Clinical presentation, comorbidity and usual treatment of Gilles de la Tourette's syndrome: study of 17 cases
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2005-12-01
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de Lucas Taracena, M. T., Montañés Rada, F., & Martínez Granero, M. A. (2005). Clinical presentation, comorbidity and usual treatment of Gilles de la Tourette’s syndrome: study of 17 cases. Revista De Psiquiatría Infanto-Juvenil, 22(4), 155–163. Retrieved from https://aepnya.eu/index.php/revistaaepnya/article/view/71
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Section
Orginial article
Keywords:
Tourette's syndrome, comorbidity, attention deficit disorder, metilphenidate, neurolepticsAbstract
Background: Tourette's syndrome (TS) is a childhood-onset neuropsychiatric disorder characterized by chronic multiple motor and vocal tics. Comorbid psychiatric disorders, particularly attention deficit hyperactivity disorder (ADHD), anxiety disorders and obsessive-compulsive disorder (OCD) often are present. Methods: Seventeen pediatric cases attending an outpatient neuropediatric or psychiatric clinic from 1998 to 2003 and suffering from Tourette's disorder are retrospectively studied. Age, sex, clinical symptoms, age of onset, family history, comorbidity, treatment strategies and outcome data are described. Results: All but one case were male; mean age was 10 years but mean age of onset was 5 years and 9 months. Comorbidity was present in 82,3% of patients (ADHD 53%, anxiety disorders 41,1%, OCD spectrum 58,7%). Family history was positive in 72% of cases: 41,1% for tics and 17,6% for OC conditions. Treatments mostly prescribed were antipsychotics (n=15), and metilphenidate (n=7). Treatment with metilphenidate did not exacerbate tics. Adverse effects were present in 16 patients, allowing to withdraw haloperidol (n=2) or pimocide (3 out of 7 cases) because of neurologic y/o heart side effects. Risperidone and olanzapine produced weight gain and somnolence but were better tolerated. The rate of total remission was 64,7%. Conclusion: treatment of TS should be considered in severe cases, focusing also on comorbid disorders.
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References
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19. Gadow KD, Sverd J, Sprafkin J, Nolan EE, Grossman S. Long-term methylphenidate therapy in children with comorbid attention-deficit hyperactivity disorder and chronic multiple tic disorder. Arch Gen Psychiatry 1999;56:330-6.
20. Gaffney GR, Perry PJ, Lund BC, Bever-Stille KA; Arndt S, Kuperman S. Risperidone versus clonidine in the treatment of children and adolescents with Tourette' syndrome. J Am Acad Child Adolesc Psychiatry 2002; 41(3):330-6.
21. Gilbert DL, Batterson JR; Sethuraman G, Sallee FR. Tic reduction with risperidone versus pimozide in a randomized, double-blind, crossover trial. J Am Acad Child Adolesc Psychiatry 2004;43(2):206-14.
22. Gilbert DL, Dure L, Sethuraman G, Raab D, Lane J, Sallee FR. Tic reduction with pergolide in a randomized controlled trial in children.Neurology 2003;60:606-11.
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24. Jimenez-Jimenez FJ, Puertas-Muñoz I, García-Ruiz PJ. Neuroquímica y neurofarmacología del síndrome de Tourette. Neurología 2003;18(supl 3):80-95.
25. Kadesjo B, Gillberg C. Tourette´s disorder: epidemiology and comorbidity in primary school children. J Am Acad Child Adolesc Psychiatry 2000;39:548-55.
26. Karam-Hage M, Ghaziuddin N. Olanzapine in Tourette's disorder. J Am Acad Child Adolesc Psychiatry 2000;39(2):139.
27. Kossoff EH, Singer HS. Tourette syndrome. Clinical characteristics and current management strategies. Paediatr Drugs 2001;3:355-63.
28. Kurlan R, Como PG, Miller B, Palumbo D, Deeley C, Andresen EM, et al. The behavioral spectrum of tic disorders: a community-based study. Neurology 2002;59:414-20.
