Article

A randomised, double-blind, placebo-controlled study of topiramate in the treatment of Tourette syndrome

Baylor College of Medicine, Department of Neurology, Houston, TX 77030, USA.
Journal of neurology, neurosurgery, and psychiatry (Impact Factor: 6.81). 09/2009; 81(1):70-3. DOI: 10.1136/jnnp.2009.185348
Source: PubMed

ABSTRACT

To investigate the effects of topiramate on Tourette syndrome (TS).
Dopamine-receptor-blocking drugs have been traditionally used to control tics in patients with TS, but these neuroleptics are associated with potentially limiting side effects.
This is a randomised, double-blind, placebo-controlled, parallel group study. To be included in the study, subjects required a DSM-IV diagnosis of TS, were 7-65 years of age, had moderate to severe symptoms (Yale Global Tic Severity Scale (YGTSS) > or =19), were markedly impaired as determined by the Clinical Global Impression (CGI) scale severity score of > or =4 and were taking no more than one drug each for tics or TS comorbidities.
There were 29 patients (26 males), mean age 16.5 (SD 9.89) years, randomised, and 20 (69%) completed the double-blind phase of the study. The primary endpoint was Total Tic Score, which improved by 14.29 (10.47) points from baseline to visit 5 (day 70) with topiramate (mean dose 118 mg) compared with a 5.00 (9.88) point change in the placebo group (p = 0.0259). There were statistically significant improvements also in the other components of the YGTSS as well as improvements in various secondary measures, including the CGI and premonitory urge CGI. No differences were observed in the frequency of adverse events between the two treatment groups.
This double-blind, placebo-controlled trial provides evidence that topiramate may have utility in the treatment of moderately severe TS.

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Available from: Joseph Jankovic, Oct 08, 2014
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    • "Tel.: +44 121 3012317; Fax: +44 121 3012291; E-mail: a.cavanna@ion.ucl.ac.uk. havioural problems, such as attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) [4] [5]. It is estimated that GTS affects 1–8 per 1000 children [6] worldwide [7], in different degrees of severity [7], however due to misdiagnosis in reality prevalence may be even higher. "
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    • "A naturalistic follow-up study from 2004 including 41 patients indicated that treatment with fluphenazine for at least one year was safe and effective.27 A retrospective review from 2009 also showed fluphenazine to be an effective and well-tolerated therapy.28 The main data were collected in a few older studies including placebo-controlled, double-blind trials between 1982 and 1985 which revealed that fluphenazine is effective in controlling tics, while having fewer side effects than haloperidol (small, open-label studies).29–31 "
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    • "Newer anticonvulsants such as topiramate and lamotrigine have not been fully investigated. Preliminary studies (Nelson et al. 2007; Jankovic et al. 2010) conducted in children with TD and tics show that topiramate may reduce tic severity by 50% in add-on therapy patients and by 51% in monotherapy patients. Lamotrigine is not indicated for children with tics or TD. "
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