European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment

Abstract

To develop a European guideline on pharmacologic treatment of Tourette syndrome (TS) the available literature was thoroughly screened and extensively discussed by a working group of the European Society for the Study of Tourette syndrome (ESSTS). Although there are many more studies on pharmacotherapy of TS than on behavioral treatment options, only a limited number of studies meets rigorous quality criteria. Therefore, we have devised a two-stage approach. First, we present the highest level of evidence by reporting the findings of existing Cochrane reviews in this field. Subsequently, we provide the first comprehensive overview of all reports on pharmacological treatment options for TS through a MEDLINE, PubMed, and EMBASE search for all studies that document the effect of pharmacological treatment of TS and other tic disorders between 1970 and November 2010. We present a summary of the current consensus on pharmacological treatment options for TS in Europe to guide the clinician in daily practice. This summary is, however, rather a status quo of a clinically helpful but merely low evidence guideline, mainly driven by expert experience and opinion, since rigorous experimental studies are scarce.

Histaminergic modulation in Tourette syndrome

“…Although pilot clinical studies in narcolepsy, schizophrenia and attention deficit disorder have yielded mixed results (with more favorable outcomes in conditions characterized by hypersomnia), preclinical evidence strongly suggests that H3 antagonism could open novel therapeutic avenues in TS and other neuropsychiatric disorders [99]. Specifically, the use of H3 antagonists could be assessed either as a monotherapy or in combination therapy for patients already taking medication, with the goal of expanding the relatively narrow range of safe and effective pharmacological options currently available to clinicians treating patients with TS [39,40,100]. Further implications of additional research into this field may include identification of families at risk of TS.…”

“…A proportion of patients with TS do not require intervention, however when tics and/or comorbid behavioral problems are considered physically, socially or emotionally disabling and cause functional impairment, active treatment can be implemented [39]. Management of TS is primarily pharmacological [39,40], although behavioral therapies [41,42] and neurosurgical interventions [43][44][45] have shown benefit in selected patients.…”

“…Management of TS is primarily pharmacological [39,40], although behavioral therapies [41,42] and neurosurgical interventions [43][44][45] have shown benefit in selected patients. Pharmacological agents belonging to a number of classes are routinely used in the treatment of TS, the most commonly prescribed being dopamine antagonists [46].…”

“…Pharmacological agents belonging to a number of classes are routinely used in the treatment of TS, the most commonly prescribed being dopamine antagonists [46]. First-line treatment options often include either an alpha-adrenergic agonist such as clonidine [47] or atypical antipsychotic agents such as risperidone and aripiprazole [39]. Second-line options include old generation or typical neuroleptics, such as haloperidol and pimozide, with established efficacy but worse tolerability profiles [48].…”

Treatment of Tourette Syndrome

“…Pharmacotherapy for Tics (Table 1) A number of recommendations and guidelines for the pharmacotherapy of TS have been published [10,11]. Due to the general paucity of class I and class II evidence, current treatment recommendations are often based on the personal experience of skilled clinicians and the variable regional availability of particular medications.…”