Clonidine and Gilles de la Tourette's syndrome: Double‐blind study using objective rating methods

Goetz, Christopher G.; Tanner, Caroline M.; Wilson, Robert S.; Carroll, V. Susan; Como, Peter; Shannon, Kathleen M.

doi:10.1002/ana.410210313

Cited by 169 publications

(62 citation statements)

References 9 publications

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“…123,125 Medications shown to have efficacy and to be used clinically but not FDA approved for ADHD include clonidine 126,127 and bupropion (Wellbutrin). 128,129 Bradycardia and decreased blood pressure have been reported in children treated with clonidine 130 but not in adults 131 or in children with Tourette's disorder. 132 Elevations in systolic and diastolic blood pressure were noted with abrupt withdrawal of clonidine but not with gradual titration.…”

Section: Other Pharmacological Treatment Of Adhdmentioning

confidence: 99%

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder

Vetter¹,

Elia²,

Erickson³

et al. 2008

Circulation

262

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Section: Other Pharmacological Treatment Of Adhdmentioning

confidence: 99%

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder

Vetter¹,

Elia²,

Erickson³

et al. 2008

Circulation

262

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“…One fair study 44 comparing the clonidine patch to placebo in 437 patients (aged between 6 and 18 years) found benefit for tics using 1 to 2 mg clonidine patches administered on a weekly basis. Two additional poor-quality studies 45,46 failed to show any effect of clonidine on tics. Side effects commonly seen with clonidine include sedation, bradycardia, orthostatic hypotension, and dry mouth, as well as localized skin irritation with the clonidine patch.…”

Section: Nonantipsychotics For the Treatment Of Ticsmentioning

confidence: 99%

Canadian Guidelines for the Evidence-Based Treatment of Tic Disorders: Pharmacotherapy

et al. 2012

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This article seeks to provide the practising clinician with guidance on the pharmacological management of tic disorders in children and adults. We performed a systematic review of the literature on the treatment of tic disorders. A multi-institutional group of 14 experts in psychiatry, child psychiatry, neurology, pediatrics, and psychology engaged in a consensus meeting. The evidence was presented and discussed, and nominal group techniques were employed to arrive at consensus on recommendations. A strong recommendation is made when the benefits of treatment clearly outweigh the risks and burdens, and can apply to most patients in most circumstances without reservation. With a weak recommendation, the benefits, risks, and burdens are more closely balanced, and the best action may differ depending on the circumstances. Based on these principles, weak recommendations were made for the use of pimozide, haloperidol, fluphenazine, metoclopramide (children only), risperidone, aripiprazole, olanzapine, quetiapine, ziprasidone, topiramate, baclofen (children only), botulinum toxin injections, tetrabenazine, and cannabinoids (adults only). Strong recommendations were made for the use of clonidine and guanfacine (children only). While the evidence supports the efficacy of many of the antipsychotics for the treatment of tics, the high rates of side effects associated with these medications resulted in only weak recommendations for these drugs. In situations where tics are not severe or disabling, the use of a medication with only a weak recommendation is not warranted. However, when tics are more distressing and interfering, the need for tic suppression to improve quality of life is stronger, and patients and clinicians may be more willing to accept the risks of pharmacotherapy.

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“…In another child study of clonidine compared with placebo [mixed study but individual patient data (IPD) for children obtained], 114 the method of randomisation and the presence of allocation concealment was unclear but there appears to have been blinding of participants and providers and outcome assessors. The presence of dropout from the study was unclear.…”

Section: Interventions For Tics In Children and Adolescentsmentioning

confidence: 99%

“…113 For one mixed crossover trial, data for a subset of 24 children were obtained from authors. 114 This study compared the use of 0.0075-0.015 mg/kg/day clonidine with placebo for 12 weeks each. One crossover trial in 37 children compared maximum dose of 0.2 mg/day clonidine (and maximum dose of 100 mg/day desipramine) with placebo for 6 weeks each.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Nine studies in children and two mixed studies compared the efficacy of a noradrenergic agent with placebo (PRISMA diagram, Appendix 2): l clonidine versus placebo: three child [113][114][115] and one mixed 116 study l clonidine patch versus placebo: two child 117,118 and one mixed 119 study l guanfacine versus placebo: two child studies 120,121 l atomoxetine versus placebo: one child study 122 (subgroup analysis 123 ).…”

Section: Included Studiesmentioning

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

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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.

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Clonidine and Gilles de la Tourette's syndrome: Double‐blind study using objective rating methods

Cited by 169 publications

References 9 publications

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder

Canadian Guidelines for the Evidence-Based Treatment of Tic Disorders: Pharmacotherapy

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

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