Pharmacotherapeutics of Tourette Syndrome and Stereotypies in Autism

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Tourette syndrome (TS) and stereotypy in autism spectrum disorders (ASDs) are 2 common movement disorders in childhood. The objective of this review was to summarize randomized controlled trials published over the past 5 years as an update of the current pharmacotherapeutic options for the treatment of tics, TS, and motor stereotypies in children with ASD. We searched MEDLINE (2005-May 2010) for randomized controlled trials of medications used for the treatment of these disorders. For the treatment of tics in TS, 2 trials suggest that levetiracetam is not effective, whereas 1 trial found that topiramate was effective. Single clinical trials of metoclopramide, atomoxetine, and ondansetron were of limited quality, preventing conclusions to be made regarding the usefulness of these treatments for tic disorders. For the treatment of stereotypy in children with ASD, risperidone has been shown in both a Cochrane review in 2006 and 2 subsequent randomized control trials to be effective. The addition of pentoxifylline to risperidone may have added benefit. Haloperidol did not improve stereotypy and was poorly tolerated. There is good evidence that aripiprazole is effective in the treatment of sterotypies in children with ASD. A large randomized trial of citalopram did not show any improvement in stereotypy. Single trials of levetiracetam, guanfacine, and atomoxetine suggest they are not useful in the reduction of stereotypy in children with ASD.

Section snippets

Search Methods and Criteria

We searched MEDLINE (2005-May 2010) for clinical trials of medications used for the treatment of tics, TS, and motor stereotypy in children with ASD. Randomized, double-blind, controlled trials of any pharmacologic treatment for these disorders were included. Only trials that included children were examined. Trials for symptoms of autism that did not assess the effect on motor stereotypies were excluded. Both parallel group and crossover study designs were included.

Data Collection and Analysis

Articles meeting the search criteria were discussed between the 2 authors before dismissal or consideration for this review based on fulfillment of inclusion criteria. Data were abstracted independently by 1 author onto standardized forms. Levels of quality were assigned to RCTs using criteria (Table 1) based on guidelines from the US Preventive Services Task Force.6

2005 to 2010 Pharmaceutical Treatment of Tics

Six RCTs for the treatment of tics were published during the search period of this review. One trial each evaluated levetiracetam, clonidine versus levetiracetam, metoclopramide, atomoxetine, topiramate, and ondansetron. The primary outcomes used in most trials were tic severity as measured using the Yale Global Tic Severity Scale (YGTSS)7 or the Clinical Global Impression Scales.8 The YGTSS has a total tic score (TTS) of 50 possible points, which is divided equally into motor and vocal tics.

Conclusions

The last five years have produced a promising amount of literature regarding the pharmacotherapy of tics, Tourette syndrome and stereotypy in children with ASD (summarized in Table 2). While some medications hold promise in managing these conditions, further trials confirming their results would provide greater confidence in their effect estimates. In light of recent data confirming the risk of metabolic syndrome in children on atypical antipsychotic medications,27 it becomes essential that our

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