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How is Tourette syndrome treated?
Tics require treatment when they are socially embarrassing, painful (dystonic tics often cause pain), and severe enough to interfere with functioning.
Medications such as topiramate, dopamine blockers such as fluphenazine, or dopamine depletors such as tetrabenazine are used.
Tetrabenazine has the added advantage, unlike neuroleptics, of not causing tardive dyskinesia (TD). The behavioral problems present in Tourette syndrome usually can be more disabling than tics.
For ADHD, currently three classes of drugs are used: alpha-agonists (clonidine and guanfacine), stimulants (amphetamine enantiomers, methylphenidate enantiomers, or slow release preparation), and a selective norepinephrine reuptake inhibitor (atomoxetine).
For management of bothersome OCD, cognitive-behavioral therapy, selective serotonin reuptake inhibitors such as fluvoxamine, sertraline, and fluoxetine or tricyclincs such as clomipramine, or imipramine, may be useful.
Carbamazepine and lithium are sometimes used in patients with impulse control problems.
Deep brain stimulation can be effective in medically refractory patients.
Guidelines for the Treatment of Tourette Syndrome
| Feature | Treatment |
|---|---|
| Tics | Topamax |
| Fluphenazine | |
| Tetrabenazine | |
| Botox | |
| ADHD | Clonidine |
| Methylphenidate | |
| Dextroamphetamine | |
| OCD | Fluvoxamine |
| Sertraline | |
| Clomipramine | |
| Imipramine | |
| Low impulse control | Carbamazepine |
| Lithium |
ADHD , Attention deficit hyperactivity disorder; OCD , obsessive compulsive disorder.
Sources
- Jankovic J, Kurlan R: Tourette syndrome: evolving concepts. Mov Disord 26(6):1149-1156, 2011.
- Davis LK, Yu D, Keenan CL, Gamazon ER, Konkashbaev AI, Derks EM, et al.: Partitioning the heritability of Tourette syndrome and obsessive compulsive disorder reveals differences in genetic architecture. PLoS Genet 9(10):e1003864, 2013.
- Scharf JM, Yu D, Mathews CA, Neale BM, Stewart SE, Fagerness JA, et al.: Genome-wide association study of Tourette’s syndrome. Mol Psychiatry 18(6):721-728, 2013.
- Deng H, Gao K, Jankovic J: The genetics of Tourette syndrome. Nat Rev Neurol 8(4):203-213, 2012.
- Jankovic J: Tics and Tourette’s syndrome. In Jankovic J, Tolosa E (eds): Parkinson’s disease and movement disorders, ed 5. Baltimore: Lippincott Williams & Wilkins, 2006.
- Wijemanne S, Wu LJ, Jankovic J: Long-term efficacy and safety of fluphenazine in patients with Tourette syndrome. Mov Disord 29(1):126-130, 2014.
- Jankovic J, Jimenez-Shahed J, Brown LW: A randomised, double-blind, placebo-controlled study of topiramate in the treatment of Tourette syndrome. J Neurol Neurosurg Psychiatry 81(1):70-73, 2010.
- Baizabal-Carvallo JF, Jankovic J: The clinical features of psychogenic movement disorders resembling tics. J Neurol Neurosurg Psychiatry 85(5):573-575, 2014.
- Viswanathan A, Jimenez-Shahed J, Baizabal Carvallo JF, Jankovic J. Deep brain stimulation for Tourette syndrome: target selection. Stereotact Funct Neurosurg 90(4):213-224, 2012.
