The present review gives an overview of current pharmacological treatment options of
tic disorders and
Tourette Syndrome (TS). After a short summary on phenomenology,
clinical course and comorbid conditions we review indications for pharmacological treatment in detail. Unfortunately, standardized and large enough drug trials in TS patients fulfilling evidence based medicine standards are still scarce. Treatment decisions are often guided by individual needs and personal experience of treating clinicians. The present recommendations for pharmacological
tic treatment are therefore based on both scientific evidence and expert opinion. As first-line treatment of
tics risperidone (best evidence level for atypical
antipsychotics) or
tiapride (largest clinical experience in Europe and low rate of adverse reactions) are recommended.
Aripiprazole (still limited but promising data with low risk for adverse reactions) and
pimozide (best evidence of the typical
antipsychotics) are agents of second choice. In TS patients with comorbid
attention deficit hyperactivity disorder (
ADHD)
atomoxetine, stimulants or
clonidine should be considered, or, if
tics are severe, a combination of stimulants and
risperidone. When mild to moderate
tics are associated with obsessive-compulsive symptoms, depression or anxiety
sulpiride monotherapy can be helpful. In more severe cases the combination of
risperidone and a
selective serotonin reuptake inhibitor should be given. In summary, further studies, particularly randomized, double-blind, placebo-controlled trials including larger and/or more homogenous patient groups over longer periods are urgently needed to enhance the scientific basis for drug treatment in
tic disorders. This article is part of the Special Issue entitled '
Neurodevelopmental Disorders'.