Update on the Pharmacological Treatment of Tics with Dopamine-Modulating Agents

Abstract

More than 40 years of research and clinical practice have proven the effectiveness of dopamine receptor antagonists in the pharmacological treatment of tics. A blockade of the striatal dopamine-D2 receptors is mainly responsible for their tic-reducing effect. A broad spectrum of dopamine-modulating agents, such as typical and atypical antipsychotics, but also dopamine receptor agonists are used with an immanent discord between experts about which of them should be considered as first choice. The present Review outlines the state of the art on pharmacological treatment of tics with dopamine-modulating agents by giving an systematic overview of studies on their effectiveness and a critical discussion of their specific adverse effects. It is considered as an update of a previous review of our research group published in 2013. The Review closes with a description of the current resulting treatment recommendations including the results of a first published revised survey on European expert's prescription preferences. Based on the enormously growing evidence on its effectiveness and safety, aripiprazole currently seems to be the most promising agent in the pharmacological treatment of tics. Furthermore, benzamides (especially tiapride), which are commonly used in Europe, have proven their excellent effectiveness-tolerability profile over decades in clinical practice and are therefore also highly recommended for the treatment of tics. Nevertheless, pharmacological treatment of tics remains an indiviual choice depending on each patient's own specific needs.

Merging the Pathophysiology and Pharmacotherapy of Tics

“…1) Dopamine-modulating pharmacotherapy in TS : Dopamine modulating pharmacotherapies for tic suppression, although effective, are generally not the initial prescribed medication, due to their potential side effects. Several recent reviews provide in-depth updates on the efficacy and safety of this therapy 54,55. Recognizing the varied pathophysiologic hypotheses discussed above, it is not surprising that approaches to therapy have included the use of dopamine antagonists, VMAT-2 inhibitors, and dopamine agonists.…”

“…VMAT-2 inhibitors exert their effect by blocking the transport of dopamine into presynaptic vesicles and depletion of the level of dopamine at the synaptic terminal. Tetrabenazine, a benzoquinolizine derivative, has been shown to be beneficial in open label trials 54. Concerns, however, exist regarding its use in individuals with depression and suicidality.…”

Merging the Pathophysiology and Pharmacotherapy of Tics

“…Several recent reviews provide in-depth updates on the efficacy and safety of this therapy. 54 , 55 Recognizing the varied pathophysiologic hypotheses discussed above, it is not surprising that approaches to therapy have included the use of dopamine antagonists, VMAT-2 inhibitors, and dopamine agonists.…”

“…Tetrabenazine, a benzoquinolizine derivative, has been shown to be beneficial in open label trials. 54 Concerns, however, exist regarding its use in individuals with depression and suicidality. Two new VMAT-2 inhibitors, approved for use in tardive dyskinesia, are currently being evaluated for the treatment of tics.…”

Use of Complementary and Alternative Medicine in Children With Tourette Syndrome

“…Pharmacologic therapies consists of alpha-2 agonists, antipsychotics, or newer agents such as tetrabenazine and topiramate but their efficacy rate is variable and side effects have been reported in 50% to 85% of the cases. [3][4][5][6][7][8] Nonpharmacologic therapy primarily includes comprehensive behavioral intervention for tics. Benefits of comprehensive behavioral intervention for tics was established in multiple trials and it is especially appealing because of its safety and lack of any major side effects.…”