29. Law SF, Schachar RJ. Do typical clinical doses of methylphenidate cause tics in children treated for attention-deficit hyperactivity disorder?. J Am Acad Child Adolesc Psychiatry 1999;38:944-51.
30. Leckman JF, Zhang H, Vitale A, Lahnin F, Lynch K, Bondi C, et al. Course of tic severity in Tourette syndrome: the first two decades. Pediatrics 1998;102:14-9.
31. Leckman JF. Tourette´s syndrome. Lancet 2002;360:1577-86.
32. Lombroso PJ, Scahill L, King RA, Lynch KA, Chappell PB, Peterson BS, et al. Risperidone treatment of children and adolescents with chronic tic disorders: a preliminary report. J Am Acad Child Adolesc Psychiatry 1995;34(9):1147-52.
33. Margolese HC, Annable L, Dion Y. Depression and dysphoria in adult and adolescent patients with Tourette´s disorder treated with risperidone. J Clin Psychiatry 200263:1040-4.
34. Mason A, Banerjee S, Eapen V, Zeitlin H, Robertson MM. The prevalence of Tourette syndrome in a mainstream school population. Dev Med Child Neurol 1998;40:292-6.
35. Matur Z, Ucok A. Quetiapine treatment in a patient with Tourette´s syndrome, obsessive compulsive disorder and drug-induced mania. Isr J Psychiatry Relat Sci 2003;40 (2):150-2.
36. McDougle CJ, Goodman WK, Leckman JF, Barr LC, Heninger GR, Price LH. The efficacy of fluvoxamine in obsessive-compulsive disorder: effects of comorbid chronic tic disorder. J Clin Psychopharmacol 1993;13:354-8.
37. Mc Dougle CJ, Epperson CN, Pelton GH, Wasylink S, Price LH. A double blind, placebo-controlled study of risperidone addition in serotonin reuptake inhibitor-refractory obsessive-compulsive disorder. Arch Gen
Psychiatry 2000;57:794-801.
38. Meisel A, Winter C, Zschenderlein R, Arnold G. Tourette syndrome: efficient treatment with ziprasidone and normalization of body weight in a patient with excessive weight gain under tiapride. Mov Disord 2004;19 (8):991-2.
39. Mukaddes NM, Abali O. Quetiapine treatment of children and adoles- 163 cents with Tourette's disorder. J Child Adolesc Psychopharmacol 2003; 13(3):295-9.
40. Nolan EE, Gadow KD. Children with ADHD and tic disorder and their classmates: behavioral normalization with methylphenidate. J Am Acad Child Adolesc Psychiatry 1997;36:597-604.
41. Onofrj M, Paci C, D'Andreamatteo G, Toma L. Olanzapine in severe Gilles de la Tourette syndrome: a 52-week double-blind cross-over study vs low-dose pimozide. J Neurol 2000;247:443-6.
42. Parraga HC, Parraga MI. Quetiapine treatment in patients with Tourette syndrome. Can J Psychiatry 2001;46 (2):184-5.
43.Parraga HC, Parraga MI, Woodward RL, Fenning PA. Quetiapine treatment of children with Tourette´s syndrome: report of two cases. J Child Adolesc Psychopharmacol 2001;11:187-91.
44. Parraga HC, Woodward RL. Quetiapine for Tourette's syndrome. J Am Acad Child Adolesc Psychiatry 2001;40(4):389-91.
45. Price RA, Leckman JF, Pauls DL, Cohen DJ, Kidd KK. Gilles de la Tourette´s syndrome: tics and central nervous system stimulant in twin and non-twin. Neurology 1986;36:232-7.
46. Ruiz Lázaro PM. Fumarato de quetiapina en el síndrome de Gilles de la Tourette en un niño. Rev Psiquiatr Infant Juv 2003; 20(3):139-41.
47. Sallee FR, Kurlan R, Goetz CG, Singer H, Scahill L, Law G, et al. Ziprasidone treatment of children and adolescents with Tourette´s syndrome: a pilot study. J Am Acad Child Adolesc Psychiatry 2000;39: 292-9.
