A pediatric neurobehavioral treatment challenge

Tourette ‘s syndrome (TS) currently has very limited FDA approved treatment options, despite the fact that TS and other pediatric tic disorders are not uncommon and can cause significant emotional and physical distress for patients and their families. For providers who regularly see these conditions in practice this inadequacy is highly frustrating on the treatment side as there are such limited options to offer to these families, and the outcome to hope for is not highly optimistic. The outcome of this case presentation is an example of how health care providers can use clinical knowledge in combination with evidence-based practice to advocate for their patients and find new solutions that could be, and in this case were, life changing. It promotes providers to advocate for their patients and expand their knowledge. The final medication treatment utilized in this case is currently off label, however the method of finding and obtaining the treatment explained in the case additionally reveal to readers how to cautiously but judiciously make off label treatment decisions that can be important to practice and patient outcomes. In the course of this case the off-label medication use decision was backed by scientific literature and ongoing FDA studies as well as consulting with a collaborating psychiatrist. The subject matter and method of reasoning within this case also promote psychiatric providers use of evidence-based practice and implementation of science into active practice.
Highlights • Tourette’s Syndrome can cause significant emotional and physical distress, but has limited FDA approved treatment options. • VMAT2 inhibitors are FDA approved for other hyperkinetic disorders and tetrabenazine was effective in 2 open label TS trials. • In this case valbenazine compellingly improved Tourette’s symptoms (91% reduction in AIMS), as well as quality of life. • AIMS score improvement went from 23 pre-treatment to 2 pos-treatment with valbenazine (91.3% reduction)