Healthy Skepticism Library item: 4948

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Publication type: Journal Article

Silay YS, Jankovic J.
Emerging drugs in Tourette syndrome.
Expert Opin Emerg Drugs 2005 May 01; 10:(2):365-80
http://www.expertopin.com/doi/abs/10.1517/14728214.10.2.365

Abstract:

Proper education of the patient is the first step in the treatment of Tourette syndrome (TS). Before deciding how to treat the patient, it is important to decide whether to treat the TS-related symptoms. Counselling and behavioural modification may be sufficient for those with mild symptoms. Medications, however, may be considered when symptoms begin to interfere with peer relationships, social interactions, academic or job performance, or with activities of daily living. Therapy must be individualised and the most troublesome symptoms should be targeted first. Antidopaminergic agents are clearly the most effective drugs in the treatment of tics. Although haloperidol and pimozide are the only drugs currently approved by the FDA for the treatment of TS, other dopamine receptor-blocking drugs and tetrabenazine, a dopamine depleting drug, as well as botulinum toxin injections, have been used to treat tics associated with TS. Carefully designed, comparative, longitudinal trials assessing the efficacy and adverse-effect profiles of these drugs, including tardive dyskinesia, are lacking. Selective serotonin reuptake inhibitors are recommended for the treatment of obsessive-compulsive behaviour: a common comorbidity. Psychostimulants, such as methylphenidate, are the treatment of choice for attention deficit hyperactivity disorder. Even though these drugs may transiently increase tics, this does not necessarily constitute a definite contraindication to the use of these drugs in patients with TS. Here, existing and emerging medical treatments in patients with tics and comorbid behavioural disorders associated with TS are reviewed.

Keywords:
Attention Deficit Disorder with Hyperactivity/complications Attention Deficit Disorder with Hyperactivity/drug therapy Attention Deficit Disorder with Hyperactivity/psychology Autistic Disorder/complications Autistic Disorder/drug therapy Autistic Disorder/psychology Drug Industry/trends* Drugs, Investigational/therapeutic use* Humans Tic Disorders/complications Tic Disorders/drug therapy Tic Disorders/psychology Tourette Syndrome/complications Tourette Syndrome/drug therapy* Tourette Syndrome/psychology