A practical guide to the main strategies of the management of the motor and vocal/phonic tics of Tourette syndrome in young people, showing the current evidence (modified from Robertson5 and Scahill et al9)7
| Treatment modality | Empirical support; A=good =2–3 DBT; B=adequate =1 DBT+series total >150 patients; C=fair=1 DBT only or open label or series/case reports (<150 patients); D=minimal–only case reports; small series | References | Comments |
|---|---|---|---|
| Haloperidol (antipsychotic) | A=good = 2-3 DBTs | Scahill et al113 Robertson5 | Three DBTs show haloperidol better than placebo; used worldwide and in many countries is the only drug licensed for GTS but has many adverse side effects |
| Risperidone (antipsychotic) | A | Scahill et al113 Robertson5 | Four RCTs in adults and children; subsequently reports of serious adverse effects=increase in weight and glucose abnormalities (diabetes); widely used worldwide |
| Pimozide (antipsychotic) | A | Scahill et al115 Robertson5 | Four DBTs show that pimozide and haloperidol have equal efficacy, pimozide less adverse side effects than haloperidol but some reports of prolongated QTC interval with pimozide; widely used |
| Sulpiride (antipsychotic) | B=adequate=1DBT+other evidence>150 patients | Robertson5 | One DBT showed that sulpiride was superior to placebo; one small case series and two large case series encompassing 249 patients showed that Sulpiride improved motor and vocal tics and had few side effects; widely used in UK; unavailable in USA, Canada |
| Tiapride (antipsychotic) | B=fair=two small DBT only or open label or larger case reports (>100 patients) | Chouza et al131 Eggers et al132 | DBT versus placebo; not stated how many patients; 800 mg per day. Tiapride>placebo; 10 patients in DBT; widely used in Europe (most common in Russia and Germany); unavailable in UK, USA, Canada |
| Aripiprazole (antipsychotic) | C=1 small DBT only or open label or larger case studies | Robertson5 | Becoming first-line treatment in many dedicated GTS clinics in UK and Europe; appears useful and safe, with transient minimal side effects and successful reports totalling 222 patients have been published |
| Clonidine | A | Robertson5 | Six DBTs involving tablets and transdermal patch showed that clonidine was superior to placebo |
| Botulinum toxin | B | Robertson5 | A DBT showed decreased tics, decreased urges, pts not satisfied; a series of 30, open label, showed decreased tics, decreased urges, increased QoL; hypophonia in 80%: other case series and reports=successful |
| Atomoxetine | B | Robertson5 | Two DBTs show tics and ADHD reduce |
| Tetrabenazine | D | Robertson5 | Two studies encompassing 86 patients have documented success with this agent; used mainly by neurologists; depression common; no DBTs |
| Habit reversal training | A | Robertson5 | RCTs>psychotherapy: WL=to other behavioural methods |
| Exposure and response prevention | Verdellen et al118–121 | Somewhat more evidence for habit reversal training than exposure and response prevention |
Modified from Robertson.5
ADHD, attention deficit hyperactivity disorder; DBTs, double blind randomised; GTS, Gilles de la Tourette syndrome; QoL, quality of life; RCTs, randomised controlled trials; WL, waiting list.