Pharmacological Treatment of Tics

Abstract

AbstractThis chapter provides a literature review and a critical commentary of the available evidence on pharmacological treatment of tics in Tourette syndrome (TS). Because of the waxing and waning nature of tics, a meaningful appraisal of treatment efficacy in TS can only be given in most cases after a longer observation time. Environmental or situational factors have a modulating influence on tics, possibly biasing the appraisal of treatment efficacy. Many affected children, adolescents, and adults do not seek/require pharmacological treatment (tic severity: mild to moderate). Nonpharmacological and/or pharmacological interventions are beneficial for persons with subjective discomfort, social and/or emotional problems, functional interference, etc. The clinical experience is that the pharmacotherapy induces faster and probably more prominent tic reduction in comparison to behavioral treatment options. The goal of pharmacological treatment is a reduction in tic symptoms. Antipsychotic drugs may lead to the most reliable and fastest treatment effectiveness, but they also pose the greatest risk of side effects. Risperidone can be favored as a first-choice agent for the treatment of tics. Pimozide, tiapride, sulpiride, and aripiprazole are regarded as second-choice agents. Clonidine might be helpful mainly in case of TS plus attention-deficit/hyperactivity disorder. For high-quality evidence on pharmacological treatment in TS, future studies should include, for instance, longer observation periods, larger groups, a more standardized methodological approach, placebo controls, and a double-blind design.