Medications for Tic Treatment

• Neuroleptics (Haldol-like drugs)
  • haloperidol (Haldol), 0.5 mg - 5.0 mg/day
  • pimozide (Orap), 0.5 mg - 10 mg/day
  • risperidone (Risperdal), 1.0 - 6.0 mg/day
  • neuroleptic medication side effects: sedation; weight gain; EPS: muscle spasms, tremors, restlessness; risk of tardive dyskinesia; skin sensitivity; eyesight changes; anxiety; monitor liver, EKG (esp. Orap), EEG

• Alpha-adrenergic drugs
  • gaunfacine (Tenex), 0.5 - 2.0 mg/day
  • clonidine (Catepres), 0.05 - 0.2 mg/day
  • Alpha-adrenergic medication side effects: lethargy; drowsiness; deceased blood pressure; EKG changes

Medications for obsessive-compulsive (OCD) symptoms in TS

• Serotonin Reuptake Inhibitors (SRIs, SSRIs)
  • Prozac, Zoloft, Paxil, Luvox
  • Very good for OCD & depression
  • SSRI side effects: gastrointestinal symptoms; restlessness; insomnia; genital-urinary side effects

• Anafranil (clomipramine, a tricyclic compound)
  • may improve obsessive-compulsive components of TS
  • (also anti-depressant & anti-anxiety medication)
  • side effects: dry mouth, constipation, urinary problems; skin changes; lower blood pressure; monitor EKG, EEG, and liver

Medications for Attention Deficit

• Ritalin
  • May not increase tics if used in reasonable dosages; may decrease vocal tics
  • Improve concentration, impulsivity, hyperactivity
  • Ritalin side effects: anorexia, insomnia, irritability; gastro-intestinal upset

• Tricyclics (Anafranil, imipramine etc.)
  • Improve attention, impulsivity, hyperactivity
  • Also anti-depressant, anti-anxiety
  • Tricyclic side effects: dry mouth, constipation, urinary problems; skin changes; lower blood pressure; monitor EKG, EEG, and liver

• Alpha-drugs
  • clonidine, Tenex
  • improves attention
  • Alpha-adrenergic medication side effects: lethargy; drowsiness; deceased blood pressure; EKG changes

Sensory Symptoms

"Just right" feeling

Premonitory urge (sensation or pressure immediately before a tic)

Restless Legs Syndrome

Because of these sensations the movements are more like compulsions,

Therefore, many movements are voluntary-like

Biochemistry

• Norepinephrine involved in pathobiology of Tourette's Syndrome
• Altered balance of NE, 5HT, and DA likely involved in OCD

Environmental Factors in Tourette's Syndrome

• 11 factors resulted in decreased symptoms: visits to doctor's office, relaxed reading, talking to friends
• 17 factors increased the tics: anxiety, emotional trauma, social gatherings
• Other factors were neutral

School

Poor attention in achool may be due to:

1. Tic severity
2. Medication
3. Executive dysfunction (cognitive dysfunction)
4. Social consequences of a stigmatizing disorder
5. Coexistent ADHD, OCD or other disorders

Goals of health professionals

• Clarify reasons for school problems
• Develop an individualized multimodality treatment program