Pharmacotherapy for tics in adult patients with Tourette syndrome and other tic disorders

Abstract

Background: Tourette syndrome (TS) and persistent motor/vocal tic disorders are neurodevelopmental conditions characterised by the chronic presence of motor and/or vocal tics. Patients with TS often present with co-morbid disorders, especially attention-deficit and hyperactivity disorder (which tends to improve after childhood), and obsessive-compulsive disorder (which can persist in adulthood). We set out to explore pharmacotherapy for tics in adult patients with TS and persistent motor/vocal tic disorders, as well as its relationship with the presence of co-morbid conditions.

Methods: We retrospectively reviewed the clinical characteristics and pharmacotherapy of 192 adult patients with TS (n = 187), persistent motor tic disorder (n = 3) and persistent vocal tic disorder (n = 2) attending a specialist clinic in the UK.

Results: Anti-dopaminergic medications (n = 65) and alpha-2-agonists (n = 50) were the most commonly prescribed pharmacotherapy for tic management. A sub-group analysis revealed that co-morbid obsessive-compulsive disorder and sub-threshold obsessive-compulsive behaviours were significantly more common in patients treated with anti-dopaminergic medications than patients taking alpha-2-agonists (p = 0.013 and p = 0.047, respectively).

Conclusions: The use of pharmacotherapy options for tic management observed at a specialist clinic for adults with TS reflects guideline recommendations. We found that the presence of co-morbid obsessive-compulsive disorder/behaviours correlates with the choice of anti-dopaminergic medications over alpha-2-agonists, in line with available evidence on the efficacy of anti-dopaminergic medications for the treatment of specific tic-related behavioural symptoms.

Keywords: Alpha-2 agonist medications; Anti-dopaminergic medications; Guidelines; Pharmacotherapy; Tics; Tourette syndrome.