Evidence-based review of pharmacotherapy for tics: New Canadian Guidelines

Abstract:

"This article seeks to provide the practising clinician with guidance on the pharmacological management of tic disorders in children and adults. We performed a systematic review of the literature on the treatment of tic disorders. A multi-institutional group of 14 experts in psychiatry, child psychiatry, neurology, pediatrics, and psychology engaged in a consensus meeting. The evidence was presented and discussed, and nominal group techniques were employed to arrive at consensus on recommendations. A strong recommendation is made when the benefits of treatment clearly outweigh the risks and burdens, and can apply to most patients in most circumstances without reservation. With a weak recommendation, the benefits, risks, and burdens are more closely balanced, and the best action may differ depending on the circumstances. Based on these principles, weak recommendations were made for the use of pimozide, haloperidol, fluphenazine, metoclopramide (children only), risperidone, aripiprazole, olanzapine, quetiapine, ziprasidone, topiramate, baclofen (children only), botulinum toxin injections, tetrabenazine, and cannabinoids (adults only). Strong recommendations were made for the use of clonidine and guanfacine (children only). While the evidence supports the efficacy of many of the antipsychotics for the treatment of tics, the high rates of side effects associated with these medications resulted in only weak recommendations for these drugs. In situations where tics are not severe or disabling, the use of a medication with only a weak recommendation is not warranted. However, when tics are more distressing and interfering, the need for tic suppression to improve quality of life is stronger, and patients and clinicians may be more willing to accept the risks of pharmacotherapy."

From: Pringsheim T, Doja A, Gorman D, McKinlay D, Day L, Billinghurst L, Carroll A, Dion Y, Luscombe S, Steeves T, Sandor P. Canadian guidelines for the evidence-based treatment of tic disorders: pharmacotherapy. Can J Psychiatry 2012 Mar; 57(3):133-43.

Tony Attwood talks about Asperger's

An interview with Prof. Tony Attwood, one of the world's leading experts on Asperger's Syndrome. (Asperger's is a 'disorder' that sometimes co-occurs in people with Tourette Syndrome and which has some shared symptom groups). An excellent overview and in depth insights into the nature Asperger's. New research on ASD in women and girls is discussed and how it is more prevalent than previously thought and how it often presents different challenges. 

>> Click here to listen (interview starts at 00:42)

Broadcast date: Thursday 2 February 2012 on ABC Radio Brisbane

Dr Duncan McKinley on the CoffeeKlatch discusses Tourette Syndrome

Listen to programme (1hr 4mins):

Listen to internet radio with The Coffee Klatch on Blog Talk Radio

Watch the documentary 'Life's a Twitch' featuring Duncan McKinley: Life's a Twitch

Intelligence can disguise disabilities and disabilities can disguise intelligence

The majority of people with Tourette Syndrome fall into the average to above average range of intelligence. A child with TS may appear bright and highly articulate. Most are early readers and develop impressive verbal skills and a substantial vocabulary. Herein lies a potential paradox. They may have non-verbal learning difficulties. Their reading (and writing) speed may be slow and assignments may take them considerably longer to do than other children/students and their performance in written assessments may poorly reflect their actual academic abilities. 


Concentration, attention span and listening ability can be impaired significantly and mean children with TS may have difficulties in following the content of lessons but may compensate in other ways as a consequence of high intelligence. Evidence suggests that children with Tourette's are often highly verbal. This is a possible unintentional compensating strategy for difficulties experienced in other communication modalities that are impaired by tics, hyperactivity, sensory processing difficulties, obsessive behaviours and thoughts and attention deficit. Conversely it often happens that individuals with overt tic behaviours (and complex ritualistic behaviours) are perceived, mistakenly, as being impaired intellectually and cognitively.


Many of the difficulties that educators have in evaluating individuals with TS and in determining appropriate educational provisions, accommodations and adjustments, arise from a misunderstanding of the disorder. It is essential that the often more profound, 'hidden' but central aspects of TS are understood. TS in most cases involves much more than the tics that are seen and heard (many tics are also not observable). In fact 'tics-only' TS is apparent in only 8 - 12% of recorded cases. In children, diagnosis tends to be more dependent on observable signs that are reported by parents or seen by a physician. Children are less able to articulate their symptoms (e.g. what they experience) as they do not know how to do so or have little basis for interpreting aspects of the disorder, with which they live daily, as anything unusual. TS is a complex disorder of 'central' neurological dysregulation/dysinhibition and overactivity, affecting cognitive, motor and somatosensory pathways and appears to involve a number of distinct areas of the brain including cortical, sub-cortical and cerebellar regions.


An excellent quotation that embraces the misconceptions that are commonly made about Tourette Syndrome is:

"Intelligence can disguise disabilities and disabilities can disguise intelligence" 


The original author of this quote is unknown but it was used recently at a conference, with good effect and insight, by specialist educator Kathy Giordano in relation to special educational provision for students with TS.