The neurotoxicity of tramadol commonly manifests as generalized tonic-clonic seizures occurring most frequently within 24 h after tramadol intake. Seizures were more common in younger abusers with a longer duration of exposure to tramadol and with the combined use of tramadol with alcohol.
Introduction:
Tourette syndrome (TS) is a neurodevelopmental disorder with a high prevalence of psychiatric comorbidity. The most common comorbid disorder in patients with TS is attention-deficit/hyperactivity disorder (ADHD). To date, there have been few reports concerning the association of TS with addiction.
Methods:
We report on 4 patients with TS, ADHD, and heroin addiction.
Results:
All 4 patients were male and initially presented with TS when they were between 5 and 12 years of age, although 2 of the patients were not diagnosed with TS until they were adults. The patients currently range in age from 21 to 52 years, all having experienced the onset of heroin addiction in adolescence. A reduction in tics during periods of heroin abuse was noted in all patients.
Discussion:
The lifetime prevalence of psychiatric comorbidity in patients with TS is 85.7%, with 57.7% of patients having ≥2 psychiatric conditions in addition to TS. All of the 4 patients in our case series demonstrated a pattern of severe tics, ADHD, impulsive behavior, and heroin addiction. Our observation that these 4 patients with TS showed reduced tics during periods of heroin dependence could be related to the previously described effects of opiates on dopaminergic transmission.
Conclusions:
The observed reduction of tics during heroin dependence warrants further clinical research.
Failure of additional diagnostic procedures to distinguish MSA patients required a precise understanding of their clinical specificities. Our results support this statement.
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