Clinical and attentional effects of acute nicotine treatment in Tourette's syndrome.
Evidence from pre-clinical infrahuman investigations, open-label clinical trials, and a single controlled trial found acute nicotine treatment potentiated up to 4 weeks neuroleptic-induced reductions of dyskinetic symptoms characterizing Tourette's syndrome (TS). Given the attentional disturbances associated with this syndrome, and the improvements in attentional processes reported with nicotine, this randomized, double-blind, placebo-controlled trial examined the acute (4 h) and sustained (2 weeks) effects of a single dose of transdermal nicotine on clinical (i.e., tics), attentional (continuous performance task, event-related potential, patient and parental reports) and behavioral symptoms in 23 children and adolescents with TS receiving neuroleptic treatment. In the 14 evaluable patients with complete primary efficacy data, nicotine (compared to placebo) failed to alter symptoms at 4 h but counteracted ERP-P300 signs of diminished attention seen 2 weeks following placebo treatment. Secondary efficacy measures, including patient self-reports and parental ratings, found nicotine to reduce complex tics and improve behaviors related to inattention. Additional work with intermittent dosing schedules is required to characterize optimal clinical and cognitive effects with nicotine treatment.
Howson
Anne L
AL
Adult Metabolic Disease Clinic, Vancouver General Hospital, Vancouver Coastal Health Authority, BC, Canada.
Batth
Sue
S
Ilivitsky
Vadim
V
Boisjoli
Armand
A
Jaworski
Martine
M
Mahoney
Colleen
C
Knott
Verner J
VJ
D000279:Administration, Cutaneous; D000293:Adolescent; D000704:Analysis of Variance; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001288:Attention / Q000187:drug effects*; D002648:Child; D004311:Double-Blind Method; D004569:Electroencephalography; D005071:Evoked Potentials / Q000187:drug effects; D005260:Female; D005731:Ganglionic Stimulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009538:Nicotine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011930:Reaction Time / Q000187:drug effects; D012720:Severity of Illness Index; D013647:Task Performance and Analysis; D013997:Time Factors; D005879:Tourette Syndrome / Q000188:drug therapy*; D016896:Treatment Outcome; D014743:Videotape Recording
D014150:Antipsychotic Agents; D005731:Ganglionic Stimulants; D009538:Nicotine