Levetiracetam in Tourette syndrome: A controlled double blind, placebo controlled study

Journal of pediatric neurology: JPN 01/2009; 7(3):257-263. DOI: 10.3233/JPN-2009-0300


Some drugs currently used to treat tics have drawbacks, including the risk of side effects such as tardive dyskinesia. Therapeutic options with better safety profiles are needed. Levetiracetam is an antiepileptic drug with atypical GABAergic effects that might be beneficial for this indication. To evaluate the effect of levetiracetam on motor and focal tics, behavior, and school performance in children and adolescents with tics and Tourette syndrome. Twenty-four patients, age 6–18 years, with tics and Tourette syndrome were enrolled in this prospective, double-blinded placebo randomized study for 8 weeks. Each group had 12 patients. The initial starting dose of levetiracetam was 250 mg. The dosage was titrated over 3 weeks to 1,000 to 2,000 mg. Clinical outcomes were assessed with the Clinical Global Impression Scale, Yale Global Tic Severity Scale, and Revised Conners' Scale. Ten out of 12 patients in the levetiracetam group showed improvements based on all of the scales used and four patients improved with regard to behavior and school performance. Two patients dropped out. Nine patients out of 12 patients in the placebo group showed no improvement, one patient showed a great placebo effect, and two patients dropped out of the study. Levetiracetam was generally well tolerated. Two patients discontinued because of exaggeration of pre-existing behavioral problems. Levetiracetam may be useful in treating tics in children and adolescents. Given its established safety profile, levetiracetam is a candidate for additional evaluation.
DOI 10.3233/JPN-2009-0300

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Available from: Tamer Rizk, Feb 01, 2014
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    Preview · Article · May 2010 · Neuropsychiatric Disease and Treatment
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    ABSTRACT: Tourette syndrome is a common childhood-onset neuropsychiatric disorder characterized by chronic tics and frequent comorbid conditions such as attention deficit disorder. Most currently used tic-suppressing drugs are frequently associated with serious adverse events. Thus, alternative therapeutic agents with more favorable side-effect profiles are being evaluated. New hypotheses and recent studies involving GABAergic system in the pathophysiology of Tourette syndrome suppose a reason for the evaluation of GABAergic drugs. Levetiracetam is a drug with an atypical GABAergic mechanism of action that might be expected to improve tics. Although trials performed to evaluate the efficacy of levetiracetam in the treatment of Tourette syndrome have provided conflicting results, it may be useful in some patients. The established safe profile of levetiracetam makes this drug an alternative for treatment if intolerance to currently used drugs appears, but additional evaluation with larger and longer duration controlled studies are necessary to assess the real efficacy in patients with Tourette syndrome.
    Full-text · Article · Jun 2010 · Neuropsychiatric Disease and Treatment
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    ABSTRACT: This article seeks to provide the practising clinician with guidance on the pharmacological management of tic disorders in children and adults. We performed a systematic review of the literature on the treatment of tic disorders. A multi-institutional group of 14 experts in psychiatry, child psychiatry, neurology, pediatrics, and psychology engaged in a consensus meeting. The evidence was presented and discussed, and nominal group techniques were employed to arrive at consensus on recommendations. A strong recommendation is made when the benefits of treatment clearly outweigh the risks and burdens, and can apply to most patients in most circumstances without reservation. With a weak recommendation, the benefits, risks, and burdens are more closely balanced, and the best action may differ depending on the circumstances. Based on these principles, weak recommendations were made for the use of pimozide, haloperidol, fluphenazine, metoclopramide (children only), risperidone, aripiprazole, olanzapine, quetiapine, ziprasidone, topiramate, baclofen (children only), botulinum toxin injections, tetrabenazine, and cannabinoids (adults only). Strong recommendations were made for the use of clonidine and guanfacine (children only). While the evidence supports the efficacy of many of the antipsychotics for the treatment of tics, the high rates of side effects associated with these medications resulted in only weak recommendations for these drugs. In situations where tics are not severe or disabling, the use of a medication with only a weak recommendation is not warranted. However, when tics are more distressing and interfering, the need for tic suppression to improve quality of life is stronger, and patients and clinicians may be more willing to accept the risks of pharmacotherapy.
    No preview · Article · Mar 2012 · Canadian journal of psychiatry. Revue canadienne de psychiatrie
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