppression of tics.
A key premise is that tics may be related to an altered balance between the activation and suppression of movements.
By influencing specific brain networks, these processes are modulated.
Several areas serve as potential targets:
- The supplementary motor area (SMA).
- The anterior cingulate cortex (ACC).
- The primary motor cortex.
- Prefrontal brain networks involved in impulse control.
- Connections between the basal ganglia, thalamus, and cerebral cortex.
Peripheral nerve stimulation is also being investigated for its influence on the interaction between sensory and motor brain networks.
What does scientific research show?
Scientific interest in neuromodulation for Tourette's has increased significantly in recent years.
Various clinical studies have investigated how targeted stimulation can influence the severity of tics and the premonitory urges that precede them.
Electrical brain stimulation and motor tics
In 2025,Movement Disorders Clinical Practicepublished a randomized, double-blind, placebo-controlled study on transcranial direct current stimulation (tDCS) of the SMA in patients with Tourette's.
A total of 24 patients participated.
The participants received active or placebo stimulation for five consecutive days.
The group receiving active treatment showed greater improvement in the severity of motor tics.
The intensity of the premonitory urge to perform a tic also decreased more significantly.
No significant difference in total tic scores was found between active and placebo stimulation.
These results are interesting because they show that targeted electrical stimulation can influence specific components of the tic process.
Magnetic stimulation and the premonitory urge
Transcranial magnetic stimulation (TMS) is also being investigated for Tourette syndrome.
A 2024 meta-analysis synthesized the results of randomized clinical trials.
It showed that, on average, TMS had a beneficial effect on the premonitory urge to perform a tic.
In this analysis, no statistically significant advantage over placebo was found for overall tic severity.
This distinction is important because the premonitory urge itself can be a burdensome aspect of Tourette syndrome.
Combining different brain networks
A 2025 clinical case report describes the treatment of a patient with treatment-resistant Tourette syndrome using a combination of magnetic and electrical stimulation.
The researchers focused on the SMA, the motor cortex, and the cerebellum.
A reduction in tics was reported following treatment, with the positive results maintained during a three-month follow-up.
This case illustrates an interesting research direction:influencing multiple interconnected brain regions instead of using only a single stimulation site.
Network-targeted neuromodulation
In a recent 2026 review, Worbe and Courtin describe how research into Tourette syndrome is increasingly evolving toward a network-oriented approach.
This approach does not focus solely on one brain region, but rather on the dynamic interaction between various motor and cognitive circuits.
These insights can help further refine the development of neuromodulation.
Measuring brain activity during specific movement and control processes is also an important area of research.
How does BRAI3N approach treatment?
At BRAI3N, we start from neuroscientific insights into the brain networks involved in Tourette's.
We look not only at which tics are present, but also at what other symptoms affect daily functioning.
For some patients, motor tics are the primary concern. For others, the premonitory urge, concentration problems, impulsivity, or additional anxiety and obsessive-compulsive symptoms play a major role.
Based on this individual approach, we investigate whether neuromodulation can offer a suitable addition to existing treatments.
In this context, non-invasive techniques such as transcranial electrical stimulation (tES) and transcranial magnetic stimulation (TMS) may be considered.
Scientific results provide concrete starting points for influencing motor brain networks and the processes involved in the development of tics.
At the same time, results vary between the techniques, stimulation protocols, and patient groups studied.
That is why we always evaluate which approach fits the individual's specific symptoms and treatment goals.
The BRAI3N treatment process
1. Assessment
During the initial evaluation, we will discuss your symptoms, medical history, and previous treatments.
We will focus on areas including:
- The nature and frequency of motor and vocal tics.
- The severity and impact of the symptoms.
- The premonitory urge to perform a tic.
- Concentration, attention, and impulsivity.
- Any anxiety or obsessive-compulsive symptoms.
- Sleep quality and stress sensitivity.
- Previous medication and behavioral therapy treatments.
AnqEEG measurement and analysisprovides additional information about electrical brain activity but is not a standalone diagnostic test for Tourette's and cannot, by itself, determine which form of neuromodulation is most suitable.
2. Targeted treatment
Based on the clinical evaluation, we will determine which symptoms to prioritize.
