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Tourette’s syndrome in children

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This paper will provide a review of the Tourette’s syndrome (TS) in children, focusing on treatment options, including a drug-by-drug evaluation of available pharmacologic agents and other treatments. Despite increasing knowledge of the neurophysiologic basis of the tics of TS, ideal and universally effective treatments do not yet exist. Affected children may present a wide variety of phenotypes, which are best managed in a case-by-case manner, with the well-informed patient and family weighing the risks and benefits of interventions together with a knowledgeable and committed clinician. The clinician treating TS will encounter a wide range of tic severity, comorbidity, adherence to treatment, and treatment response. The clinician’s most important task is to identify the main sources of distress and impairment, and set priorities for their management. Common treatment may involve education and reassurance, psychosocial and school interventions, and choices from an array of pharmacologic agents. Decisions regarding treatment ought to be made collaboratively with the clinician and family, after a careful discussion of symptom extent and severity, psychosocial impact, desired outcome, and realistic treatment expectations and side effects. Given the waxing and waning course of tics in TS, clinicians often monitor each patient for several weeks before starting a somatic treatment, based on a judgement that even when tics are at their best, they are severe enough to warrant pharmacotherapy. With children for whom the decision has been taken to target tics with medication, the authors recommend beginning with guanfacine or clonidine, especially when there are any hyperactivity symptoms. The next choice would be a low-dose neuroleptic. Patience and close ongoing monitoring of efficacy and side effects is necessary, whenever a clinical trial of medications is undertaken, to achieve an acceptable balance between tic control and side effects. Treatments should be targeted at specific symptoms and comorbidities, such as attention deficit hyperactivity disorder and obsessive-compulsive disorder. Clinicians tend to treat comorbid conditions first because they may be the greatest sources of difficulty. On occasion, the successful treatment of a comorbid condition will lead to an amelioration of tics.

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References and Recommended Reading

  1. American Psychiatric Association: In Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington DC: American Psychiatric Association; 1994.

    Google Scholar 

  2. King RA, Leckman, Scahill L: Obsessive-compulsive disorder, anxiety, and depression. In Tourette Syndrome: Tics, Obsessions, Compulsions: Developmental Psychopathology and Clinical Care. Edited by Leckman JF, Cohen DJ. New York: John Wiley and Sons; 1999:43–62.

    Google Scholar 

  3. Leckman JF: Tourette’s syndrome. Lancet 2002, 360:1577–1586. This recent review contains the most up-to-date model of the neural substrates of habit formation and tics, schematically diagramed and discussed.

    Article  PubMed  Google Scholar 

  4. Leckman JF, Zhang H, Vitale A, et al.: Course of tic severity in Tourette syndrome: the first two decades. Pediatrics 1998, 102:14–19.

    Article  PubMed  CAS  Google Scholar 

  5. King RA, Scahill L, Lombroso PJ, Leckman JF: Tourette’s syndrome and other tic disorders, In Pediatric Psychopharmacology. Edited by Scahill L, King RA, Leckman JF. New York: Oxford; 2002:526–542.

    Google Scholar 

  6. Findley DB, King RA, Cohen DJ, Leckman JF: Yale Child Study Center Tourette’s syndrome obsessive-compulsive disorder specialty clinic symptom questionnaire. In Tourette Syndrome: Tics, Obsessions, Compulsions: Developmental Psychopathology and Clinical Care. Edited by Leckman JF, Cohen DJ. New York: John Wiley and Sons; 1999:415–454.

    Google Scholar 

  7. The Tourette’s Syndrome Study Group: Treatment of ADHD in children with tics: a randomized controlled trial. Neurology 2002, 58:527–536. This is a key, multicenter, randomized, double-blind, placebocontrolled study showing efficacy of clonidine for tic reduction in children with ADHD.

    Google Scholar 

  8. Babel TB, Warnke PC, Ostertag CB: Immediate and long term outcome after infrathalamic and thalamic lesioning for intractable Tourette’s syndrome. J Neurol Neurosurg Psychiatry 2001, 70:666–671.

    Article  PubMed  CAS  Google Scholar 

  9. Vandewalle W, VanderLinden C, Groenewegen HJ, Caemaert J: Stereotactic treatment of Gilles de la Tourette syndrome by high frequency stimulation of thalamus. Lancet 1999, 353:724.

