Atypical Antipsychotics for Tourette Syndrome

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.