Pediatrics

AAN Issues New Guidelines on Treating Tics in Tourette Syndrome

The American Academy of Neurology (AAN) has published 49 new recommendations in a new guideline for treating tics in patients with Tourette syndrome and other chronic tic disorders.

To produce the guideline, the Guideline Development, Dissemination, and Implementation Subcommittee of the AAN assessed all high-quality randomized controlled trials that evaluated the efficacy of treatments for tics and the risks associated with their use. With this analysis, the Subcommittee made recommendations for when clinicians and patients should pursue treatment for tics and how clinicians and patients should choose between evidence-based treatment options.

Among the recommendations for the treatment of tics in individuals with Tourette syndrome or other chronic tic disorders are:

  • Pimozide is probably more effective than placebo in reducing tic severity,
  • Haloperidol is more effective than placebo in reducing tic severity, and
  • There is insufficient evidence to determine the efficacy of haloperidol compared with pimozide in reducing tic severity.

“There was high confidence that several interventions are more effective than placebo in reducing tic severity, including the Comprehensive Behavioural Intervention for Tics, haloperidol, risperidone, aripiprazole, tiapraide, clonidine, and guanfacine,” the committee wrote.

“There was moderate confidence that pimozide, ziprasidone, metoclopramide, topiramate, botulinum toxin injections, tetrahydrocannibinol and deep brain stimulation of the globus pallidus were more effective than placebo in reducing tic severity. Evidence of harm associated with various treatments were also demonstrated,” the committee wrote.

There were 49 recommendations in all, ranging from counseling recommendations, psychoeducation for teachers and peers, and assessment for comorbidities.

“The treatment of tics in individuals with [Tourette syndrome] and other chronic tic disorders must be individualized and based on collaborative decisions between patients, caregivers, and clinicians. Many children and adults with tic disorders have psychiatric comorbidities, and clinicians must endeavor to establish treatment priorities with their patients,” the committee concluded.

—Amanda Balbi

Reference:

Pringsheim T, Holler Y, Okun M, et al. Practice guideline: the treatment of tics in people with Tourette syndrome and chronic 3 tic disorders [published online May 7, 2019]. Neurology.  https://doi.org/10.1212/WNL.0000000000007466.