    Article  PubMed  CAS  Google Scholar 

  10. George MS, Sallee FR, Nahas Z, et al.: Transcranial magnetic stimulation (TMS) as a research tool. In Tourette Syndrome and Associated Disorders. Edited by Leckman JF, Cohen DJ. Philadelphia: Lippincott Williams & Wilkins; 2001:225–235. This paper reviews the exciting new experimental modality of transcranial magnetic stimulation.

    Google Scholar 

  11. King RA, Scahill L, Findley D, Cohen DJ: Psychosocial and behavioral treatments. In Tourette Syndrome: Tics, Obsessions, Compulsions: Developmental Psychopathology and Clinical Care. Edited by Leckman JF, Cohen DJ. New York: John Wiley and Sons; 1999:338–359.

    Google Scholar 

  12. Scahill L, Chappell PB, Kim YS, et al.: A placebo-controlled study of guanfacine in the treatment of children with tic disorders and attention deficit hyperactivity disorder. Am J Psychiatry 2001, 158:1067–1074. This is the key, placebo-controlled double-blind parallel study showing efficacy of guanfacine for tic reduction.

    Article  PubMed  CAS  Google Scholar 

  13. Leckman JF, Hardin MT, Riddle MA, et al.: Clonidine Treatment of Gilles de la Tourette’s syndrome. Ach Gen Psychiatry 1991, 48:324–328.

    CAS  Google Scholar 

  14. Bruggeman R, van der Linden C, Buitelaar JK, et al.: Risperidone versus pimozide in Tourette’s disorder: a comparative double-blind parallel-group study. J Clin Psychiatry 2001, 62:50–56.

    Article  PubMed  CAS  Google Scholar 

  15. Gaffney GR, Perry PJ, Lund BC, et al.: Risperidone versus clonidine in the treatment of children and adolescents with Tourette’s syndrome. J Am Amer Acad Child Adolesc Psychiatry 2002, 41:330–336.

    Article  Google Scholar 

  16. Scahill L, Leckman JF, Schultz RT, et al.: A placebo-controlled trial of risperidone in Tourette syndrome. Neurology 2003, 60:1130–1135. This is the key, placebo-controlled, double-blind, parallel study showing efficacy of risperidone for tic reduction.

    Article  PubMed  CAS  Google Scholar 

  17. Stamenkovic M, Schindle SD, Aschauser HN, et al.: Effective open-label treatment of Tourette disorder with olanzapine. Int Clin Psychopharmacol 2000, 15:23–28.

    Article  PubMed  CAS  Google Scholar 

  18. Budman CL, Gayer A, Lesser M, et al.: An open-label study of the treatment efficacy of olanzapine for Tourette’s disorder. J Clin Psychiatry 2001, 62:290–294.

    Article  PubMed  CAS  Google Scholar 

  19. Onofrj M, Paci C, D’Andrematteo G, Toma L: Olanzapine in severe Gilles de la Tourette syndrome: a 52-week double blind cross over study vs. low-dose pimozide. J Neurol 2000, 247:443–446.

    Article  PubMed  CAS  Google Scholar 

  20. Sallee FR, Kurlan R, Goetz CG, et al.: Ziprasidone treatment of children and adolescents with Tourette’s disorder. J Am Amer Acad Child Adolesc Psychiatry 2000, 39:292–299. This is the key, placebo-controlled parallel study showing efficacy of ziprasidone for tic reduction.

    Article  CAS  Google Scholar 

  21. Shapiro E, Shapiro AK, Fulop G, et al.: Controlled study of haloperidol, pimozide, and placebo for the treatment of Gilles de la Tourette’s syndrome. Arch Gen Psychiatry 1989, 46:722–730.

    PubMed  CAS  Google Scholar 

  22. Shapiro AK, Shapiro E: Controlled study of pimozide vs. placebo in Tourette’s syndrome. J Am Acad Child Adolesc Psychiatry 1984, 23:161–173.

    Article  CAS  Google Scholar 

  23. Eggers CH, Rothenberger A, Berghaus U: Clinical and neurobiological findings in children suffering from tic disease following treatment with tiapride. Eur Arch Psychiatry Neurol Sci 1988, 237:223–229.