48. Scahill L, Leckman JF, Schultz RT, Katsovich L, Peterson BS. A placebo- controlled trial of risperidone in Tourette syndrome.Neurology 2003;60:1130-5.
49. Scahill L, Chappell PB, Kim YS, Schultz RT, Katsovich L, Shepherd E, et al. A placebo-controlled study of guanfacine in the treatment of children with tic disorders and attention deficit hyperactivity disorder. Am J Psychiatry 2001;158:1067-74.
50. Schaller JL, Behar D. Quetiapine treatment of adolescent and child tic disorders. Two case reports. Eur Child Adolesc Psychiatry 2002;11(4): 196-7.
51. Schuerholtz LJ, Baumgardner TL, Singer HS, Reiss AL, Denkla MB. Neuropsychological status of children with Tourette's syndrome with and without attention deficit hyperactivity disorder. Neurology 1996; 46:958-65.
52. Shin MS, Chung SJ, Hong KM. Comparative study of the behavioral and neuropsychologic characteristics of tics disorder with and without attention-deficit hyperactivity disorder. J Child Neurol 2001;16:719-26.
53. Shulman LM, Singer C, Weiner WJ. Risperidone in Gilles de la Tourette syndrome. Neurology 1995;45(7):1419.
54. Silva RR, Muñoz DM, Daniel W, Barickman J, Friedhoff AJ. Causes of haloperidol discontinuation in patients with Tourette´s disorder: management and alternatives. J Clin Psychiatry 1996;57:129-35.
55. Spencer T, Biederman J, Coffey B, Geller D, Crawford M, Bearman SK, et al. Adouble blind comparison of desipramine and placebo in children and adolescents with chronic tic disorder and comorbid ADHD. Arch Gen Psychiatry 2002;59:649-56.
56. Stamenkovic M, Aschauer H, Kasper S. Risperidone for Tourette's syndrome. Lancet 1994;344(8936):1577-8.
57.Stamenkovic M, Schindler SD, Aschauer HN, De Zwaan M, Willinger U, Resinger E, et al. Effective open-label treatment of Tourette´s disorder with olanzapine. Int Clin Psychopharmacol 2000;15:23-8.
58. Steele M, Couturier J. Apossible tetracycline-risperidone-sertraline interaction in an adolescent. Can J Clin Pharmacol 1999; 6(1):15-7.
59. Stephens RJ, Bassel C, Sandor P. Olanzapine in the treatment of aggression and tics in children with Tourette's syndrome: a pilot study. J Child Adolesc Psychopharmacol 2004;14(2):255-66.
60. Sverd J, Gadow KD, Paolicelli LM. Methylphenidate treatment of attention- deficit hyperactivity disorder in boys with Tourette´s syndrome. J Am Acad Child Adolesc Psychiatry 1989;28:574-9.
61. The Tourette Syndrome Classification Study Group. Definitions and classification of tics disorders. Arch Neurol 1993;50:1013-6.
62. The Tourette Syndrome Study Group. Treatment of ADHD in children with tics. Neurology 2002;58:527-36.
63. Trillet M, Moreau T, Dalery J, de Villard R, Aimard G. Treatment of Gilles de la Tourette's disease with amisulpride. Presse Med 1990;19(4):175.
2. Abwender DA, Como PG, Kurlan R, Parry K, Fett KA, Cui L, et al. School problems in Tourette syndrome. Arch Neurol 1996;53:509-11.
3. Bhadrinath BR. Olanzapine in Tourette syndrome. Br J Psychiatry 1998; 172:366.
4. Bengi Semerci Z. Olanzapine in Tourette's disorder. J Am Acad Child Adolesc Psychiatry 2000;39(2):140.
5. Budman CL, Gayer A, Lesser M, Shi Q, Bruun RD. An opel-label study of the treatment efficacy of olanzapine for Tourette´s disorder. J Clin Psychiatry 2001;62:290-4.
