Gilles de la Tourette syndrome: symptomatic treatment based on evidence.
The treatment of the Gilles de la Tourette syndrome has evolved from case reports, clinical experience and more recently blinded trials usually in small numbers of patients. We have reviewed the evidence available to clinicians. The oldest and still most widely prescribed drug, haloperidol, should now not be considered the first-line agent in children as other agents have superior adverse effects profiles. Symptomatic treatment should be targeted to the specific additional psychopathologies seen in the syndrome. For the treatment of tics, sulpiride, tiapride, possibly pimozide and in some cases clonidine may be considered first-line agents. Although a body of data supports pimozide, caution has to be exercised in relation to possible cardiac effects. Antidepressants and stimulants have an important place in the management of depression, obsessionality and attention deficit hyperactivity disorder. The latter also responds to clonidine making it a rational first choice where ADHD coexists with GTS. There are a multitude of other drugs advocated in the literature in addition to reports of neurosurgery and the novel use of immune modulation. Therapeutic trials for GTS are challenging. However, further data from blinded trials are required before many of these treatments can be considered to be mainstream treatment options.
Robertson
M M
MM
Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, University College, London, UK.
Stern
J S
JS
D000293:Adolescent; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001521:Behavior Therapy; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003710:Demography; D018492:Dopamine Antagonists / Q000627:therapeutic use*; D005260:Female; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D007167:Immunotherapy; D008297:Male; D010868:Pimozide / Q000627:therapeutic use*; D015995:Prevalence; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D013469:Sulpiride / Q000627:therapeutic use*; D005879:Tourette Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology
D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D018492:Dopamine Antagonists; D006728:Hormones; D010868:Pimozide; D017367:Selective Serotonin Reuptake Inhibitors; D013469:Sulpiride