Treatment of ADHD in children with tics

Kurlan, Roger; Goetz, Christopher G.; McDermott, Michael P.; Plumb, Sandra; Singer, Harvey S.; Dure, Leon S.; Como, Peter; Sallee, Floyd R.; Budman, Cathy L.; Coffey, Barbara J.; Juncos, Jorge L.; Mink, Jonathan W.; Stebbins, Glenn T.; Tuite, Paul; Seeberger, Lauren; Pelham, William E.; Palumbo, Donna; Giuliano, Joseph; Krieger, Madeline; Lane, Jane; Pearson, Nancy; Sine, Lauren; Parsons, Kathy; Peters, Sara; Thorne-Petrizzi, Denise; Parks, Ken; Kim, Grace; Craddock, Kathleen; Wood, Colleen; Randle, Jennifer; Janko, Kim; Lasher, Deborah; Johnston, Terri; Bean, Stephen; Riddle, Mark A.; Leckman, James F.; Oakes, David; Richard, Irene Hegeman; Sehgal, Neeru; Hogarth, Penelope; Marcus, David K.; Kieburtz, Karl; Harris, Peter; Sulkes, Stephen; Cox, Christopher; LaDonna, Donna; Brower, Christine A.; Greiner, Andrew R.

doi:10.1212/wnl.58.4.527

Cited by 447 publications

(85 citation statements)

References 38 publications

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“…Nine studies in children and two mixed studies compared the efficacy of a noradrenergic agent with placebo (PRISMA diagram, Appendix 2): l clonidine versus placebo: three child [113][114][115] and one mixed 116 study l clonidine patch versus placebo: two child 117,118 and one mixed 119 study l guanfacine versus placebo: two child studies 120,121 l atomoxetine versus placebo: one child study 122 (subgroup analysis 123 ).…”

Section: Included Studiesmentioning

confidence: 99%

“…One parallel trial in 136 children compared maximum dose of 0.6 mg/day clonidine, 60 mg/day methylphenidate and a combination of clonidine and methylphenidate with placebo for 16 weeks. 113 For one mixed crossover trial, data for a subset of 24 children were obtained from authors. 114 This study compared the use of 0.0075-0.015 mg/kg/day clonidine with placebo for 12 weeks each.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…In one child study of clonidine compared with placebo, 113 randomisation was computer generated and there is assurance of allocation concealment and blinding of participants, providers and outcome assessors. Dropout was relatively low (14%) and analysis was by intention to treat.…”

Section: Risk Of Biasmentioning

confidence: 99%

“…Two studies in children 113,115 and two mixed studies 114,116 in adults and children compared the efficacy of clonidine with placebo. For one of the mixed studies, 114 IPD for children and adolescents in the study (24 children and adolescents from a total of 30 participants) were obtained.…”

Section: Clonidine Compared With Placebomentioning

confidence: 99%

“…Three studies presented findings for motor tics and used the Tourette's Syndrome Global Scale (TSGS) motor tic score, 116 the YGTSS motor tic score 113 and an assessment of motor tic severity (body areas and motor tic frequency also assessed). 114 Motor tic score favoured clonidine compared with placebo (SMD -0.55, 95% CI -0.90 to -0.20; n = 130) ( Figure 67).…”

Section: Clonidine Compared With Placebomentioning

confidence: 99%

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Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis

Hollis

Pennant

Cuenca

et al. 2016

Health Technol Assess

135

109

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BackgroundTourette syndrome (TS) is a neurodevelopmental condition characterised by chronic motor and vocal tics affecting up to 1% of school-age children and young people and is associated with significant distress and psychosocial impairment.ObjectiveTo conduct a systematic review of the benefits and risks of pharmacological, behavioural and physical interventions for tics in children and young people with TS (part 1) and to explore the experience of treatment and services from the perspective of young people with TS and their parents (part 2).Data SourcesFor the systematic reviews (parts 1 and 2), mainstream bibliographic databases, The Cochrane Library, education, social care and grey literature databases were searched using subject headings and text words for tic* and Tourette* from database inception to January 2013.Review/research methodsFor part 1, randomised controlled trials and controlled before-and-after studies of pharmacological, behavioural or physical interventions in children or young people (aged < 18 years) with TS or chronic tic disorder were included. Mixed studies and studies in adults were considered as supporting evidence. Risk of bias associated with each study was evaluated using the Cochrane tool. When there was sufficient data, random-effects meta-analysis was used to synthesize the evidence and the quality of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. For part 2, qualitative studies and survey literature conducted in populations of children/young people with TS or their carers or in health professionals with experience of treating TS were included in the qualitative review. Results were synthesized narratively. In addition, a national parent/carer survey was conducted via the Tourettes Action website. Participants included parents of children and young people with TS aged under 18 years. Participants (young people with TS aged 10–17 years) for the in-depth interviews were recruited via a national survey and specialist Tourettes clinics in the UK.ResultsFor part 1, 70 studies were included in the quantitative systematic review. The evidence suggested that for treating tics in children and young people with TS, antipsychotic drugs [standardised mean difference (SMD) –0.74, 95% confidence interval (CI) –1.08 to –0.41;n = 75] and noradrenergic agents [clonidine (Dixarit®, Boehringer Ingelheim) and guanfacine: SMD –0.72, 95% CI –1.03 to –0.40;n = 164] are effective in the short term. There was little difference among antipsychotics in terms of benefits, but adverse effect profiles do differ. Habit reversal training (HRT)/comprehensive behavioural intervention for tics (CBIT) was also shown to be effective (SMD –0.64, 95% CI –0.99 to –0.29;n = 133). For part 2, 295 parents/carers of children and young people with TS contributed useable survey data. Forty young people with TS participated in in-depth interviews. Four studies were in the qualitative review. Key themes were difficulties in accessing specialist care and behavioural interventions, delay in diagnosis, importance of anxiety and emotional symptoms, lack of provision of information to schools and inadequate information regarding medication and adverse effects.LimitationsThe number and quality of clinical trials is low and this downgrades the strength of the evidence and conclusions.ConclusionsAntipsychotics, noradrenergic agents and HRT/CBIT are effective in reducing tics in children and young people with TS. The balance of benefits and harms favours the most commonly used medications: risperidone (Risperdal®, Janssen), clonidine and aripiprazole (Abilify®, Otsuka). Larger and better-conducted trials addressing important clinical uncertainties are required. Further research is needed into widening access to behavioural interventions through use of technology including mobile applications (‘apps’) and video consultation.Study registrationThis study is registered as PROSPERO CRD42012002059.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Included Studiesmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Risk Of Biasmentioning

confidence: 99%

Section: Clonidine Compared With Placebomentioning

confidence: 99%

Section: Clonidine Compared With Placebomentioning

confidence: 99%

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Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis

Hollis

Pennant

Cuenca

et al. 2016

Health Technol Assess

135

109

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Enlargement of Thalamic Nuclei in Tourette Syndrome

Miller¹,

Bansal²,

Hao³

et al. 2010

Arch Gen Psychiatry

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Context The basal ganglia and thalamus together connect in parallel closed-loop circuits with the cortex. Previous imaging studies have shown modifications of the basal ganglia and cortical targets in individuals with Tourette syndrome (TS), but less is known regarding the role of the thalamus in TS pathogenesis. Objective To study the morphological features of the thalamus in children and adults with TS. Design A cross-sectional, case-control study using anatomical magnetic resonance imaging. Setting University research center. Participants The 283 participants included 149 with TS and 134 normal control individuals aged 6 to 63 years. Main Outcome Measures Conventional volumes and measures of surface morphology of the thalamus. Results Analyses of conventional volumes and surface morphology were consistent in demonstrating an enlargement in TS-affected thalami. Overall volumes were 5% larger in the group composed of children and adults with TS. Statistical maps of surface contour demonstrated enlargement over the lateral thalamus. Post hoc testing indicated that differences in IQ, comorbid illnesses, and medication use did not account for these findings. Conclusions Morphological abnormalities in the thalamus, together with the disturbances reported in the sensorimotor cortex, striatum, and globus pallidus, support the hypothesis of a circuit wide disorder within motor pathways in TS. The connectivity and function of the numerous and diverse thalamic nuclei within cortical-subcortical circuits constitute an anatomical crossroad wherein enlargement of motor nuclei may represent activity-dependent hypertrophy within this component of cortical-subcortical motor circuits, or an adaptive response within a larger putative compensatory system that could thereby directly modulate activity in motor circuits to attenuate the severity of tics.

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Therapies for Movement Disorders

Goetz¹,

Hinson²

2002

Arch Neurol

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A DVANCES IN neurophysiology, pharmacology, surgical technology, and molecular biology have provided the basis for contemporary therapies (Table) for movement disorders. This article will focus on the treatment of 4 conditions commonly seen in a movement disorder practice: Parkinson disease (PD), dystonia, essential tremor, and tic disorders. EDITORIAL (REPRINTED) ARCH NEUROL / VOL 59, MAY 2002 WWW.ARCHNEUROL.COM 699

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Treatment of ADHD in children with tics

Abstract: Methylphenidate and clonidine (particularly in combination) are effective for ADHD in children with comorbid tics. Prior recommendations to avoid methylphenidate in these children because of concerns of worsening tics are unsupported by this trial.

Cited by 447 publications

References 38 publications

Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis

Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis

Enlargement of Thalamic Nuclei in Tourette Syndrome

Therapies for Movement Disorders

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