Article

Emerging Treatment Strategies in Tourette Syndrome: What's in the Pipeline?

Child Neuropsychiatry Unit, Department of Experimental Medicine, University of Insubria, Varese, Italy. Electronic address: .
International Review of Neurobiology (Impact Factor: 1.92). 12/2013; 112:445-80. DOI: 10.1016/B978-0-12-411546-0.00015-9
Source: PubMed

ABSTRACT

Tourette syndrome (TS) is a neurodevelopmental disorder characterized by multiple motor/phonic tics and a wide spectrum of behavioral problems (e.g., complex tic-like symptoms, attention deficit hyperactivity disorder, and obsessive-compulsive disorder). TS can be a challenging condition even for the specialists, because of the complexity of the clinical picture and the potential adverse effects of the most commonly prescribed medications. Expert opinions and consensus guidelines on the assessment and treatment of tic disorders have recently been published in Europe and Canada. All pharmacological treatment options are mere symptomatic treatments that alleviate, but do not cure, the tics. We still lack evidence of their effects on the natural long-term course and on the prognosis of TS and how these treatments may influence the natural course of brain development. The most commonly prescribed drugs are dopamine antagonists, such as typical (e.g., haloperidol, pimozide) and atypical neuroleptics (e.g., risperidone, aripiprazole), and α-2-adrenoreceptor agonists (e.g., clonidine). However, several studies have investigated the efficacy and tolerability of alternative pharmacological agents that may be efficacious, including the newest atypical antipsychotic agents (e.g., paliperidone, sertindole), tetrabenazine, drugs that modulate acetylcholine (e.g., nicotine) and GABA (e.g., baclofen, levetiracetam), tetrahydrocannabinol, botulinum toxin injections, anticonvulsant drugs (e.g., topiramate, carbamazepine), naloxone, lithium, norepinephrine, steroid 5α reductase, and other neuroactive agents (buspirone, metoclopramide, phytostigmine, and spiradoline mesylate). As regards nonpharmacological interventions, some of the more recent treatments that have been studied include electroconvulsive therapy and repetitive transcranial magnetic stimulation. This review focuses primarily on the efficacy and safety of these emerging treatment strategies in TS.

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    • "Psychopharmacologic research on cellular neurotransmitters long ago elucidated mechanisms of action of classic and variant antipsychotic, antidepressant, anxiolytic, and stimulant drugs, yet, as Dr. Insel stated last April, it is barely starting to spawn truly novel medications. New therapeutic approaches like deep brain stimulation and transcranial magnetic stimulation for depression, Tourette syndrome, and other behaviorally defined disorders remain largely investigational today (Kennedy et al. 2011;Termine et al. 2013). Thus far Level A behavioral and educational research has provided most of the effective interventions for developmental and psychiatric disorders, but it has taken level B neuroscience to show the biologic reality of their effects on widely distributed brain connectivity and focal brain volumes (Dichter et al. 2012;Krafnick et al. 2011). "

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