Nathanel Zelnik* Pages 132 - 142 ( 11 )
Background: Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by multiple repetitive motor and vocal tics. In most patients, its clinical course has a waxing and waning nature and most patients, usually children, will benefit from tolerant environmental and psychoeducation. Patients with more complicated tics, in particular, those with significant comorbidities will require drug therapy.
Objective: The present paper is a mini-review of the current therapeutic arsenal for TS with reference to drug and non-drug management approach.
Methods: A systematic survey of medical literature regarding the treatment decision making and the reported clinical trials or accumulating experience with different medications or other therapeutic modalities which were proven beneficial over the years.
Results: Reviewing the literature indicates that dopamine antagonists, such as haloperidol and pimozoide, are the most reliable agents in terms of treatment response. Due to numerous adverse effects, newer atypical anti-psychotic drugs have been shown effective. Other widely accepted medications include alpha-2 adrenergic agonists, benzamides, dopamine depleting agents, benzodiazepines and dopamine depleting agents. In more selective and intractable cases botulinum toxin, dopamine agonists and cannabinoids should be also considered. Non-pharmacologic therapies reported beneficial effects, which include on the one hand, non-invasive behavioral techniques, such as comprehensive behavior therapy for tics. While on the other hand, in cases with particular protracted pharmaco-resistant tics electric stimulation techniques, such as deep brain stimulation, have been shown to be successful.
Conclusion: Currently, there are numerous multifarious options for treatment of tics and other comorbid symptoms of TS. Nevertheless, treatment options and decision-making algorithms are still a clinical challenge.
Area Covered: A step by step decision-making and various drugs and non-pharmacologic modalities appropriate for the management of TS.
Tourette syndrome, tics, ADHD, OCD, treatment, antipsychotic drugs, haloperidol, clonidine, risperidone, aripiprazole, tetrabenazine, cannabinoids, CBIT, deep brain stimulation.
Child Neurology and Development, Carmel Medical Center & Clalit Health Services, Haifa District, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa