TY - JOUR
T1 - Current Management of Tics and Tourette Syndrome
T2 - Behavioral, Pharmacologic, and Surgical Treatments
AU - Billnitzer, Andrew
AU - Jankovic, Joseph
N1 - Funding Information:
Joseph Jankovic, MD, has received the following research/training funding: AbbVie Inc.; Acadia Pharmaceuticals; Allergan, Inc.; Biotek; Cerevel Therapeutics; CHDI Foundation; Dystonia Coalition; Emalex Biosciences, Inc.; F. Hoffmann-La Roche Ltd.; Huntington Study Group; Medtronic Neuromodulation; Merz Pharmaceuticals; Michael J Fox Foundation for Parkinson Research; National Institutes of Health; Neuraly, Inc.; Neurocrine Biosciences; Parkinson’s Foundation; Parkinson Study Group; Prilenia Therapeutics; Revance Therapeutics, Inc.; and Teva Pharmaceutical Industries Ltd. He has served as a consultant for Aeon BioPharma; Nuvelution Pharma, Inc.; and Teva Pharmaceutical Industries Ltd. and is on the following editorial boards: Expert Review of Neurotherapeutics; Journal of Parkinson’s Disease; Medlink; Neurology in Clinical Practice; The Botulinum Journal; PeerJ; Therapeutic Advances in Neurological Disorders; Toxins; Tremor and Other Hyperkinetic Movements; Toxins; and UpToDate.
Publisher Copyright:
© 2020, The American Society for Experimental NeuroTherapeutics, Inc.
PY - 2020/10
Y1 - 2020/10
N2 - Tourette syndrome is a heterogeneous neurobehavioral disorder manifested by childhood-onset motor and phonic tics, often accompanied by a variety of behavioral comorbidities, including attention deficit and obsessive compulsive disorder. Treatment must be tailored to the needs and goals of the individual patients and their families. All patients should receive education on the condition and, if possible, engage behavioral therapy targeted towards tics and/or comorbidities. Pharmacological therapies, such as alpha agonists, topiramate, and vesicular monoamine transport type 2 inhibitors, are generally used as first-line therapies in patients with troublesome tics that are not controlled by behavioral therapy or when the latter is not available or accessible. Botulinum toxin injections can be used in patients with bothersome focal tics. Second-line therapy includes antipsychotics, such as fluphenazine, aripiprazole, risperidone, and ziprasidone. These medications are generally efficacious but carry the risk of metabolic syndrome, tardive dyskinesia, and other side effects. Much more research is needed before novel therapies such as cannabis-derived products or transcranial magnetic stimulation can be recommended. There is promise in ongoing clinical trials with D1 receptor antagonist ecopipam and other experimental therapeutics. Patients with tics that are refractory to conventional treatments may be candidates for deep brain stimulation, but further studies are needed to determine the optimal target selection.
AB - Tourette syndrome is a heterogeneous neurobehavioral disorder manifested by childhood-onset motor and phonic tics, often accompanied by a variety of behavioral comorbidities, including attention deficit and obsessive compulsive disorder. Treatment must be tailored to the needs and goals of the individual patients and their families. All patients should receive education on the condition and, if possible, engage behavioral therapy targeted towards tics and/or comorbidities. Pharmacological therapies, such as alpha agonists, topiramate, and vesicular monoamine transport type 2 inhibitors, are generally used as first-line therapies in patients with troublesome tics that are not controlled by behavioral therapy or when the latter is not available or accessible. Botulinum toxin injections can be used in patients with bothersome focal tics. Second-line therapy includes antipsychotics, such as fluphenazine, aripiprazole, risperidone, and ziprasidone. These medications are generally efficacious but carry the risk of metabolic syndrome, tardive dyskinesia, and other side effects. Much more research is needed before novel therapies such as cannabis-derived products or transcranial magnetic stimulation can be recommended. There is promise in ongoing clinical trials with D1 receptor antagonist ecopipam and other experimental therapeutics. Patients with tics that are refractory to conventional treatments may be candidates for deep brain stimulation, but further studies are needed to determine the optimal target selection.
KW - Comprehensive behavioral therapy in tics (CBIT)
KW - Deep brain stimulation (DBS)
KW - Tics
KW - Tourette syndrome (TS)
KW - Vesicular monoamine transport inhibitor (VMAT2)
UR - http://www.scopus.com/inward/record.url?scp=85089957856&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85089957856&partnerID=8YFLogxK
U2 - 10.1007/s13311-020-00914-6
DO - 10.1007/s13311-020-00914-6
M3 - Review article
C2 - 32856174
AN - SCOPUS:85089957856
SN - 1933-7213
VL - 17
SP - 1681
EP - 1693
JO - Neurotherapeutics
JF - Neurotherapeutics
IS - 4
ER -