6. Bruun RD, Budman CL. Risperidone as a treatment for Tourette's syndrome. J Clin Psychiatry 1996;57:29-31.
7. Caine ED, Polinsky RJ, Kartzinel R, Ebert M. The trial use of clozapine for abnormal involuntary movement disorders. Am J Psychiatry 1979; 136(3):317-20.
8. Calderón-González R, Calderón-Sepúlveda RF. Síndrome de Gilles de la Tourette: espectro clínico y tratamiento. Rev Neurol 2003; 6:679-88.
9. Castellanos FX, Giedd JN, Elia J, Marsh WL, Ritchie GF, Hamburger SD, et al. Controlled stimulant treatment of ADHD and comorbid Tourette´s syndrome. Effects of stimulant and dose. J Am Acad Child Adolesc Psychiatry 1997;36:589-96.
10. De Lucas MT, Montañés F. Tras casos de síndrome de Gilles de la Tourette tratados con olanzapina. Actas Esp Psiquiatr 2002;30:129-32.
11. Dion Y, Annable L, Sandor P, Chouinard G. Risperidone in the treatment of Tourette syndrome: a double-blind, placebo-controlled trial. J Clin Psychopharmacol 2002;22:31-9.
12. Farré-Riba A, Narbona J. Escalas de Conners en la evaluación del trastorno por déficit de atención con hiperactividad: nuevo estudio factorial en niños españoles. Rev Neurol 1997;25:200-4.
13. Feigin A, Kurlan R, McDermott M, Beach J, Dimitsopoulos T, Brower CA, et al. Acontrolled trial of Deprenyl in children with Tourette's syndrome and attention deficit hyperactivity disorder. Neurology 1996;45: 965-8.
14. Fernández-Álvarez E. Trastornos comórbidos relacionados con los tics. Rev Neurol 2002; 34(Supl 1):S122-9.
15. Fisman S, Reniers D, Diaz P. Erythromycin interaction with risperidone or clomipramine in an adolescent. J Child Adolesc Psychopharmacol 1996;6(2):133-8.
16. Fountoulakis KN, Iacovides A, St Kaprinis G. Successful treatment of Tourette' disorder with amisulpride. Ann Pharmacother 2004;38(5): 901.
17. Freeman RD, Fast DK, Burd L, Kerbeshian J, Robertson MM, Sandor P. An international perspective on Tourette Syndrome: selected findings from 3500 individuals in 22 countries. Dev Med Child Neurol 2000;42:436-47.
18. Gadow KD, Sverd J, Sprafkin J, Nolan EE, Ezor SN. Efficacy of methylphenidate for attention-deficit hyperactivity disorder in children with tic disorder. Arch Gen Psychiatry 1995;52:444-55.
19. Gadow KD, Sverd J, Sprafkin J, Nolan EE, Grossman S. Long-term methylphenidate therapy in children with comorbid attention-deficit hyperactivity disorder and chronic multiple tic disorder. Arch Gen Psychiatry 1999;56:330-6.
20. Gaffney GR, Perry PJ, Lund BC, Bever-Stille KA; Arndt S, Kuperman S. Risperidone versus clonidine in the treatment of children and adolescents with Tourette' syndrome. J Am Acad Child Adolesc Psychiatry 2002; 41(3):330-6.
21. Gilbert DL, Batterson JR; Sethuraman G, Sallee FR. Tic reduction with risperidone versus pimozide in a randomized, double-blind, crossover trial. J Am Acad Child Adolesc Psychiatry 2004;43(2):206-14.
22. Gilbert DL, Dure L, Sethuraman G, Raab D, Lane J, Sallee FR. Tic reduction with pergolide in a randomized controlled trial in children.Neurology 2003;60:606-11.
23. Jankovic J. Tourette´s syndrome. N Eng J Med 2001;345:1184-92.
24. Jimenez-Jimenez FJ, Puertas-Muñoz I, García-Ruiz PJ. Neuroquímica y neurofarmacología del síndrome de Tourette. Neurología 2003;18(supl 3):80-95.
