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Aim To systematically examine prescribing practices in Tourette syndrome (TS) among European based professionals. Method All members of the European Society for the Study of Tourette Syndrome (ESSTS) formed the sampling frame for the current study. A total of 44 clinicians from 18 different European locations who were currently prescribing for TS completed an online survey. Results Risperidone (n=13 clinicians), methylphenidate (n=21) and sertraline (n=17) were the most commonly prescribed medications for the treatment of tics, ADHD and OCD, respectively. The vast majority of clinicians opted for SSRIs for the treatment of anxiety and depression. However, there was a large overall variability regarding both the medication choices and dosages used for each of these symptom domains. Subsequent analysis revealed differences in first-line medication choices between clinicians who prescribe for adults and clinicians who prescribe for children. For example, twice as many clinicians prescribed risperidone for children with tics (n=6) than for adults with tics (n=3). Conclusion The current results provide an indication of the pharmacological management of TS in Europe. There is a need for general consensus on treatment algorithms for the management of tics and behavioural symptoms, which target specific patient groups.

Aims The aim of this Cochrane review is to evaluate the efficacy and safety of atypical antipsychotics compared with placebo in treating tics in patients with Tourette syndrome (TS). Methods We cross referenced atypical antipsychotics-risperidone, olanzapine, clozapine, amisulpiride, quetiapine, loxapine, ziprasidone, clotiapine, aripiprazole, remoxipride, sertindole, zotepine, sulpiride and their proprietary names with “Tourette Syndrome” and its derivations and searched the Cochrane Movement Disorder Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, issue 3), MEDLINE (1950–2010), EMBASE (1980–2010), PsycINFO(1987–2010), and CINAHL (2010). Grey literature, reference lists, hand searching, clinical trials websites and pharmaceutical company sites were also searched. All relevant randomised, controlled, double blind studies were considered for inclusion in this review. Results The search identified three randomised controlled trials, two comparing risperidone and one comparing ziprasidone with placebo. Risperidone was superior to placebo in one trial although the 95% CIs were very large. Two trials showed no statistical difference between risperidone and ziprasidone against placebo. Methodological quality was rated as “unclear”. Clinical heterogeneity made meta-analysis inappropriate. Conclusions It is difficult to draw clear conclusions from the identified trials in the review as evidence is limited. Placebo controlled trials with longer duration and larger groups are needed to investigate the safety and efficacy of atypical antipsychotics as a pharmaceutical class in TS populations.

Aims Little is known about the tolerability profile of Aripiprazole in the TS population. We set out to evaluate the prevalence of psychiatric and non-psychiatric adverse events (PAE and nPAE) of Aripiprazole through a retrospective chart review of adult patients seen at a specialist TS clinic. Methods We reviewed the clinical files of 29 patients (22 males; mean age 29.7±13.0) who had been started on Aripiprazole (median starting dose: 5.0 mg; median maintenance dose: 10.0 mg). Results Twenty-one patients (72.4%) developed adverse effects: 6 (20.7%) PAE (most common: anxiety); 17 (58.6%) nPAE (most common: sedation). Thirteen patients (44.8%) discontinued the Aripiprazole, 6 (20.7%) solely because of the severity of specific adverse effects (sedation, sleep problems, weight gain, nausea, lost appetite, tic worsening, hot flushes). When comparing patients with and without adverse effects, we found no differences in socio-demographic or clinical variables. However, there was a trend towards a statistically significant difference in Aripiprazole starting dose (p=0.07). Conclusions The most commonly reported adverse effects of Aripiprazole treatment in TS were sedation and sleep problems. In the majority of cases, adverse effects were not severe. In our clinical sample there were no predictors for poor tolerability. Slow titration is recommended in order to minimise the occurrence of adverse effects.

Background: Tourette syndrome (TS) is a chronic neurodevelopmental disorder characterised by the presence of multiple motor and phonic tics. Recent brain imaging investigations with diffusion tensor imaging (DTI) techniques found reduced measures of connectivity in the corpus callosum of children with TS compared with healthy controls, thus raising the hypothesis that the reduced interhemispherical connectivity in TS reflects neural plasticity processes. Methods: We assessed corpus callosum white-matter connectivity with fractional anisotropy (FA) index from magnetic resonance-DTI in two monozygotic twins (male sex; age 20) discordant for the diagnosis of TS. Results: Both conventional morphological magnetic resonance images and fibre-tracking reconstruction failed to show any difference between the two twins. On the other hand, mean corpus callosum FA values were significantly lower in the affected twin than in the unaffected twin (p<0.01). The differences in FA values were highest in the posterior portions of the corpus callosum, and lowest in the central area. Conclusions: Our findings of reduced interhemispherical white-matter connectivity in the affected twin support the hypothesis that plastic remodelling in the corpus callosum possibly represents an adaptation mechanism in TS.