Gilles de la Tourette's Syndrome – an update of drug treatment

Gilles de la Tourette's syndrome (TS) is a neuropsychiatric disorder characterized by motor and vocal tics, and often associated with a variety of behavioral disturbances such as Obsessive-Compulsive Disorder (OCD) and Attention Deficit Hyperactivity Disorder (ADHD). Although the neurochemical pathology of TS is not fully known dysfunction of the basal ganglia with involvement of the central monoaminergic pathways is believed to be essential for the symptomatology.Other neurotransmitters like GABA, acetylcholine and opoids also seem to be involved. This has provided the rationale for drug treatment. Because of the variable clinical manifestations of TS therapy for TS must be individualized and the most troublesome symptoms should be targeted first. Antipsychotic drugs (mainly haloperidol and pimozide) and clonidine have been the most frequently used drugs for disabling tics, but other antidopaminergic drugs such as fluphenazine, sulpiride, tiapride, thioridazine and tetrabenazine have been preferred by some clinicians. During the last years atypical antipsychotic drugs have gradually displaced haloperidol and pimozide as the first line drug because of a lower propensity to cause extrapyramidal side effects or tardive dyskinesias. Other drugs found to be useful in the treatment of tics include clonazepam, pergolide, cannabinoids, nicotine gum or transdermal patches, baclofen, selegiline and botulinum toxin. The drugs of choice in the treatment of OCD are the selective serotonin-reuptake inhibitors (SSRIs), although tricyclic antidepressants such as clomipramine has also been useful.

In the treatment of ADHD central nervous stimulants such as methylphenidate, dextroamphetamine and pemoline are the most effective agents. Other potential useful drugs are clonidine, guanfacine, selegiline, some TCAs (such as imipramine, nortriptyline, and desipramine), sertraline, pimozide and clonazepam. Not all TS-patients respond sufficiently to pharmacological treatment, even if several drugs are combined according to symptom-profile. In these non-responders surgical treatment may be considered.