Pharmacological options for
the treatment of Tourette's disorder
by
Jimenez-Jimenez FJ, Garcia-Ruiz PJ.
Department of Medicine - Neurology,
Hospital 'Principe de Asturias',
Universidad de Alcala, Alcala de Henares (Madrid),
and Neuro-Magister S.L. Company, Madrid, Spain.
fjimenezj@meditex.es
Drugs 2001;61(15):2207-20

ABSTRACT

Tourette's disorder is a neuropsychiatric disorder characterised clinically by motor and vocal tics, which may be associated to conductual disorders such as obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD). Although the neurochemistry of Tourette's disorder is not well known, there are some effective therapies for tics, OCD and ADHD. However, these are not devoid of adverse effects. Tics only require treatment when they interfere with the functioning of the patient. If therapy is needed, monotherapy at the minimal effective dose is desirable, but some patients may require two or more drugs. The most frequently used drugs for tics are antipsychotics (mainly pimozide and haloperidol) and clonidine. The potential usefulness of atypical antipsychotic drugs (risperidone, olanzapine, clozapine, ziprasidone) and other dopaminergic drugs (fluphenazine, sulpiride, tiapride, metoclopramide, piquindone, tetrabenazine), clonazepam, calcium channel antagonists, botulinum toxin, dopamine agonists, selegiline, and other drugs is discussed. The drugs of choice for OCD in patients with Tourette's disorder are the selective serotonin reuptake inhibitors (SSRIs), although the tricyclic antidepressant clomiplamine, which inhibits both serotonin and noradrenaline uptake, has also been found to be useful. ADHD can be treated with some psychostimulants, mainly methylphenidate, although these drugs must be used with caution. Other potentially useful drugs for the treatment of ADHD in patients with Tourette's disorder are clonidine, guanfacine, selegiline, some tricyclic antidepressants, sertraline, pimozide and clonazepam. Finally, the potential value of some nonpharmacological therapies (hypnotherapy, biofeedback, conductual therapies, electroconvulsive therapy, acupuncture and surgery) is briefly reviewed.

D1
Genes
Reward
Structure
Selegiline
Roxindole
Dopamine
Amineptine
Pramipexole
Bromocriptine
Methylphenidate
Tranylcypromine
Drugs and reward
Dopamine and sex
The dopamine transporter
Dopamine knock-out mice
The pleasure and the pain
Drugs for Tourette's syndrome
Tourette's and the basal ganglia

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