Affiliations: The Michael Trimble Neuropsychiatry Research Group,
Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham,
UK | Child Neuropsychiatry Unit, Department of Clinical and
Experimental Medicine, University of Insubria, Varese, Italy | Child Neuropsychiatry Unit, IRCCS 'C. Mondino
Institute of Neurology' Foundation, University of Pavia, Pavia, Italy | Department of Motor Neuroscience and Movement
Disorders, Institute of Neurology and University College London, London,
UK
Note: [] Correspondence: Dr. Andrea Eugenio Cavanna MD, Department of
Neuropsychiatry, The Barberry National Centre for Mental Health, B15 2FG,
Birmingham, UK. Tel.: +44 121 3012317; Fax: +44 121 3012291; E-mail:
a.cavanna@ion.ucl.ac.uk
Abstract: Introduction: Gilles de la Tourette Syndrome (GTS) is a
childhood-onset hyperkinetic movement disorder defined by the chronic presence
of multiple motor tics and at least one vocal tic and often complicated by
co-morbid behavioural problems. The pharmacological treatment of GTS focuses on
the modulation of monoaminergic pathways within the
cortico-striato-thalamo-cortical circuitry. This paper aims to evaluate the
efficacy and safety profiles of pharmacological agents used in the treatment of
tics in patients with GTS, in order to provide clinicians with an
evidence-based rationale for the pharmacological treatment in GTS. Method: In order to ascertain the best level of evidence, we
conducted a systematic literature review to identify double-blind randomised
controlled trials of medications in GTS populations. Results: We identified a large number of pharmacological agents as
potentially effective in improving tic symptoms. The alpha-2 agonist Clonidine
is amongst the agents with the most favourable efficacy-versus-adverse events
ratio, especially in patients with co-morbid attention-deficit hyperactivity
disorder, although effect sizes vary evidence-based studies. Discussion: Our results are in line with the findings of
uncontrolled open-label studies. However, most trials have low statistical
power due to the small sample sizes, and newer agents, such as Aripiprazole,
have not been formally tested in double-blind randomised controlled trials.
Further research should focus on better outcome measures, including Quality of
Life instruments.
Keywords: Drug therapy, movement disorder, pharmacological treatment, randomised controlled trial, tics, Tourette Syndrome