    Article  PubMed  CAS  Google Scholar 

  24. Roberston MM, Schneiden V, Lees AJ: Management of Gilles de la Tourette syndrome using sulipride. Clin Neuropsychopharmacol 1990, 13:229–235.

    Article  Google Scholar 

  25. Gilbert DL, Sethuraman G, Sine L, et al.: Tourette’s syndrome improvement with pergolide in a randomized, double-blind, crossover trial. Neurology 2000, 54:1310–1315.

    PubMed  CAS  Google Scholar 

  26. Jankovic J, Orman J: Tetrabenazine therapy of dystonia, chorea, tics, and other dyskinesias. Neurology 1988, 38:391–394.

    PubMed  CAS  Google Scholar 

  27. Jankovic J, Beach J: Long-term effects of tetrabenazine in hyperkinetic movement disorders. Neurology 1997, 48:358–362.

    PubMed  CAS  Google Scholar 

  28. Goetz CG: Clonidine and clonazpam in Tourettes syndrome. Adv Neurol 1992, 58:245–251.

    PubMed  CAS  Google Scholar 

  29. Hoopes SP: Donepezil for Tourette’s disorder and ADHD. J Clin Psychopharmacol 1999, 19:381–382.

    Article  PubMed  CAS  Google Scholar 

  30. Michaeli F, Gatto M, Lekuniec E, et al.: Treatment of Tourette’s syndrome with calcium antagonists. Clin Neuropsychopharmacol 1990, 13:77–83.

    Article  Google Scholar 

  31. Goldstein JA: Nifedipine treatment of Tourette’s syndrome. J Clin Psychiatry 1984, 45:360.

    PubMed  CAS  Google Scholar 

  32. Berg R: A case of Tourette’s syndrome treated with nifedipine. Acta Psychiatr Scand 1985, 72:400–401.

    PubMed  CAS  Google Scholar 

  33. Jankovic J: Deprenyl in attention deficit associated with Tourette’s syndrome. Arch Neurol 1993, 50:286–288.

    PubMed  CAS  Google Scholar 

  34. Feigin A, Kurlan R, McDermott MP, et al.: A controlled trial of deprenyl in children with Tourette’s syndrome and attention deficit hyperactivity disorder. Neurology 1996, 46:965–968.

    PubMed  CAS  Google Scholar 

  35. Black JK, Mink JW: Response to levodopa challenge in Tourette’s syndrome. Mov Disord 2000, 15:1194–1198.

    Article  PubMed  CAS  Google Scholar 

  36. Toren P, Laor N, Cohen DJ, et al.: Odansetron treatment in patients with Tourette’s syndrome. Int Clin Psychopharmacol 1999, 14:373–376.

    Article  PubMed  CAS  Google Scholar 

  37. Kurlan R, Majumdar L, Deeley C, et al.: A controlled trial of propoxyphene and naltrexone in patients with Tourette’s syndrome. Ann Neurol 1991, 30:19–23.

    Article  PubMed  CAS  Google Scholar 

  38. Peterson BS, Zhang H, Anderson GM, Leckman JF: A double-blind placebo-controlled, crossover trial of an antiandrogen in the treatment of Tourette’s syndrome. J Clin Psychopharmacol 1998, 18:324–331.

    Article  PubMed  CAS  Google Scholar 

  39. Izmir M, Dursun SM: Cyproterone acetate treatment of Tourette’s syndrome. Can J Psychiatry 1999, 44:710–711.

    PubMed  CAS  Google Scholar 

  40. Abuzzahab FS, Brown VL: Control of Tourette’s syndrome with topiramate. Am J Psychiatry 2001, 158:968.

    PubMed  CAS  Google Scholar 

  41. Scahill L, Riddle MA, King RA, et al.: Fluoxetine has no marked effect on tic symptoms in patients with Tourette’s syndrome: a double-blind placebo-controlled study. J Am Amer Acad Child Adolesc Psychiatry 1997, 7:75–85.

    CAS  Google Scholar 

  42. Riddle MA, King RA, Hardin MT, et al.: Behavioral side effects of fluoxetine in children and adolescents. J Child Adolesc Psychopharmacol 1991, 3:193–198.

