What is the treatment for Tourette syndrome? Medications to suppress symptoms

There is as yet no cure for Tourette's syndrome.

The only medications used in therapy are those that suppress symptoms in patients with a more severe form of the disease, where individual symptoms are already a problem in the patient's normal life.

However, there is no single drug that can suppress all the symptoms, so it is necessary to take several drugs to cope with the symptoms.

Until recently recommended preparations in the treatment of Tourette syndrome

Haloperidol was the first to be used in the treatment of TS, as early as 1965.
Due to the high number of side effects, it is no longer commonly used today, it should be considered if nothing else works.

Tiapride belongs to a group of drugs also called atypical neuroleptics, it has antidyskinetic effects and relatively good tolerability.
It relieves the intensity and depth of abnormal movements, overall calms and dampens behavioral disturbances.
However, its negative effects on paediatric patients have not been rigorously studied, so it is rather used in elderly patients.

Not so long ago, tricyclic antidepressants (TCAs) were used to treat Tourette's syndrome.
These drugs have been used so far, but their target diseases are depression.
The reason for their selection was not only patients with worsening tics, but also the negative effects of TCAs on the cardiovascular system.

Fluoxetine is a selective serotonin inhibitor, i.e. a drug with the ability to uptake the "happiness hormone".
According to the studies done so far, the treatment could be effective in patients with TS and comorbid obsessive-compulsive disorder, but had little effect on tic disorder.

Noteworthy:
One study included only a 9-year-old child with TS, concomitant with comorbid obsessive-compulsive disorder and ADHD.
The study lasted almost a year and tested a combination of several drugs, namely clonidine, fluoxetine and methylphenidate.
The child died, and the autopsy showed a genetic polymorphism of cytochrome P450 CYP2D.
It was this polymorphism that probably caused the problem with fluoxetine metabolism, resulting in the child's overdose with subsequent death. 

Current pharmacological treatment of Tourette syndrome

Currently, the number one drug against TS is clonidine.
Clonidine affects noradrenergic activity, which means that it inhibits the production and release of noradrenaline.
It also increases the release of serotonin and dopamine, which means it is effective in treating not only tics, but also mood disorders, anxiety and depressive states.
It is a good choice for comorbid TS with concomitant hyperkinetic tics.
For patients, its use is not pleasant, because it has pronounced sedative effects, causes irritation, headache, dry mouth.
The problem can also occur with high doses of clonidine, when the effect of the drug is exactly the opposite.

Among the group of second-generation antipsychotics, there is good experience with risperidone and pimozide, which attenuate tic dyskinesias.
The positive effect of these neuroleptics has been confirmed by several studies conducted so far.
Risperidone is more suitable for TS with comorbidities because it also reduces aggressive behaviour, restlessness, nervousness or hyperactivity.
Pimozide is several times more effective in the therapy of extramuscular movements, but its use is rather recommended in isolated TS.
In more severe forms of the disease, both of these preparations are usually combined with clonidine.

Botulinum toxin is not just for beauty?
That's right!

Botulinum toxin A injection is used in patients whose tics appear at the same site.
Botulinum toxin only works for milder tics.

Noteworthy:
Vitamin B6 and some trace elements, such as magnesium or calcium, have a beneficial effect on the manifestations of TS.
However, no targeted clinical trials have yet been conducted to confirm this unequivocally.

Non-pharmacological treatment and support

As already mentioned, drug treatment is recommended only in severe cases. The vast majority of TS patients with mild symptomatology can get by with psychobehavioral therapy.

It is important to educate the patient and his/her family members about the disease, as well as about the factors that aggravate and improve the manifestations of the disease.
For children, parental support plays a big role.

Targeted training is given to manage, suppress, avoid or replace tics.
Patients also learn to cope with outbursts of anger and rage.
With the help of various relaxation techniques, they try to cope with the stress aggravating tics.
Recommended relaxation techniques include, for example, meditation, yoga, massage.

Psychoeducation and psychological support:

• help manage stress
• reduce anxiety and depression
• prevent social suffering
• improve social functioning and perception
• help reverse unwanted habits
• help suppress tics
• minimise exposure to deteriorating factors

New options in the treatment of Tourette's disease

Guanfacine is a drug that is so far only used in a few countries.
It has a positive effect in the treatment of tic and hyperkinetic disorders.
It has a similar effect to clonidine, but the side effects of this preparation are less pronounced.
However, some authors also mention its negative effect, namely the provocation of a manic state.

Ziprasidone suppresses psychotic behavior, hyperactivity, improves sleep, relieves anxiety states and depression, thereby improving social relationships.
At the same time, it alleviates both motor and auditory tics, i.e. it is able to dampen multiple manifestations of TS at the same time.
However, the lack of experience with it, and the lack of information about its side effects do not allow it to be used in the treatment of TS yet.
Nevertheless, it represents great hope for the future for all patients.

Is cannabis good for Tourette's?

Is that even possible?

More than one doctor and scientist has already described the beneficial effects of cannabis on human health.

Cannabis is still an illegal drug. 

In most countries, research is continuing.Perhaps in time it will become a commonly available medicine.

The beneficial effects of cannabis on tic disorders have also been described.

This is probably due to the localisation of cannabinoid receptors in the basal ganglia, which affect our motor function.