title: Canadian guidelines for the evidence-based treatment of tic disorders: pharmacotherapy.
abstract: This article seeks to provide the practising clinician with guidance on the pharmacological management of tic disorders in children and adults. We performed a systematic review of the literature on the treatment of tic disorders. A multi-institutional group of 14 experts in psychiatry, child psychiatry, neurology, pediatrics, and psychology engaged in a consensus meeting. The evidence was presented and discussed, and nominal group techniques were employed to arrive at consensus on recommendations. A strong recommendation is made when the benefits of treatment clearly outweigh the risks and burdens, and can apply to most patients in most circumstances without reservation. With a weak recommendation, the benefits, risks, and burdens are more closely balanced, and the best action may differ depending on the circumstances. Based on these principles, weak recommendations were made for the use of pimozide, haloperidol, fluphenazine, metoclopramide (children only), risperidone, aripiprazole, olanzapine, quetiapine, ziprasidone, topiramate, baclofen (children only), botulinum toxin injections, tetrabenazine, and cannabinoids (adults only). Strong recommendations were made for the use of clonidine and guanfacine (children only). While the evidence supports the efficacy of many of the antipsychotics for the treatment of tics, the high rates of side effects associated with these medications resulted in only weak recommendations for these drugs. In situations where tics are not severe or disabling, the use of a medication with only a weak recommendation is not warranted. However, when tics are more distressing and interfering, the need for tic suppression to improve quality of life is stronger, and patients and clinicians may be more willing to accept the risks of pharmacotherapy.
authors.affiliation: Department of Clinical Neurosciences and Pediatrics, University of Calgary, Calgary, Alberta. tmprings@ucalgary.ca
authors.forename: Tamara
authors.initials: T
authors.lastname: Pringsheim
authors.forename: Asif
authors.initials: A
authors.lastname: Doja
authors.forename: Daniel
authors.initials: D
authors.lastname: Gorman
authors.forename: Duncan
authors.initials: D
authors.lastname: McKinlay
authors.forename: Lundy
authors.initials: L
authors.lastname: Day
authors.forename: Lori
authors.initials: L
authors.lastname: Billinghurst
authors.forename: Alan
authors.initials: A
authors.lastname: Carroll
authors.forename: Yves
authors.initials: Y
authors.lastname: Dion
authors.forename: Sandra
authors.initials: S
authors.lastname: Luscombe
authors.forename: Thomas
authors.initials: T
authors.lastname: Steeves
authors.forename: Paul
authors.initials: P
authors.lastname: Sandor
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000627:therapeutic use*; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002170:Canada; D002648:Child; D003000:Clonidine / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D016316:Guanfacine / Q000627:therapeutic use*; D006801:Humans; D017410:Practice Guidelines as Topic; D013981:Tic Disorders / Q000188:drug therapy*; D005879:Tourette Syndrome / Q000188:drug therapy*
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D014150:Antipsychotic Agents; D016316:Guanfacine; D003000:Clonidine