Atomoxetine treatment in children and adolescents with ADHD and comorbid tic disorders

Allen, Albert J.; Kurlan, Roger; Gilbert, Donald L.; Coffey, Barbara J.; Linder, Steven L.; Lewis, Donald W.; Winner, Paul; Dunn, David W.; Dure, Leon S.; Sallee, Floyd R.; Milton, Denái R.; Mintz, Mark; Ricardi, R. K.; Erenberg, Gerald; Layton, L. L.; Feldman, Peter D.; Kelsey, Douglas K.; Spencer, Thomas

doi:10.1212/01.wnl.0000188869.58300.a7

Cited by 195 publications

(131 citation statements)

References 42 publications

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“…In addition, a conservative approach to dosing of the stimulant as well as combined use of an alpha-2 agonist may reduce the likelihood of tic worsening. Nonstimulant medications such as guanfacine or atomoxetine should be considered for children with ADHD who cannot tolerate stimulant medications [41] [42].…”

Section: Medications For Tsmentioning

confidence: 99%

Tourette syndrome and obsessive–compulsive disorder

Lombroso

Scahill

2008

Brain and Development

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Tourette syndrome and obsessive-compulsive disorder are neuropsychiatric disorders that have sparked considerable interest over the decades. They are the focus of research for a remarkable diversity of disciplines, ranging from neuroimagers and prenatal epidemiologists to experts in the neural circuits that connect the cortex with the basal ganglia, as well as neuroimmunologists focusing on brain-based autoimmune phenomena. Several hypotheses have been put forward to explain the onset and exacerbation of these illnesses. Here we discuss the clinical phenomenology and treatment options that are currently available. New psychopharmacological agents are being used that are based on a greater understanding of the neurobiology and are being used in combination with behavioral interventions. Longitudinal clinical investigations into clinical symptoms and the natural course are providing additional clues on the underlying pathophysiology. Recent advances in research models are also reviewed in an attempt to clarify some of the molecular etiologies that lead to these disorders. KeywordsTorrette syndrome; obsessive-compulsive disorder; basal ganglia; autoimmune disorders; streptococcal infections; neuroleptic treatment Tourette syndrome (TS) and obsessive-compulsive disorder (OCD) are model neuropsychiatric disorders that have been the subject of medical interest for centuries [1]. Many explanations have been suggested for the etiology of tics and OCD symptoms and have included genetic factors, the influence of toxins, psychological, and infectious processes. There have been significant advances of our understanding of the neurobiological mechanisms at work in these disorders, as well as improvements in the treatments available. Several reviews on more specialized aspect of TS, OCD and related disorders have appeared over the last several years [2][3][4]. Here we concentrate on the clinical features of tic disorders and OCD and discuss evidence-based interventions for these disorders. Tourette syndromeTourette syndrome is one of several tic disorders that are classified either by their type (motor or phonic tic) or their duration (transient or chronic). The diagnosis of a transient tic is made if the tics are present for less than 12 months. If the tics persist for more than 12 months, they

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Section: Medications For Tsmentioning

confidence: 99%

Tourette syndrome and obsessive–compulsive disorder

Lombroso

Scahill

2008

Brain and Development

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“…We selected the norepinephrine reuptake inhibitor ATX, which tends to reduce ADHD symptoms in children with TS without exacerbating tics (Allen et al, 2005), but has more gradual and variable clinical effects than stimulants. The aim of this study was to determine whether one-month clinical ADHD responses to ATX correlate with: 1) first-ATX-dose induced changes in SICI; or 2) one-month-ATX induced changes in SICI.…”

Section: Introductionmentioning

confidence: 99%

Atomoxetine treatment of ADHD in Tourette Syndrome: Reduction in motor cortex inhibition correlates with clinical improvement

Gilbert

Zhang

Lipps

et al. 2007

Clinical Neurophysiology

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Objective: In children with Attention Deficit Hyperactivity Disorder (ADHD), clinical responses to the selective norepinephrine reuptake inhibitor atomoxetine (ATX) vary. We sought to determine in children with Tourette Syndrome (TS) whether clinical responses correlate with changes in short interval cortical inhibition (SICI). Methods:Fourteen children, ages 8 to 16, with ADHD and TS were treated open-label with ATX for one month. ADHD rating scale scores and SICI, measured with paired-pulse Transcranial Magnetic Stimulation (pTMS), were assessed blindly and independently at treatment onset and one month later.Results: Eleven children, mean ADHD Rating Scale scores 31.8 (SD 8.2) at onset completed the study. After one month, ADHDRS changes ranged from an increase of 4 points to a decrease (improvement) of 24 points (mean change -9.6, SD 9.1). The changes in ADHDRS scores correlated with reduction in SICI (r = .74, p = .010). Conclusions:In children with TS, one month of atomoxetine treatment appears to induce correlated improvements in ADHD and, paradoxically, further reductions in cortical inhibition.Significance: PTMS-evoked SICI in ADHD with TS may be a biomarker of both deficiency and compensatory changes within cortical interneuronal systems. Effective atomoxetine treatment may augment compensatory processes and thereby reduce SICI.

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“…Other types of stimulants, such as dexedrine and mixed amphetamine salts, have not been studied in patients with TS. The selective norepinephrine reuptake inhibitor atomoxetine has been shown to improve ADHD symptoms without worsening of tics in children with both conditions [31]. Given the fact that many TS patients require treatment for both tics and comorbidities, combination therapy with ticsuppressing, anti-OCD and anti-ADHD medications is commonly employed.…”

Section: Treatment Of Behavioral Comorbiditiesmentioning

confidence: 99%

Treatment of Tourette Syndrome

Kurlan

2014

Neurotherapeutics

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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.

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Atomoxetine treatment in children and adolescents with ADHD and comorbid tic disorders

Abstract: Atomoxetine did not exacerbate tic symptoms. Rather, there was some evidence of reduction in tic severity with a significant reduction of attention deficit/hyperactivity disorder symptoms. Atomoxetine treatment appeared safe and well tolerated.

Cited by 195 publications

References 42 publications

Tourette syndrome and obsessive–compulsive disorder

Tourette syndrome and obsessive–compulsive disorder

Atomoxetine treatment of ADHD in Tourette Syndrome: Reduction in motor cortex inhibition correlates with clinical improvement

Treatment of Tourette Syndrome

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