title: N-Acetylcysteine in the Treatment of Pediatric Tourette Syndrome: Randomized, Double-Blind, Placebo-Controlled Add-On Trial.
abstract: Current pharmacological treatments for Tourette Syndrome (TS), such as antipsychotic agents and α-2 agonists, are moderately effective in the treatment of tics, but have substantial side effects that limit their use. N-acetylcysteine (NAC) modulates glutamatergic systems, and has been used safely as an antioxidant agent with minimal side effects for decades. NAC has been increasingly studied for the treatment of other obsessive-compulsive spectrum disorders. We aim to examine the efficacy of NAC for the treatment of pediatric TS in a double-blind, placebo-controlled, add-on study.
  
  
  
  Thirty-one children and adolescents 8-17 years of age with TS were randomly assigned to receive NAC or matching placebo for 12 weeks. Our primary outcome was change in severity of tics as measured by the Yale Global Tic Severity Scale (YGTSS), Total tic score. Secondary measures assessed comorbid obsessive-compulsive disorder (OCD), depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD). Linear mixed models in SAS were used to examine differences between NAC and placebo.
  
  
  
  Of 31 randomized subjects, 14 were assigned to placebo (two females; 11.5 + 2.8 years) and 17 to active NAC (five females; 12.4 + 1.4 years) treatment. No significant difference between NAC and placebo was found in reducing tic severity or any secondary outcomes.
  
  
  
  We found no evidence for efficacy of NAC in treating tic symptoms. Our findings stand in contrast to studies suggesting benefits of NAC in the treatment of other obsessive-compulsive spectrum disorders in adults, including OCD and trichotillomania, but are similar to a recent placebo-controlled trial of pediatric trichotillomania that found no benefit of NAC.
authors.affiliation: 1 Yale Child Study Center and the Department of Psychiatry of Yale University , New Haven, Connecticut.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Bloch
authors.affiliation: 2 Department of Psychology, Arizona State University .
authors.forename: Kaitlyn E
authors.initials: KE
authors.lastname: Panza
authors.affiliation: 3 Northern California and Hawaii Tourette Syndrome Chapter of the Tourette Syndrome Association.
authors.forename: Alisa
authors.initials: A
authors.lastname: Yaffa
authors.affiliation: 4 Department and Institute of Psychiatry, University of São Paulo Medical School of Brazil , São Paulo, Brazil .
authors.forename: Pedro G
authors.initials: PG
authors.lastname: Alvarenga
authors.affiliation: 1 Yale Child Study Center and the Department of Psychiatry of Yale University , New Haven, Connecticut.
authors.forename: Ewgeni
authors.initials: E
authors.lastname: Jakubovski
authors.affiliation: 1 Yale Child Study Center and the Department of Psychiatry of Yale University , New Haven, Connecticut.
authors.forename: Jilian M
authors.initials: JM
authors.lastname: Mulqueen
authors.affiliation: 1 Yale Child Study Center and the Department of Psychiatry of Yale University , New Haven, Connecticut.
authors.forename: Angeli
authors.initials: A
authors.lastname: Landeros-Weisenberger
authors.affiliation: 1 Yale Child Study Center and the Department of Psychiatry of Yale University , New Haven, Connecticut.
authors.forename: James F
authors.initials: JF
authors.lastname: Leckman
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use*; D000293:Adolescent; D001007:Anxiety / Q000188:drug therapy; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy; D002648:Child; D003863:Depression / Q000188:drug therapy; D004311:Double-Blind Method; D005260:Female; D016166:Free Radical Scavengers / Q000627:therapeutic use*; D006801:Humans; D016014:Linear Models; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy; D012720:Severity of Illness Index; D020323:Tics / Q000188:drug therapy* / Q000209:etiology; D005879:Tourette Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D016166:Free Radical Scavengers; D000111:Acetylcysteine