    Google Scholar 

  43. Awaad Y: Tics in Tourette syndrome: new treatment options. J Child Neurol 1999, 14:316–319.

    PubMed  CAS  Google Scholar 

  44. Singer HS, Wendlandt J, Krieger M, Giuliano J: Baclofen treatment in Tourette syndrome: a double-blind, placebo-controlled, crossover trial. Neurology 2001, 56:599–604.

    PubMed  CAS  Google Scholar 

  45. Sanberg PR, McConville BJ, Fogelson HM, et al.: Nicotine potentiates the effects of haloperidol in animals and in patients with tic disorders and attention deficit-hyperactivity disorder. Biomed Pharmacother 1989, 43:19–23.

    Article  PubMed  CAS  Google Scholar 

  46. McConville BJ, Sandberg PR, Fogelson MH, et al.: The effects of nicotine plus haloperidol compared to nicotine only and placebo nicotine only in reducing tic severity and frequency in Tourette’s disorder. Biol Psychiatry 1992:15:832–840.

    Article  Google Scholar 

  47. Silver AA, Shytle RD, Philipp MK, Sanberg PR: Case study: long-term potentiation of neuroleptics with transdermal nicotine in Tourette’s syndrome. J Am Acad Child Adolesc Psychiatry 1996, 35:1631–1636.

    Article  PubMed  CAS  Google Scholar 

  48. Silver AA, Shytle RD, Philipp MK, et al.: Transdermal nicotine and haloperidol in Tourette’s disorder: a double-blind placebo controlled study. J Clin Psychiatry 2001, 62:707–714.

    Article  PubMed  CAS  Google Scholar 

  49. Silver AA, Shytle RD, Sanberg PR: Mecamylamine in Tourette’s syndrome: a two-year case study. J Child Adolesc Psychopharmacol 2000, 10:59–68.

    PubMed  CAS  Google Scholar 

  50. Sanberg PR, Shytle RD, Silver AA: Treatment of Tourette syndrome with mecamylamine. Lancet 1998, 352:705–706.

    Article  PubMed  CAS  Google Scholar 

  51. Silver AA, Shytle RD, Sheehan KH, et al.: Multicenter, double-blind, placebo-controlled study of mecamylamine monotherapy for Tourette’s disorder. J Am Acad Child Adolesc Psychiatry 2001, 40:1103–1110.

    Article  PubMed  CAS  Google Scholar 

  52. Kwak CH, Hanna PA, Jankovic J: Botulinum toxin in the treatment of tics. Arch Neurol 2000, 57:1190–1193.

    Article  PubMed  CAS  Google Scholar 

  53. Marras C, Andrewa D, Sime E, Lang AE: Botulinum toxin for simple motor tics: a randomized, doubleblind, controlled clinical trial. Neurology 2001, 56:605–610. This is the one randomized, double-blind, placebo-controlled crossover study showing efficacy of botulinum toxin for tic reduction.

    PubMed  CAS  Google Scholar 

  54. Piacentini J, Chang S: Behavioral treatments for Tourette syndrome in tic disorders: state of the art. In Tourette Syndrome and Associated Disorders. Edited by Leckman JF, Cohen DJ. Philadelphia: Lippincott Williams & Wilkins; 2001:319–331.

    Google Scholar 

  55. Singer HS, Giuliano JD, Zimmerman AM, et al.: Infection: a stimulus for tic disorders. Pediatr Neurol 2000, 22:380–383.

    Article  PubMed  CAS  Google Scholar 

  56. Perlmutter J, Leitman SF, Garvey MA, et al.: Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood. Lancet 1999, 354:1153–1158.

    Article  PubMed  CAS  Google Scholar 

  57. Garvey MA, Perlmutter J, Allen AJ, et al.: A pilot study of penicillin prophylaxis for neuropsychiatric exacerbations triggered by streptococcal infections. Biol Psychiatry 1999, 45:1564–1571.

    Article  PubMed  CAS  Google Scholar 

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  1. Child Study Center, Yale University School of Medicine, PO Box 207900, 06520, New Haven, CT, USA

    James E. Swain MD, PhD

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  1. James E. Swain MD, PhD
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  2. James F. Leckman MD
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Swain, J.E., Leckman, J.F. Tourette’s syndrome in children. Curr Treat Options Neurol 5, 299–308 (2003). https://doi.org/10.1007/s11940-003-0036-6

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