A case series of patients with Tourette's Syndrome in the United Kingdom treated with aripiprazole

St George's Hospital, Department of Neurology, Atkinson Morley Wing, Blackshaw Rd, London, SW17-0QT, UK.
Human Psychopharmacology Clinical and Experimental (Impact Factor: 2.19). 10/2006; 21(7):447-53. DOI: 10.1002/hup.798
Source: PubMed


These cases illustrate that a new neuroleptic, aripiprazole, may be an effective treatment for the motor and vocal tics of Tourette Syndrome (TS), even in younger people.
A case series of 11 consecutive patients with TS (age range 7-50 years; M = 7) who were felt to require neuroleptic medication, were treated with aripiprazole, the majority of whom had been refractory to treatment with other neuroleptics, and in one case, Habit Reversal Training as well.
Ten out of the 11 patients who were treated with aripiprazole improved, although to differing degrees. The only individual who showed no response was treated for only 1 month with a low dose (5 mg). Eight of the patients had been treated with many typical and atypical neuroleptics without success, and which had also given unacceptable side effects, resulting in them being unable to function at times. One was also unresponsive to previous Habit Reversal Training. The response to aripiprazole was dramatic and quick in five patients; in the rest (5/10) the response was less dramatic. In the majority of patients, response was sustained. The successful aripiprazole doses were between 10-20 mg daily. Side effects were mild and transient. This, to the best of our knowledge, is the first case series of patients with TS successfully treated with aripiprazole in the United Kingdom, and one of the few to date in the English Scientific literature. Our patients are also the first cases reported, in which the patients were assessed and whose improvement was monitored using standardised schedules and rating scales, such as the Yale Global Tic Severity Rating Scale and MOVES. Aripiprazole was licensed for use in patients with schizophrenia in the European Union in June 2004. We discuss possible reasons for these dramatic and idiosyncratic responses to aripiprazole.
We suggest that aripiprazole may well be useful for individuals with TS as response to it is often quick, dramatic, sustained and with few generally mild and transient side effects.

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Available from: Niruj Agrawal,
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    • "Aripiprazole has been reported to be less likely to cause weight gain in adults compared to other atypical neuroleptics (Kolotkin et al. 2008). Recently, several case series and one openlabel study have reported on the use of aripiprazole in children and adolescents with TD or chronic tic disorder, but to date, no controlled trials have been reported (Hounie et al. 2004; Dehning et al. 2005; Kastrup et al. 2005; Murphy et al. 2005; Bubl et al. 2006; Constant et al. 2006; Davies et al. 2006; Duane 2006; Fountoulakis New York University Child Study Center, New York, New York. This was an investigator-initiated study supported by a grant from Bristol Myers Squibb to the corresponding author (B.J.C.). "
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    ABSTRACT: The aim of this study was to conduct a prospective safety and tolerability study of aripiprazole for the treatment of tics in children and adolescents with Tourette's disorder (TD). Eleven subjects (10 males) with TD (age 9-19 years, mean 13.36, standard deviation [SD] 3.33) who did not respond or were unable to tolerate previous tic medication were treated with aripiprazole in an open-label, flexible-dosing study over 10 weeks. Tic severity was rated using the Yale Global Tic Severity Scale (YGTSS) and the Clinical Global Impressions Scale for tics (CGI-Tics) at baseline and at follow-up. The mean (+/-SD) daily dose for aripiprazole was 4.5 +/- 3.0 mg. Mean (+/-SD) YGTSS Global Severity scores reduced from 61.82 +/- 13.49 at baseline to 33.73 +/- 15.18 at end point; mean YGTSS total tic scores reduced from 28.18 +/- 7.74 at baseline to 16.73 +/- 7.54 at end point. Mean (+/-SD) CGI-Tic severity scores reduced from 4.45 +/- 0.52 (moderate-marked) at baseline to 3.18 +/- 0.60 (mild) at end point. On the CGI-Tic improvement scale, 10 (91%) subjects achieved 1 ("very much improved") or 2 ("much improved") at end point. Most common adverse effects included appetite increase and weight gain in 5 subjects, mild extrapyramidal effects in 7 subjects, and headaches and tiredness/fatigue in 7 subjects; 1 subject experienced akathisia and muscle cramps. Aripiprazole appears to be a safe and tolerable treatment in children and adolescents with TD that appears to reduce tics; it should be further investigated as a treatment option in controlled trials.
    Journal of child and adolescent psychopharmacology 12/2009; 19(6):623-33. DOI:10.1089/cap.2009.0035 · 2.93 Impact Factor
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