Systematic Review: Pharmacological Treatment of Tic Disorders - Efficacy of Antipsychotic and Alpha-2 Adrenergic Agonist Agents.

ArticleinNeuroscience & Biobehavioral Reviews 37(6) · October 2012with22 Reads
DOI: 10.1016/j.neubiorev.2012.09.008 · Source: PubMed
Abstract
We conducted a meta-analysis of randomized, placebo-controlled trials to determine the efficacy of antipsychotic and alpha-2 agonists in the treatment of chronic tic disorders and examine moderators of treatment effect. Meta-analysis demonstrated a significant benefit of antipsychotics compared to placebo (standardized mean difference (SMD)=0.58 (95% confidence interval (CI): 0.36-0.80). Stratified subgroup analysis found no significant difference in the efficacy of the 4 antipsychotic agents tested (risperidone, pimozide, haloperidol and ziprasidone). Meta-analysis also demonstrated a benefit of alpha-2 agonists compared to placebo (SMD=0.31 (95% confidence interval CI: 0.15-0.48). Stratified subgroup analysis and meta-regression demonstrated a significant moderating effect of co-occurring ADHD. Trials which enrolled subjects with tics and ADHD demonstrated a medium-to-large effect (SMD=0.68 (95%CI: 0.36-1.01) whereas trials that excluded subjects with ADHD demonstrated a small, non-significant benefit (SMD=0.15 (95%CI: -0.06-0.36). Our findings demonstrated significant benefit of both antipsychotics and alpha-2 agonists in treating tics but suggest alpha-2 agonists may have minimal benefit in tic patients without ADHD.
    • "A meta-analysis of eight randomized controlled trials involving 438 subjects with TS concluded that CBIT produced moderate treatment effects and participants receiving CBITwere more likely to exhibit a treatment response compared to control interven- tions [112]. There is a paucity of standardized, large evidence-based drug trials in TS [113]. Pharmacologically, often the first line of TS treatment are the alpha agonists guanfacine [114] and clonidine [115]. "
    [Show abstract] [Hide abstract] ABSTRACT: Tourette syndrome (TS) is a childhood onset neurologic disorder with manifestations including multiple motor and phonic tics, and in most cases a variety of behavioral comorbidities such as attention deficit hyperactivity disorder, obsessive compulsive disorder, and other impulse control disorders. Although it is considered a hereditary disorder, likely modified by environmental factors, genetic studies have yet to uncover relevant causative genes and there is no animal model that mimics the broad clinical phenomenology of TS. There has been a marked increase in the number of neurophysiological, neuroimaging, and other studies on TS. The findings from these studies, however, have been difficult to interpret because of small sample sizes, variability of symptoms across patients, and comorbidities. Although anti-dopaminergic drugs are the most widely used medications in the treatment of TS, there has been increasing interest in other drugs, behavioral therapies, and surgical approaches including deep brain stimulation. Herein, we review the current literature and discuss the complexities of TS and the challenges in understanding its pathophysiology and in selecting the most appropriate treatment. We also offer an expert’s view of where the field of TS may be headed.
    Full-text · Article · Apr 2016
    • "Additionally , several of the most effective medications used to treat tics have significant side effects (Robertson et al. 2000; Roessner and Rothenberger 2013). Antipsychotic agents, which are primarily D2-receptor antagonists, are the most effective treatment currently available for TS (Weisman et al. 2013). Randomized, double-blind, placebo-controlled trials (RCT) estimate that antipsychotic agents reduce tic severity on average by 20–30% compared with placebo (Dion et al. 2002;.]), the Tourette Syndrome Association, the Patterson and Rembrandt Foundation, Grifols (formerly Talecris [J.F.L.]), and the UL1 RR024139 from the National Center for Research Resources, a component of the NIH, and NIH roadmap for Medical Research (M.H.B.). "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Current pharmacological treatments for Tourette Syndrome (TS), such as antipsychotic agents and α-2 agonists, are moderately effective in the treatment of tics, but have substantial side effects that limit their use. N-acetylcysteine (NAC) modulates glutamatergic systems, and has been used safely as an antioxidant agent with minimal side effects for decades. NAC has been increasingly studied for the treatment of other obsessive-compulsive spectrum disorders. We aim to examine the efficacy of NAC for the treatment of pediatric TS in a double-blind, placebo-controlled, add-on study. Methods: Thirty-one children and adolescents 8-17 years of age with TS were randomly assigned to receive NAC or matching placebo for 12 weeks. Our primary outcome was change in severity of tics as measured by the Yale Global Tic Severity Scale (YGTSS), Total tic score. Secondary measures assessed comorbid obsessive-compulsive disorder (OCD), depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD). Linear mixed models in SAS were used to examine differences between NAC and placebo. Results: Of 31 randomized subjects, 14 were assigned to placebo (two females; 11.5 + 2.8 years) and 17 to active NAC (five females; 12.4 + 1.4 years) treatment. No significant difference between NAC and placebo was found in reducing tic severity or any secondary outcomes. Conclusions: We found no evidence for efficacy of NAC in treating tic symptoms. Our findings stand in contrast to studies suggesting benefits of NAC in the treatment of other obsessive-compulsive spectrum disorders in adults, including OCD and trichotillomania, but are similar to a recent placebo-controlled trial of pediatric trichotillomania that found no benefit of NAC.
    Full-text · Article · Mar 2016
    • "Given the worsening of his tics and ADHD, David was reevaluated by his neurologist who prescribed guanfacine (an alpha-2 agonist), titrated slowly to a maximum tolerable dose of 2.5 mg/day in three divided doses (1 mg dose in the morning, 0.5 mg dose in the afternoon, and 1 mg dose at bedtime). Alpha-2 agonists have been shown to be effective for managing ADHD symptoms and have also been shown to modestly reduce tics in some children with ADHD (Weisman et al. 2012). Given the potential for adverse side effects from more potent tic-suppressing medications (see McNaught and Mink 2011, for a review ), the neurologist also recommended a trial of CBIT prior to initiating additional psychotropic medication for his tics. "
    [Show abstract] [Hide abstract] ABSTRACT: In this chapter, we provide a brief overview of Tourette syndrome (TS) and tic disorders, including diagnostic information, prevalence, course, and associated features. We then provide a brief summary of evidence-based treatment with a focus on comprehensive behavioral intervention for tics (CBIT). Following this background overview, we then describe the use of CBIT to treat tics in an 11-year-old boy with TS and attention-deficit/hyperactivity disorder (ADHD). We describe, in detail, evidence-based assessment, case conceptualization, and detailed information on intervention techniques. Specifically, we discuss managing comorbidity in CBIT, implementation, and relevant modification of interventions and patient clinical response. Complicating factors and their impact on treatment are discussed. Conclusions and a brief list of key practice points are provided.
    Full-text · Chapter · Jan 2016 · Journal of child and adolescent psychopharmacology
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