When neuromodulation appears to be a useful supplementary treatment option, we will investigate which brain networks could potentially be influenced.
Where appropriate, treatment can be coordinated with existing behavioral, neurological, or psychiatric care.
3. Stabilization
Throughout the treatment process, we will monitor how your tics and associated symptoms evolve.
We look at factors including:
- The frequency and intensity of the tics.
- The premonitory urge.
- The extent to which tics can be suppressed.
- Concentration and impulse control.
- The impact of the symptoms on daily activities.
Because tics can naturally fluctuate, we assess the effect of treatment over multiple measurement points.
The treatment plan is adjusted as necessary.
4. Maintenance
Once symptoms improve, we look at how to best maintain that progress.
Depending on the situation, continued behavioral therapy, neurological or psychiatric support, and follow-up care may remain important.
Not every patient requires the same treatment or a maintenance plan.
Can neuromodulation help with Tourette's?
Are you struggling with persistent motor or vocal tics, a strong premonitory urge, or additional symptoms that affect your daily functioning?
When previous treatments have not provided sufficient improvement, it may be worth exploring whether neuromodulation offers an additional treatment option.
BRAI3N offers a unique combination of science and care.
Through close collaboration between neuroscientists and clinicians, scientific insights are carefully translated into clinical practice.
During an initial evaluation, we will discuss your symptoms, previous treatments, and which options may be relevant for your situation.
Contact us for a no-obligation consultation or to schedule an appointment
Scientific Background
Monfrini E, Saleh C, Servello D, Jaszczuk P, Porta M.International Journal of Molecular Sciences. 2025;26(18):8831.
Tourette Syndrome: Clinical Features, Pathophysiology, and Treatment
Johnson KA, Worbe Y, Foote KD, Butson CR, Gunduz A, Okun MS.The Lancet Neurology. 2023;22(2):147–158.
Neurobiology of Tourette Syndrome
Singer HS.Neurologic Clinics. 1997;15(2):357–379.
Neuromodulation in Tourette Syndrome: Dopamine and Beyond
Buse J, Schoenefeld K, Münchau A, Roessner V.Neuroscience & Biobehavioral Reviews. 2013;37(6):1069–1084.
Worbe Y, Courtin E.Current Opinion in Neurology. 2026;39(4):439–446.
Current Management of Tics and Tourette Syndrome: Behavioral, Pharmacologic, and Surgical Treatments
Billnitzer A, Jankovic J.Neurotherapeutics. 2020;17:1681–1693.
Neuromodulation for Tourette Syndrome: Current Techniques and Future Perspectives
Haslam S, Johnson K, Anderson DN, Mahant N, Anderson CJ.Journal of Neural Engineering. 2025;22(6).
Noninvasive Brain Stimulation for Gilles de la Tourette Syndrome
Houlgreave MS, Dyke K, Jackson SR.Handbook of Clinical Neurology. 2026;215:299–310.
Role and Related Mechanisms of Non-Invasive Brain Stimulation in the Treatment of Tourette Syndrome
Liang B, Zhou Y, Jiang C, Zhao T, Qin D, Gao F.Brain Research Bulletin. 2025;222:111258.
Mahjoub Y, Szejko N, Gan LS, Adeoti JA, Nitsche MA, Vicario CM, et al.Movement Disorders Clinical Practice. 2025;12(3):313–324.
A Meta-Analysis of Transcranial Magnetic Stimulation in Tourette Syndrome
Steuber ER, McGuire JF.Journal of Psychiatric Research. 2024;173:34–40.
An Overview of Transcranial Direct Current Stimulation for Tic Symptoms in Tourette's Syndrome
Frey J, Malaty I.Expert Review of Neurotherapeutics. 2025;25(10):1165–1173.
Multi-Target Combination Treatment with rTMS and tDCS for Tourette Syndrome: A Case Report
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Fregni F, El-Hagrassy MM, Pacheco-Barrios K, Carvalho S, Leite J, Simis M, et al.International Journal of Neuropsychopharmacology. 2021;24(4):256–313.
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Authored by Prof. Dr. Sven Vanneste, Prof. Dr. Dirk De Ridder and Jan Ost - 10/23/2026
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