To the Editor: ”Mr. P” is a 52-year-old man first diagnosed with Tourette syndrome (TS) at the age of 44 after referral to our specialist TS clinic for chronic tic symptoms1,2. On neuropsychiatric examination, he presented with multiple motor tics (including facial grimacing and shoulder shrugging) and phonic tics (mainly yelping and barking), which were present since the age of 11. All tics were characteristically preceded by premonitory urges, and he was able to voluntarily suppress them at the expense of mounting inner tension. There was no evidence of comorbid psychiatric disorders, with the exception of mild obsessive-compulsive behaviors (counting, lining up newspapers), previous episodes of depression, and sleep problems as a child (somnambulism).