The Effectiveness of Lurasidone Add-On for Residual Aggressive Behavior and Obsessive Symptoms in Antipsychotic-Treated Children and Adolescents with Tourette Syndrome: Preliminary Evidence from a Case Series

Abstract

Children and adolescents with Tourette syndrome may suffer from comorbid psychological and behavioral difficulties, primarily Attention-Deficit Hyperactivity Disorder-related manifestations including impulsive, aggressive, and disruptive behavior, and Obsessive-Compulsive Disorder-related disturbances. Often, such additional problems represent the major cause of disability, requiring their prioritization above the tic symptomatology. Here, we present six cases of children and adolescents with treatment-resistant Tourette syndrome aged 11–17 years, whose symptoms, especially the non-tic symptoms such as aggressive behavior and obsessive symptoms, failed to respond adequately to at least two different antipsychotics and, where deemed appropriate, to a combination with a medication with a different therapeutic indication or chemical class (e.g., antidepressant or anticonvulsant). Such symptomatic manifestations were significantly reduced by the time of the subsequent control visit planned 30 days later, by using lurasidone as an add-on therapy to risperidone or aripiprazole (all p ≤ 0.009). No significant neuromotor or metabolic side effects were reported in all cases in a follow-up period ranging from 4 months to 6 months, supporting the stability of the observed clinical improvement. While still investigational, the preliminary evidence presented here gives reason to hope that lurasidone could possibly be an effective option in Tourette syndrome, warranting further investigation of its potential benefits in neurodevelopmental conditions.

Tourette syndrome research highlights from 2021

“…An interesting case series described six children or adolescents with aggressive behaviors in whom lurasidone, a novel antipsychotic, was added to either aripiprazole or risperidone; the addition of lurasidone appeared to diminish these symptoms with good tolerability. 93 …”

“…92 An interesting case series described six children or adolescents with aggressive behaviors in whom lurasidone, a novel antipsychotic, was added to either aripiprazole or risperidone; the addition of lurasidone appeared to diminish these symptoms with good tolerability. 93 Interest in cannabis (and, more generally, the cannabinoid system) in the treatment of tics is ongoing. Monoacylglycerol lipase inhibition to increase levels of 2-arachidonoylglycerol (2-AG), an endocannabinoid, was tested in a 12-week, multicenter, randomized, placebo-controlled, double-blind clinical trial using a compound called Lu AG06466 (formerly known as ABX-1431).…”

Recent progress on Tourette syndrome

“…Lurasidone, a dopamine and serotonin receptor antagonist, is an atypical antipsychotic used for the treatment of schizophrenia and bipolar disorder 108 . Six children and adolescents with treatment-refractory TS, aggressive behavior, and obsessive symptoms responded significantly to lurasidone as an add-on therapy to risperidone or aripiprazole 109 .…”