Pharmacotherapeutics of Tourette Syndrome and Stereotypies in Autism
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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2019, Handbook of Clinical NeurologyCitation Excerpt :The most relevant side effect was aggression. Levetiracetam was also found ineffective for controlling stereotyped movements in patients with ASD (Rajapakse and Pringsheim, 2010). Importantly, one case report documents an autistic regression, characterized by stereotypic behaviors and severe social and communicative dysfunction after administration of levetiracetam in a 6-year-old girl with cerebral palsy, whose main symptoms were mild intellectual disability and focal epilepsy.
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2016, Revue NeurologiqueCitation Excerpt :While some medications hold promise in managing these movement disorders in pediatric populations, there is a paucity of data in adults. Usually, the treatment of stereotypical movement disorders includes drugs that work through opioid, serotonergic or dopaminergic systems (Table 3) [52]. Antipsychotics have long been used to manage stereotyped behaviors in mental retardation, and controlled trials have shown them to be effective in almost 50% of patients with autism [53].
Advances in management of movement disorders in children
2016, The Lancet NeurologyCitation Excerpt :Further studies on long-term safety and efficacy of these drugs on disease course in children with Tourette's syndrome are needed. D2-receptor blockers, such as risperidone and aripiprazole, can also be effective for the management of intrusive stereotypies in patients with autism,40 and neuroleptics and atypical antipsychotics might also be effective for chorea and dystonia; however, in view of the potential side-effects of these drugs their use in children should generally be limited to short, rapidly weaning courses.34,95,97 Drug-induced movement disorders related to dopamine receptor-blocking agents have been increasingly recognised in children as use of polypharmacological treatment with dopaminergic modulation for paediatric movement disorders has increased (for treatment, see anticholinergics).98,99
Advances in Tourette Syndrome. Diagnoses and Treatment.
2015, Pediatric Clinics of North AmericaCitation Excerpt :One trial suggested potential efficacy and tolerability of topiramate for tics.67 Single clinical trials of metoclopramide, atomoxetine, and ondansetron were of limited quality, and these would benefit from additional controlled trials.68 Botulinum toxins showed a roughly 40% reduction in tics in a placebo-controlled trial.69
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