Pharmacological treatment of tic disorders and Tourette Syndrome

AbstractIn 2011, the European Society for the Study of Tourette Syndrome (ESSTS) published the first European guidelines for Tourette Syndrome (TS). We now present an update of the part on pharmacological treatment, based on a review of new literature with special attention to other evidence-based guidelines, meta-analyses, and randomized double-blinded studies. Moreover, our revision took into consideration results of a recent survey on treatment preferences conducted among ESSTS experts. The first preference should be given to psychoeducation and to behavioral approaches, as it strengthens the patients’ self-regulatory control and thus his/her autonomy. Because behavioral approaches are not effective, available, or feasible in all patients, in a substantial number of patients pharmacological treatment is indicated, alone or in combination with behavioral therapy. The largest amount of evidence supports the use of dopamine blocking agents, preferably aripiprazole because of a more favorable profile of adverse events than first- and second-generation antipsychotics. Other agents that can be considered include tiapride, risperidone, and especially in case of co-existing attention deficit hyperactivity disorder (ADHD), clonidine and guanfacine. This view is supported by the results of our survey on medication preference among members of ESSTS, in which aripiprazole was indicated as the drug of first choice both in children and adults. In treatment resistant cases, treatment with agents with either a limited evidence base or risk of extrapyramidal adverse effects might be considered, including pimozide, haloperidol, topiramate, cannabis-based agents, and botulinum toxin injections. Overall, treatment of TS should be individualized, and decisions based on the patient’s needs and preferences, presence of co-existing conditions, latest scientific findings as well as on the physician’s preferences, experience, and local regulatory requirements.

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Pharmacological treatment of Tourette syndrome

Journal of Obsessive-Compulsive and Related Disorders ◽

10.1016/j.jocrd.2014.04.006 ◽

2014 ◽

Vol 3 (4) ◽

pp. 407-414 ◽

Cited By ~ 18

Author(s):

Donald L. Gilbert ◽

Joseph Jankovic

Keyword(s):

Tourette Syndrome ◽

Pharmacological Treatment

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Altered urinary tetrahydroisoquinoline derivatives in patients with Tourette syndrome: reflection of dopaminergic hyperactivity?

Journal of Neural Transmission ◽

10.1007/s00702-020-02289-6 ◽

2020 ◽

Author(s):

Philipp Capetian ◽

Veit Roessner ◽

Caroline Korte ◽

Susanne Walitza ◽

Franz Riederer ◽

...

Keyword(s):

Tourette Syndrome ◽

Diagnostic Value ◽

Tic Disorders ◽

Operating Characteristics ◽

Roc Curve Analysis ◽

Two Phase ◽

Dopaminergic Neurotransmission ◽

Hyperactivity Disorder ◽

The Central Nervous System ◽

Chronic Tic Disorders

AbstractTetrahydroisoquinolines (TIQs) such as salsolinol (SAL), norsalsolinol (NSAL) and their methylated derivatives N-methyl-norsalsolinol (NMNSAL) and N-methyl-salsolinol (NMSAL), modulate dopaminergic neurotransmission and metabolism in the central nervous system. Dopaminergic neurotransmission is thought to play an important role in the pathophysiology of chronic tic disorders, such as Tourette syndrome (TS). Therefore, the urinary concentrations of these TIQ derivatives were measured in patients with TS and patients with comorbid attention-deficit/hyperactivity disorder (TS + ADHD) compared with controls. Seventeen patients with TS, 12 with TS and ADHD, and 19 age-matched healthy controls with no medication took part in this study. Free levels of NSAL, NMNSAL, SAL, and NMSAL in urine were measured by a two-phase chromatographic approach. Furthermore, individual TIQ concentrations in TS patients were used in receiver-operating characteristics (ROC) curve analysis to examine the diagnostic value. NSAL concentrations were elevated significantly in TS [434.67 ± 55.4 nmol/l (standard error of mean = S.E.M.), two-way ANOVA, p < 0.0001] and TS + ADHD patients [605.18 ± 170.21 nmol/l (S.E.M.), two-way ANOVA, p < 0.0001] compared with controls [107.02 ± 33.18 nmol/l (S.E.M.), two-way ANOVA, p < 0.0001] and NSAL levels in TS + ADHD patients were elevated significantly in comparison with TS patients (two-way ANOVA, p = 0.017). NSAL demonstrated an AUC of 0.93 ± 0.046 (S.E.M) the highest diagnostic value of all metabolites for the diagnosis of TS. Our results suggest a dopaminergic hyperactivity underlying the pathophysiology of TS and ADHD. In addition, NSAL concentrations in urine may be a potential diagnostic biomarker of TS.

