Treatment strategies for tics in Tourette syndrome

Abstract

Tourette syndrome (TS) is a chronic neurodevelopmental disorder characterized by tics: repetitive, involuntary movements and vocalizations. These symptoms can have a significant impact on patients' daily functioning across many domains. Tics tend to be most severe in child and adolescent sufferers, so their presence has the potential to impact a period of life that is both critical for learning and is often associated with the experience of greater social tension and self-consciousness than adulthood. Furthermore, control over tics that lead to physical impairment or self-injurious behaviour is of vital importance in maintaining health and quality of life. There are numerous complicating factors in the prescription of treatment for tics, due to both the side effects associated with alleviating agents and patient characteristics, such as age and comorbid conditions. This review summarizes literature pertaining to the efficacy and safety of both traditionally prescribed and more modern medications. We also discuss the merits of behavioural and surgical techniques and highlight newer emerging treatments. Although treatment response is to some extent variable, there are a number of agents that are clearly useful as first-line treatments for TS. Other interventions may be of most benefit to patients exhibiting refractory tics or more specific symptom profiles.

Conservation law for self-paced movements

“…Clinical support for this prediction can be found in neural disorders with reduced dopamine levels, such as Parkinson's disease, where the overall speed of movements is decreased (29). Drugs that reduce dopamine activity, such as chlorapromazine and holoperidol (30), also reduce movements. In contrast, increased dopamine activity occurs in Tourette's syndrome (31), marked by fast, hyperkinetic movements, and early stages of Huntington's disease (32), characterized by choreiform movements.…”

Why so many deep brain stimulation targets in Tourette’s syndrome? Toward a broadening of the definition of the syndrome

“…However, these medications can have serious and multiple side effects, e.g. weight gain, Parkinsonism, dystonia and sedation (Weiden and Bruun 1987;Bruun 1988;Eddy et al 2011).…”

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

“…В ходе 4-летнего наблюдения в динами-ке улучшение состояния на фоне лечения леветирацета-мом наблюдалось у 49 из 70 пациентов при его хорошей переносимости [46]. Между тем опубликованные к насто-ящему времени данные о применении топирамата и леве-тирацетама в терапии СТ разноречивы как в отношении эффективности, так и побочных явлений, что требует проведения дополнительных исследований [47]. Поиск новых эффективных и безопасных медикамен-тозных средств лечения неврологических заболеваний у детей привел к появлению новой группы лекарственных препаратов, созданных на основе антител к белку S-100.…”