Tic reduction with pergolide in a randomized controlled trial in children

Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, United States
Neurology (Impact Factor: 8.29). 02/2003; 60(4):606-11. DOI: 10.1212/01.WNL.0000044058.64647.7E
Source: PubMed


To determine whether pergolide, a mixed D1/D2/D3 dopamine agonist, is efficacious and safe in the treatment of children with chronic tic disorders and Tourette syndrome.
Neuroleptics, which block dopamine transmission, are currently used to treat children with severe tics, but major side effects and limited efficacy reduce clinical utility. Prior open-label and crossover studies of pergolide suggest potential benefit.
The authors enrolled 57 children and adolescents, ages 7 to 17 years, randomizing them in a 2:1 ratio to either pergolide (0.15 to 0.45 mg per day) or placebo. Tic symptoms had to be >30 on the Yale Global Tic Severity Scale (YGTSS). The primary outcome measure was change in tic severity assessed by YGTSS.
Compared to placebo treatment, pergolide treatment was associated with lower tic severity scores (treatment effect 8.8, pergolide vs placebo; 95% CI 0.1 to 17.6; p = 0.05) and attention-deficit hyperactivity disorder symptoms scores (treatment effect 3.8; 95% CI 0.7 to 6.8; p = 0.02). No patient had a serious adverse event and pergolide was well tolerated.
In this randomized, placebo-controlled trial, pergolide appeared to be an efficacious and safe medication for tic reduction in children, and may also improve attention-deficit hyperactivity disorder symptoms.

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    • "Results for the anticonvulsant levetiracetam have been mixed (Awaad, Michon, & Minarik, 2005; Hedderick, Morris, & Singer, 2009; Smith-Hicks, Bridges, Paynter, & Singer, 2007). The use of dopamine agonists pergolide (no longer marketed) (Gilbert et al., 2003) and ropinirole (Anca, Giladi, & Korczyn, 2004) for tics initially appeared promising, but a controlled trial of pramipexole, another dopamine agonist, showed no benefit (Kurlan et al., 2012). The third tier medications include the anti-dopaminergic drugs, either dopamine receptor blocking agents, also known as neuroleptics or antipsychotics, or dopamine depletors, such as tetrabenazine. "
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    • "Pro-dopaminergic medications to treat TD may first have been suggested 30 years ago (Feinberg and Carroll 1979). Subsequently, a number of small open-label and randomized, controlled trials have suggested that dopamine agonists may have a modest effect in reducing tic scores (Lipinski et al. 1997; Black and Mink 2000; Gilbert et al. 2003; Anca et al. 2004) similar to benefit in restless leg syndrome (Earley et al. 1998). "
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