Mecamylamine in Tourette's syndrome: a two-year retrospective case study.
OBJECTIVE
To test the efficacy and safety of a nicotinic, acetylcholine antagonist, mecamylamine, in the treatment of Tourette's syndrome (TS).


METHODS
This is a retrospective, open-label study of 24 patients; 18 of whom were not responding to accepted medication for treatment of their TS and six of whom were receiving no medication. All 24 of them received mecamylamine in 2.5-6.25 mgm/day dose, at varying starting dates during the years June 1997 to June 1999. There were four females, 20 males, with 19 patients under the age of 18 years and five over the age of 18. Efficacy was evaluated by the Clinical Global Impression Scale (CGI); safety by adverse events notes during the time mecamylamine was administered.


RESULTS
The number of days each patient received mecamylamine varied from 8 days to 550 days; with nine patients more than 200 days, six patients from 100-200 days, five patients for 50-100 days, and four patients 0-50 days. Comparing baseline CGI with that obtained on the date of last evaluation for each patient, a significant improvement in clinical assessment of severity of illness was obtained for the total group (Wilcoxon signed rank test, p < 0.0001). The six patients who received mecamylamine only also significantly improved (Wilcoxon signed rank test, p < 0.2). Case vignettes are described.


CONCLUSIONS
Mecamylamine at 2.5-6.25 mgm/day has no significant peripheral parasympathetic activity and may be safely taken long term (up to 550 days in this study). It has a significant effect in relieving motor and vocal tics and in mood and behavior disturbances of children, adolescents, and adults with TS.
Silver
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AA
Department of Psychiatry, University of South Florida College of Medicine, Tampa 33613, USA. asilver@hsc.usf.edu
Shytle
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RD
Sanberg
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PR
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008464:Mecamylamine / Q000009:adverse effects / Q000627:therapeutic use*; D018733:Nicotinic Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D005879:Tourette Syndrome / Q000188:drug therapy* / Q000523:psychology
D018733:Nicotinic Antagonists; D008464:Mecamylamine