25. Kadesjo B, Gillberg C. Tourette´s disorder: epidemiology and comorbidity in primary school children. J Am Acad Child Adolesc Psychiatry 2000;39:548-55.
26. Karam-Hage M, Ghaziuddin N. Olanzapine in Tourette's disorder. J Am Acad Child Adolesc Psychiatry 2000;39(2):139.
27. Kossoff EH, Singer HS. Tourette syndrome. Clinical characteristics and current management strategies. Paediatr Drugs 2001;3:355-63.
28. Kurlan R, Como PG, Miller B, Palumbo D, Deeley C, Andresen EM, et al. The behavioral spectrum of tic disorders: a community-based study. Neurology 2002;59:414-20.
29. Law SF, Schachar RJ. Do typical clinical doses of methylphenidate cause tics in children treated for attention-deficit hyperactivity disorder?. J Am Acad Child Adolesc Psychiatry 1999;38:944-51.
30. Leckman JF, Zhang H, Vitale A, Lahnin F, Lynch K, Bondi C, et al. Course of tic severity in Tourette syndrome: the first two decades. Pediatrics 1998;102:14-9.
31. Leckman JF. Tourette´s syndrome. Lancet 2002;360:1577-86.
32. Lombroso PJ, Scahill L, King RA, Lynch KA, Chappell PB, Peterson BS, et al. Risperidone treatment of children and adolescents with chronic tic disorders: a preliminary report. J Am Acad Child Adolesc Psychiatry 1995;34(9):1147-52.
33. Margolese HC, Annable L, Dion Y. Depression and dysphoria in adult and adolescent patients with Tourette´s disorder treated with risperidone. J Clin Psychiatry 200263:1040-4.
34. Mason A, Banerjee S, Eapen V, Zeitlin H, Robertson MM. The prevalence of Tourette syndrome in a mainstream school population. Dev Med Child Neurol 1998;40:292-6.
35. Matur Z, Ucok A. Quetiapine treatment in a patient with Tourette´s syndrome, obsessive compulsive disorder and drug-induced mania. Isr J Psychiatry Relat Sci 2003;40 (2):150-2.
36. McDougle CJ, Goodman WK, Leckman JF, Barr LC, Heninger GR, Price LH. The efficacy of fluvoxamine in obsessive-compulsive disorder: effects of comorbid chronic tic disorder. J Clin Psychopharmacol 1993;13:354-8.
37. Mc Dougle CJ, Epperson CN, Pelton GH, Wasylink S, Price LH. A double blind, placebo-controlled study of risperidone addition in serotonin reuptake inhibitor-refractory obsessive-compulsive disorder. Arch Gen
Psychiatry 2000;57:794-801.
38. Meisel A, Winter C, Zschenderlein R, Arnold G. Tourette syndrome: efficient treatment with ziprasidone and normalization of body weight in a patient with excessive weight gain under tiapride. Mov Disord 2004;19 (8):991-2.
39. Mukaddes NM, Abali O. Quetiapine treatment of children and adoles- 163 cents with Tourette's disorder. J Child Adolesc Psychopharmacol 2003; 13(3):295-9.
40. Nolan EE, Gadow KD. Children with ADHD and tic disorder and their classmates: behavioral normalization with methylphenidate. J Am Acad Child Adolesc Psychiatry 1997;36:597-604.
41. Onofrj M, Paci C, D'Andreamatteo G, Toma L. Olanzapine in severe Gilles de la Tourette syndrome: a 52-week double-blind cross-over study vs low-dose pimozide. J Neurol 2000;247:443-6.
42. Parraga HC, Parraga MI. Quetiapine treatment in patients with Tourette syndrome. Can J Psychiatry 2001;46 (2):184-5.
43.Parraga HC, Parraga MI, Woodward RL, Fenning PA. Quetiapine treatment of children with Tourette´s syndrome: report of two cases. J Child Adolesc Psychopharmacol 2001;11:187-91.
