Tourette's Syndrome (cont.)
IN THIS ARTICLE
Treatment of Tics
The most effective medication for the suppression of tics is haloperidol (Haldol), a dopamine blocker medication originally approved for the treatment of psychiatric disorders. Unfortunately, this medication may result in a serious complication, tardive dyskinesia, which might be more disabling that the tics. Even though this complication has not been described in persons with Tourette's syndrome, the use of haloperidol is limited to the most serious cases.
Other medications in this group such as olanzapine (Zyprexa), risperidone (Risperdal), ziprasidone (Geodon), or aripiprazole (Abilify) might have less side effects than haloperidol (Haldol), but there is not enough clinical experience with these drugs in Tourette's syndrome, so their use is very limited.
Clonidine (Catapres) and guanfacine (Tenex), first introduced as cardiovascular medications, are effective in the treatment of tics and also in decreasing anxiety. These medications may be an acceptable first option in some patients.
Clonazepam (Klonopin) belongs to a group of medications (the benzodiazepines) that were first used because of their sedative and relaxing effect. From this group clonazepam can be effective in decreasing some tics and also in helping with anxiety disorders. Side effects such as sedation, weakness, and tiredness might be a limiting factor.
Botulinum toxin injections might be useful for certain disabling localized tics. The effect may only last for a few months, and repeated treatments might result in tolerance, rendering the drug ineffective after several applications.
Treatment of Attention Deficit Hyperactive Disorder (ADHD)
ADHD is not uncommon in children with Tourette's syndrome. Treating the deficit in attention as well as the hyperactivity with medications such as methylphenidate (Ritalin) or amphetamines (Adderall) might be very effective when accommodations in the school setting fail. There are some concerns with the use of these medications because, allegedly, they can produce or exacerbate existing tics. However, several studies have shown that their effects on tics is temporary even with continuous use. So if these medications are indicated the presence of tics is not an absolute contraindication to their use.
Treatment of Obsessive Compulsive Disorder (OCD)
As with tics and ADHD, the treatment of OCD depends on the severity of the clinical symptoms. If medications are needed to treat OCD the guidelines are the same as in persons without Tourette's syndrome.
Norberto Alvarez, MD