Treatment of Tics in Tourette Syndrome With Aripiprazole
Available from: PubMed Central
- "In contrast, higher doses of aripiprazole have been used to treat children and adolescents with bipolar disorders [38, 39], catatonia , and generalized anxiety disorder , as well as in psychiatric inpatients . The aripiprazole dose used in this study was lower than that used in adults with Tourette disorder [21, 43–45]. "
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ABSTRACT: Due to its unique pharmacodynamic properties of dopamine partial agonist activity, and its association with few and mild side effects, aripiprazole is a candidate atypical antipsychotic for patients with tic disorders. This open-label study compared the efficacy and tolerability of aripiprazole with haloperidol, a typical antipsychotic widely used to treat patients with tic disorders. Forty-eight children and adolescents with tic disorders were recruited from the outpatient clinic at South Korea and treated with aripiprazole (initial dose, 5.0 mg/d; maximum dose 20 mg/d) or haloperidol (initial dose, 0.75 mg/d; maximum dose, 4.5 mg/d) for 8 weeks. Treatment efficacy was measured using the yale global tic severity scale (YGTSS), and tolerability was measured using the extrapyramidal symptom rating scale (ESRS) and an adverse effects checklist. Total tic scores as measured by the YGTSS decreased over time in both groups (p < 0.001) without any significant differences between groups. ESRS scores were significantly higher in the haloperidol group during the 4 weeks after commencement of medication (p < 0.05). These results indicate that aripiprazole may be a promising drug in the treatment of children and adolescents with tic disorders. Further controlled studies are needed to determine the efficacy and tolerability of aripiprazole in these patients.
Available from: Gholson J Lyon
- "Aripiprazole has been reported to be less likely to cause weight gain in adults compared to other atypical neuroleptics (Kolotkin et al. 2008). Recently, several case series and one openlabel study have reported on the use of aripiprazole in children and adolescents with TD or chronic tic disorder, but to date, no controlled trials have been reported (Hounie et al. 2004; Dehning et al. 2005; Kastrup et al. 2005; Murphy et al. 2005; Bubl et al. 2006; Constant et al. 2006; Davies et al. 2006; Duane 2006; Fountoulakis New York University Child Study Center, New York, New York. This was an investigator-initiated study supported by a grant from Bristol Myers Squibb to the corresponding author (B.J.C.). "
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ABSTRACT: The aim of this study was to conduct a prospective safety and tolerability study of aripiprazole for the treatment of tics in children and adolescents with Tourette's disorder (TD).
Eleven subjects (10 males) with TD (age 9-19 years, mean 13.36, standard deviation [SD] 3.33) who did not respond or were unable to tolerate previous tic medication were treated with aripiprazole in an open-label, flexible-dosing study over 10 weeks. Tic severity was rated using the Yale Global Tic Severity Scale (YGTSS) and the Clinical Global Impressions Scale for tics (CGI-Tics) at baseline and at follow-up.
The mean (+/-SD) daily dose for aripiprazole was 4.5 +/- 3.0 mg. Mean (+/-SD) YGTSS Global Severity scores reduced from 61.82 +/- 13.49 at baseline to 33.73 +/- 15.18 at end point; mean YGTSS total tic scores reduced from 28.18 +/- 7.74 at baseline to 16.73 +/- 7.54 at end point. Mean (+/-SD) CGI-Tic severity scores reduced from 4.45 +/- 0.52 (moderate-marked) at baseline to 3.18 +/- 0.60 (mild) at end point. On the CGI-Tic improvement scale, 10 (91%) subjects achieved 1 ("very much improved") or 2 ("much improved") at end point. Most common adverse effects included appetite increase and weight gain in 5 subjects, mild extrapyramidal effects in 7 subjects, and headaches and tiredness/fatigue in 7 subjects; 1 subject experienced akathisia and muscle cramps.
Aripiprazole appears to be a safe and tolerable treatment in children and adolescents with TD that appears to reduce tics; it should be further investigated as a treatment option in controlled trials.
Available from: Niruj Agrawal
- "She was so well that she began working as a waiter for the first time. Kastrup et al. (2005) documented two cases with TS successfully treated with aripiprazole 15 mg daily. Neither experienced serious side effects. "
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ABSTRACT: These cases illustrate that a new neuroleptic, aripiprazole, may be an effective treatment for the motor and vocal tics of Tourette Syndrome (TS), even in younger people.
A case series of 11 consecutive patients with TS (age range 7-50 years; M = 7) who were felt to require neuroleptic medication, were treated with aripiprazole, the majority of whom had been refractory to treatment with other neuroleptics, and in one case, Habit Reversal Training as well.
Ten out of the 11 patients who were treated with aripiprazole improved, although to differing degrees. The only individual who showed no response was treated for only 1 month with a low dose (5 mg). Eight of the patients had been treated with many typical and atypical neuroleptics without success, and which had also given unacceptable side effects, resulting in them being unable to function at times. One was also unresponsive to previous Habit Reversal Training. The response to aripiprazole was dramatic and quick in five patients; in the rest (5/10) the response was less dramatic. In the majority of patients, response was sustained. The successful aripiprazole doses were between 10-20 mg daily. Side effects were mild and transient. This, to the best of our knowledge, is the first case series of patients with TS successfully treated with aripiprazole in the United Kingdom, and one of the few to date in the English Scientific literature. Our patients are also the first cases reported, in which the patients were assessed and whose improvement was monitored using standardised schedules and rating scales, such as the Yale Global Tic Severity Rating Scale and MOVES. Aripiprazole was licensed for use in patients with schizophrenia in the European Union in June 2004. We discuss possible reasons for these dramatic and idiosyncratic responses to aripiprazole.
We suggest that aripiprazole may well be useful for individuals with TS as response to it is often quick, dramatic, sustained and with few generally mild and transient side effects.
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