title: Donepezil use in children and adolescents with tics and attention-deficit/hyperactivity disorder: an 18-week, single-center, dose-escalating, prospective, open-label study.
abstract: BACKGROUND
  Striatal cholinergic dysfunction may be important in tics and attention-deficit/hyperactivity disorder (ADHD).
  
  
  OBJECTIVE
  The purpose of this study was to determine the safety profile of donepezil and whether it improves chronic tics in young patients with comorbid ADHD.
  
  
  METHODS
  This 18-week (14 weeks of open treatment followed by a 4-week washout period), single-center, dose-escalating, prospective, open-label trial was conducted in patients aged 7 to 17 years with tics, including chronic motor or vocal tics and Tourette's syndrome, and ADHD. Patients were treated with once-daily oral donepezil doses of 2.5 mg for 2 weeks, 5 mg for the next 6 weeks, and 10 mg for the last 6 weeks, followed by a 4-week washout period. Patients were evaluated using the Children's Global Assessment Scale; the Yale Global Tic Severity Scale (YGTSS); the Revised Conners' Parent Rating Scale; the Symbol and Digit Wisconsin Card Sorting Test; the Stroop black/white, color, and interference tests; the Rey Complex Figure Test; and the Children's Yale-Brown Obsessive Compulsive Scale at 4 visits: baseline, week 8 (5-mg dose), week 14 (10-mg dose), and week 18 (washout).
  
  
  RESULTS
  Seventeen males and 3 females (mean [SD] age, 11.3 [1.9] years [range, 8-14 years]; tic duration, 5.3 [1.9] years; ADHD duration, 6.5 [1.7] years) were included in this study. Tics were significantly reduced at the 10-mg (week-14) donepezil visit compared with the baseline and washout visits based on the total mean (SD) tic score of the YGTSS (18.6 [9.3] vs 12.2 [11.0]; P = 0.006). Fifty percent of patients withdrew and 65% experienced adverse events.
  
  
  CONCLUSIONS
  These preliminary results suggest that donepezil significantly reduced tics in these children and adolescents with comorbid ADHD who completed the study. No significant improvement in the symptoms of comorbid ADHD was found with the use of donepezil 10 mg. Donepezil 5 and 10 mg were not well tolerated in these children and adolescents.
authors.affiliation: Neurology Department, Clínica Nuestra Señnora del Rosario, Madrid, Spain. esthercub@wanadoo.es
authors.forename: Esther
authors.initials: E
authors.lastname: Cubo
authors.forename: Alberto
authors.initials: A
authors.lastname: Fernández Jaén
authors.forename: Celia
authors.initials: C
authors.lastname: Moreno
authors.forename: Belén
authors.initials: B
authors.lastname: Anaya
authors.forename: Miguel
authors.initials: M
authors.lastname: González
authors.forename: Katie
authors.initials: K
authors.lastname: Kompoliti
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D002648:Child; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage*; D015897:Comorbidity; D000077265:Donepezil; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007189:Indans / Q000008:administration & dosage*; D008297:Male; D010865:Pilot Projects; D010880:Piperidines / Q000008:administration & dosage*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013981:Tic Disorders / Q000188:drug therapy*
chemical_list: D002800:Cholinesterase Inhibitors; D007189:Indans; D010880:Piperidines; D000077265:Donepezil