A randomised, double-blind, placebo-controlled study of topiramate in the treatment of Tourette syndrome

Jankovic, Joseph; Jimenez-Shahed, Joohi; Brown, Lawrence W.

doi:10.1136/jnnp.2009.185348

Cited by 169 publications

(90 citation statements)

References 11 publications

(7 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…131 In this study, 29 adults and children were randomised to maximum dose of 200 mg/day topiramate or placebo for 6 weeks. Because the mean age of this population was low (16.5 years, SD 9.9), it was assumed that the majority of the participants would be < 18 years and this study was combined with the child studies in the meta-analysis.…”

Section: Study Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis

Hollis

Pennant

Cuenca

et al. 2016

Health Technol Assess

127

109

View full text Add to dashboard Cite

BackgroundTourette syndrome (TS) is a neurodevelopmental condition characterised by chronic motor and vocal tics affecting up to 1% of school-age children and young people and is associated with significant distress and psychosocial impairment.ObjectiveTo conduct a systematic review of the benefits and risks of pharmacological, behavioural and physical interventions for tics in children and young people with TS (part 1) and to explore the experience of treatment and services from the perspective of young people with TS and their parents (part 2).Data SourcesFor the systematic reviews (parts 1 and 2), mainstream bibliographic databases, The Cochrane Library, education, social care and grey literature databases were searched using subject headings and text words for tic* and Tourette* from database inception to January 2013.Review/research methodsFor part 1, randomised controlled trials and controlled before-and-after studies of pharmacological, behavioural or physical interventions in children or young people (aged < 18 years) with TS or chronic tic disorder were included. Mixed studies and studies in adults were considered as supporting evidence. Risk of bias associated with each study was evaluated using the Cochrane tool. When there was sufficient data, random-effects meta-analysis was used to synthesize the evidence and the quality of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. For part 2, qualitative studies and survey literature conducted in populations of children/young people with TS or their carers or in health professionals with experience of treating TS were included in the qualitative review. Results were synthesized narratively. In addition, a national parent/carer survey was conducted via the Tourettes Action website. Participants included parents of children and young people with TS aged under 18 years. Participants (young people with TS aged 10–17 years) for the in-depth interviews were recruited via a national survey and specialist Tourettes clinics in the UK.ResultsFor part 1, 70 studies were included in the quantitative systematic review. The evidence suggested that for treating tics in children and young people with TS, antipsychotic drugs [standardised mean difference (SMD) –0.74, 95% confidence interval (CI) –1.08 to –0.41;n = 75] and noradrenergic agents [clonidine (Dixarit®, Boehringer Ingelheim) and guanfacine: SMD –0.72, 95% CI –1.03 to –0.40;n = 164] are effective in the short term. There was little difference among antipsychotics in terms of benefits, but adverse effect profiles do differ. Habit reversal training (HRT)/comprehensive behavioural intervention for tics (CBIT) was also shown to be effective (SMD –0.64, 95% CI –0.99 to –0.29;n = 133). For part 2, 295 parents/carers of children and young people with TS contributed useable survey data. Forty young people with TS participated in in-depth interviews. Four studies were in the qualitative review. Key themes were difficulties in accessing specialist care and behavioural interventions, delay in diagnosis, importance of anxiety and emotional symptoms, lack of provision of information to schools and inadequate information regarding medication and adverse effects.LimitationsThe number and quality of clinical trials is low and this downgrades the strength of the evidence and conclusions.ConclusionsAntipsychotics, noradrenergic agents and HRT/CBIT are effective in reducing tics in children and young people with TS. The balance of benefits and harms favours the most commonly used medications: risperidone (Risperdal®, Janssen), clonidine and aripiprazole (Abilify®, Otsuka). Larger and better-conducted trials addressing important clinical uncertainties are required. Further research is needed into widening access to behavioural interventions through use of technology including mobile applications (‘apps’) and video consultation.Study registrationThis study is registered as PROSPERO CRD42012002059.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

Section: Study Characteristicsmentioning

confidence: 99%

“…For the study of topiramate, 131 a computer-generated randomisation code was used but the presence of allocation concealment was unclear. There was assurance of blinding of participants, providers and outcome assessors.…”

Section: Risk Of Biasmentioning

confidence: 99%

Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis

Hollis

Pennant

Cuenca

et al. 2016

Health Technol Assess

127

109

View full text Add to dashboard Cite

show abstract

“…Доступные в Российской Федерации основные лекарственные средства для лечения ХТ и СТ, указанные в Европейских рекомендациях [40]. данным двойного слепого плацебо-контролируемого ис-следования с участием 29 пациентов с СТ, топирамат ока-зался эффективным и безопасным средством при лечении среднетяжелых и тяжелых форм СТ [44]. В открытом ис-следовании леветирацетама у 60 детей с СТ показано сни-жение выраженности тиков на 20% по Йельской глобаль-ной шкале тяжести тиков и улучшение по шкале общего клинического впечатления.…”

Section: журнал неврологии и психиатрии 1 2015unclassified

Chronic tics and Tourette syndrome in children and adolescents: diagnostic and treatment characteristics