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The prevalence of tic disorders in children and adolescents in Brazil

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20140174 ◽

2014 ◽

Vol 72 (12) ◽

pp. 942-948 ◽

Cited By ~ 3

Author(s):

Helvio L. Alves ◽

Elizabeth M. A. B. Quagliato

Keyword(s):

Special Education ◽

Children And Adolescents ◽

Tourette Syndrome ◽

Special Education Students ◽

Tic Disorders ◽

Education Students ◽

Tic Disorder ◽

Item Questionnaire ◽

Chronic Tic Disorder

Tourette syndrome (TS) and tic disorders represent events of familiar magnitude characterized by involuntary movements and/or vocalization. To determine the prevalence of TS/tic disorders we studied a sample of 762 subjects (388 M, 374 F), between 1992 and 1997, age 6 to 43 years old, taken out of a population of 10,155 subjects (4,918 M, 5,237 F; age: 3-56 years old). A structured 4-item questionnaire, direct interview (multistaged), >1 yr follow-up, were used. 9,565 subjects (4,614 M, 4,951 F) sent back the questionnaires, 3,354 of these (1,671 M, 1,683 F) with positive answers to tics. 42 subjects (31 M, 11 F, age: 7-21 years old, mean: 11 years old) met the DSM-III-R criteria. The total minimal prevalence of TS is 0.43%, with a 3:1 ratio male/female. The minimal prevalence of chronic tic disorder is 2.27%. The total minimal prevalence for tic disorders at all is 2.91%. No special education students participation.

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The effects of Gilles de la Tourette syndrome and other chronic tic disorders on quality of life across the lifespan: a systematic review

European Child & Adolescent Psychiatry ◽

10.1007/s00787-016-0823-8 ◽

2016 ◽

Vol 25 (9) ◽

pp. 939-948 ◽

Cited By ~ 45

Author(s):

Joel Evans ◽

Stefano Seri ◽

Andrea E. Cavanna

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Tourette Syndrome ◽

Tic Disorders ◽

Chronic Tic Disorders

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Tourette syndrome and other tic disorders

Uncommon Causes of Movement Disorders ◽

10.1017/cbo9780511977749.018 ◽

2011 ◽

pp. 180-184

Author(s):

Roger Kurlan ◽

David Shprecher

Keyword(s):

Tourette Syndrome ◽

Tic Disorders

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Effects of physical activity on the symptoms of Tourette syndrome: A systematic review

European Psychiatry ◽

10.1016/j.eurpsy.2017.11.002 ◽

2018 ◽

Vol 48 (1) ◽

pp. 13-19 ◽

Cited By ~ 7

Author(s):

David D. Kim ◽

Darren E.R. Warburton ◽

Nana Wu ◽

Alasdair M. Barr ◽

William G. Honer ◽

...

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Tourette Syndrome ◽

Case Reports ◽

Physical Exertion ◽

Tic Disorders ◽

Physiological Mechanisms ◽

Randomized Controlled Studies ◽

Mesh Terms ◽

Vigorous Intensity

AbstractThere is irrefutable evidence that routine physical activity or exercise can offer considerable health benefits to individuals living with various mental disorders. However, it is not clear what effect physical activity has on the symptoms of Tourette syndrome. Despite a paucity of evidence, physical activity or exercise has already been recommended by various health organizations for the management of tics. We provide a systematic review of the effects of physical activity or exercise on tic symptomology in individuals with Tourette syndrome. Major electronic databases were searched for all available publications before August 2017. Keywords and MeSH terms included “physical activity” or “exercise” or “exercise therapy” or “physical exertion” or “sports” and “tics” or “tic disorders” or “Tourette.” Eight studies were included, the majority of which were case reports. Despite a number of methodological limitations of the included studies, the review points to a trend that the effects of acute physical activity are intensity-dependent, where light intensity may alleviate and vigorous intensity may exacerbate tics. Chronic physical activity, however, appears to reduce the severity of tics even at higher intensity. Several physiological mechanisms may explain the differential effects of acute and chronic physical activity in Tourette syndrome. Future randomized controlled studies should better characterize the effects of different intensities and types of physical activity in Tourette syndrome.

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