Use of the "Inverse Neuroleptic" Metoclopramide in Tourette Syndrome: An Open Case Series

Abstract

Neuroleptics are generally highly effective in suppressing tics, but their many adverse effects limit their usefulness. Animal studies have shown that, compared with both typical and atypical neuroleptics, metoclopramide has effects that are regionally circumscribed to rat motor striatum. Based on this observation and two prior case reports, metoclopramide was openly prescribed and individually titrated to diminish tics in 10 patients with Tourette syndrome. All patients improved on the Yale Global Tic Severity Scale by an average of 55%. Although we did not observe frank extrapyramidal symptoms, including tardive dyskinesia, these data are not sufficient to support clinical recommendations because of many limitations, including the absence of systematic ratings of nontic abnormal movements. However, controlled clinical studies and additional basic investigations of metoclopramide are warranted.

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

“…For example buspirone [65], carbamazepine [168, 292], metoclopramide [2, 169], physostigmine [258, 259], and spiradoline mesylate [39] have received some attention. A comprehensive overview of other case reports and non-blinded trials can be found elsewhere [195].…”

Separable noradrenergic and dopaminergic regulation of prepulse inhibition in rats: implications for predictive validity and Tourette Syndrome

“…In part, the fact that PPI-or many other behavioral measures-have not been developed as predictive models for TS medications reflects the neurochemical range of these agents, which include both DA agonists (Gilbert et al 2003;Black and Mink 2000;Anca et al 2004), typical antipsychotics (Ross and Moldofsky 1978;Goetz et al 1984;Shapiro et al 1989), atypical antipsychotics (Bruun and Budman 1996;Budman et al 2001;Dion et al 2002;Gaffney et al 2002;Parraga and Parraga 2001;Mukaddes and Abali 2003), α-2 adrenergic agonists (Leckman et al 1991;Scahill et al 2001), the DA depleter, tetrabenazine (Sweet et al 1974;Jankovic et al 1984), the "inverse neuroleptic", metoclopromide (Acosta and Castellanos 2004), nicotinic compounds (Dursun et al 1994), and possibly cannabinoids (Muller-Vahl et al 2002). However, a number of findings suggest that PPI can be utilized as a predictive tool for TS therapeutics.…”

Anesthetic management for cesarean delivery in a woman with Gilles de la Tourette’s syndrome

“…Animal studies have shown that, compared with both typical and atypical neuroleptics, metoclopramide has regional effects on the rat motor striatum. 12 Metoclopramide can improve the intelligence, short-term memory and attention in children with GTS. 13 In our case, we preferred metoclopramide as both an antiemetic and an antidopaminergic drug.…”