Zavadenko

Доронина

Nesterovsky

2015

Z. nevrol. psikhiatr. im. S.S. Korsakova

View full text Add to dashboard Cite

ЛЕКЦИЯТики -внезапные, быстрые, повторяющиеся, нерит-мичные моторные движения или вокализации [1]. По со-временным критериям Международной классификации болезней 10-го пересмотра (МКБ-10) [2,3], классифика-ции Американской психиатрической ассоциации DSM-V [1] и исследовательской группы по классификации син-дрома Туретта (СТ) [4,5] определяются следующие фор-мы первичных тикозных расстройств: транзиторное ти-козное расстройство (тики длятся не менее 4 нед, но не более 12 мес), хронические тики (ХТ) продолжительно-стью более одного года, СТ (комбинированное голосовое и множественное двигательное тикозное расстройство).Дебют тикозных расстройств в большинстве случаев приходится на возраст от 2 до 15 лет. Часто они диагности-руются поздно или не диагностируются совсем, поэтому многие пациенты не получают адекватной помощи и в те- Хронические тики (ХТ) встречаются у 3-4% населения, синдром Туретта (СТ) -у 0,1-3,0%. Дебют тикозных расстройств в большинстве случаев приходится на возраст от 2 до 15 лет. но они часто диагностируются поздно. Клинические проявления тиков и сопутствующих им расстройств разнообразны и зависят от возраста ребенка. Трудности в лечении ХТ связаны с их персистированием, СТ -с флюктуирующим течением тиков, а также возможным дебютом заболевания поведенческих нарушений. Лечение ХТ и СТ носит индивидуальный характер: если тики не мешают пациентам в их повседневной жизни, то на определенный период могут рекомендоваться методы поведенческой и психотерапии; усиление и учащение тиков служат показаниями для назначения фармакотерапевтических средств. Рассматриваются Европейские рекомендации по фармакотерапии тикозных расстройств и доступные в России препараты. Приводятся данные исследований эффективности при ХТ и СТ противоэпилептических препаратов, а также препарата тенотен детский. Ключевые слова: хронические тики, синдром Туретта, диагноз, комордидные расстройства, фармакотерапия, тенотен детский.Chronic tics (CT) are observed in 34% population, Tourette syndrome (TS) in 0.1-3.0%. In most cases, tic disorders start at age 2-15 years, but frequently they are diagnosed late. Clinical presentations of tics and comorbid disorders are various and depend on child's age. Difficulties in treatment of CT are associated with their persistence and those for TS with the fluctuating course of tics and probable onset of the disease in the form of behavioral disorders. Treatment of CT and TS is individual. Methods of behavioral and psychotherapy are recommended for a certain period of time if tics do not hamper everyday life. Increase in tick frequency and severity indicate the necessity of using pharmacological treatment. The European recommendations on pharmacotherapy of tic disorders and the drugs available in Russia are considered. Results of the studies on the efficacy of antiepileptic drugs and tenoten children in CT and TS are presented.Key words: chronic tics, Tourette syndrome, diagnosis, comorbid disorders, pharmacotherapy, tenoten children. чение длительного времени страдают не только от самого заболева...

show abstract

“…A small clinical trial indicated that the antiepileptic agent that influences excitatory and inhibitory neurotransmission, topiramate, is effective for tics [22]. This drug can cause language and other cognitive side effects which might interfere with a child's learning.…”

Section: Other Medicationsmentioning

confidence: 99%

Treatment of Tourette Syndrome

Kurlan

2014

Neurotherapeutics

View full text Add to dashboard Cite

Tourette's syndrome (TS) consists of chronic motor and phonic tics and characteristically begins in childhood. The tics can be disabling and commonly associated behavioral comorbities such as attention deficit hyperactivity disorder (ADHD) and obsessivecompulsive disorder (OCD), can also cause problems in daily functioning. The underlying etiology and neurobiology of TS remain unknown although genetic factors appear to be important, cortical control of basal ganglia motor function appears to be disturbed and neurochemical abnormalities, particularly involving dopamine neurotransmission, are likely present. The treatment of TS involves appropriate education and support. Tics can be treated with habit reversal cognitive behavioral therapy, medications (most commonly alpha agonists and antipsychotics), local intramuscular injections of botulinum toxin and some severe, refractory cases have responded to deep brain stimulation surgery (DBS). It is important to appropriately diagnose and treat comorbid behavioral disorders that are disrupting function. OCD can be treated with cognitive behavioral therapy, selective serotonin reuptake inhibitors, and atypical antipsychotics. DBS has become a treatment option for patients with disabling OCD despite other therapies. ADHD is treated with appropriate classroom accommodations, behavioral therapy, alpha agonists, atomoxetine or methylphenidate-containing stimulant drugs.

show abstract

A randomised, double-blind, placebo-controlled study of topiramate in the treatment of Tourette syndrome

Abstract: This double-blind, placebo-controlled trial provides evidence that topiramate may have utility in the treatment of moderately severe TS.

Cited by 169 publications

References 11 publications

Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis

Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis

Chronic tics and Tourette syndrome in children and adolescents: diagnostic and treatment characteristics

Treatment of Tourette Syndrome

Contact Info

Product

Resources

About