44. Parraga HC, Woodward RL. Quetiapine for Tourette's syndrome. J Am Acad Child Adolesc Psychiatry 2001;40(4):389-91.
45. Price RA, Leckman JF, Pauls DL, Cohen DJ, Kidd KK. Gilles de la Tourette´s syndrome: tics and central nervous system stimulant in twin and non-twin. Neurology 1986;36:232-7.
46. Ruiz Lázaro PM. Fumarato de quetiapina en el síndrome de Gilles de la Tourette en un niño. Rev Psiquiatr Infant Juv 2003; 20(3):139-41.
47. Sallee FR, Kurlan R, Goetz CG, Singer H, Scahill L, Law G, et al. Ziprasidone treatment of children and adolescents with Tourette´s syndrome: a pilot study. J Am Acad Child Adolesc Psychiatry 2000;39: 292-9.
48. Scahill L, Leckman JF, Schultz RT, Katsovich L, Peterson BS. A placebo- controlled trial of risperidone in Tourette syndrome.Neurology 2003;60:1130-5.
49. Scahill L, Chappell PB, Kim YS, Schultz RT, Katsovich L, Shepherd E, et al. A placebo-controlled study of guanfacine in the treatment of children with tic disorders and attention deficit hyperactivity disorder. Am J Psychiatry 2001;158:1067-74.
50. Schaller JL, Behar D. Quetiapine treatment of adolescent and child tic disorders. Two case reports. Eur Child Adolesc Psychiatry 2002;11(4): 196-7.
51. Schuerholtz LJ, Baumgardner TL, Singer HS, Reiss AL, Denkla MB. Neuropsychological status of children with Tourette's syndrome with and without attention deficit hyperactivity disorder. Neurology 1996; 46:958-65.
52. Shin MS, Chung SJ, Hong KM. Comparative study of the behavioral and neuropsychologic characteristics of tics disorder with and without attention-deficit hyperactivity disorder. J Child Neurol 2001;16:719-26.
53. Shulman LM, Singer C, Weiner WJ. Risperidone in Gilles de la Tourette syndrome. Neurology 1995;45(7):1419.
54. Silva RR, Muñoz DM, Daniel W, Barickman J, Friedhoff AJ. Causes of haloperidol discontinuation in patients with Tourette´s disorder: management and alternatives. J Clin Psychiatry 1996;57:129-35.
55. Spencer T, Biederman J, Coffey B, Geller D, Crawford M, Bearman SK, et al. Adouble blind comparison of desipramine and placebo in children and adolescents with chronic tic disorder and comorbid ADHD. Arch Gen Psychiatry 2002;59:649-56.
56. Stamenkovic M, Aschauer H, Kasper S. Risperidone for Tourette's syndrome. Lancet 1994;344(8936):1577-8.
57.Stamenkovic M, Schindler SD, Aschauer HN, De Zwaan M, Willinger U, Resinger E, et al. Effective open-label treatment of Tourette´s disorder with olanzapine. Int Clin Psychopharmacol 2000;15:23-8.
58. Steele M, Couturier J. Apossible tetracycline-risperidone-sertraline interaction in an adolescent. Can J Clin Pharmacol 1999; 6(1):15-7.
59. Stephens RJ, Bassel C, Sandor P. Olanzapine in the treatment of aggression and tics in children with Tourette's syndrome: a pilot study. J Child Adolesc Psychopharmacol 2004;14(2):255-66.
60. Sverd J, Gadow KD, Paolicelli LM. Methylphenidate treatment of attention- deficit hyperactivity disorder in boys with Tourette´s syndrome. J Am Acad Child Adolesc Psychiatry 1989;28:574-9.
61. The Tourette Syndrome Classification Study Group. Definitions and classification of tics disorders. Arch Neurol 1993;50:1013-6.
62. The Tourette Syndrome Study Group. Treatment of ADHD in children with tics. Neurology 2002;58:527-36.
63. Trillet M, Moreau T, Dalery J, de Villard R, Aimard G. Treatment of Gilles de la Tourette's disease with amisulpride. Presse Med 1990;19(4):175.
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