Tourette Syndrome and comorbid ADHD: Current pharmacological treatment options

• Published in: European journal of paediatric neurology Vol. 17; no. 5; pp. 421 - 428
• Main Authors: Rizzo, Renata, Gulisano, Mariangela, Calì, Paola V, Curatolo, Paolo
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.09.2013
• Subjects: ADHD; Adolescent; Antipsychotic Agents - therapeutic use; Attention Deficit Disorder with Hyperactivity - complications; Attention Deficit Disorder with Hyperactivity - drug therapy; Central Nervous System Stimulants - therapeutic use; Child, Preschool; Comorbidity; Humans; Neurology; Pediatrics; Pharmacological treatment; Psychostimulants; Selective norepinephrine reuptake inhibitor; Tic Disorders - complications; Tic Disorders - drug therapy; Tourette Syndrome; Tourette Syndrome - complications; Tourette Syndrome - drug therapy; Treatment Outcome; α-Agonist; ADHD; α-Agonist; Comorbidity; Tourette Syndrome; Pharmacological treatment; Selective norepinephrine reuptake inhibitor; Psychostimulants
• ISSN: 1090-3798; 1532-2130
• DOI: 10.1016/j.ejpn.2013.01.005

Abstract Background Attention Deficit Hyperactivity Disorder (ADHD) is the most common co-morbid condition encountered in people with tics and Tourette Syndrome (TS). The co-occurrence of TS and ADHD is associated with a higher psychopathological, social and academic impairment and the management may represent a challenge for the clinicians. Aim To review recent advances in management of patients with tic, Tourette Syndrome and comorbid Attention Deficit Hyperactivity Disorder. Methods We searched peer reviewed and original medical publications (PUBMED 1990–2012) and included randomized, double-blind, controlled trials related to pharmacological treatment for tic and TS used in children and adolescents with comorbid ADHD. “Tourette Syndrome” or “Tic” and “ADHD”, were cross referenced with the words “pharmacological treatment”, “α-agonist”, “psychostimulants”, “selective norepinephrine reuptake inhibitor”, “antipsychotics”. Results Three classes of drugs are currently used in the treatment of TS and comorbid ADHD: α-agonists (clonidine and guanfacine), stimulants (amphetamine enantiomers, methylphenidate enantiomers or slow release preparation), and selective norepinephrine reuptake inhibitor (atomoxetine). It has been recently suggested that in a few selected cases partial dopamine agonists (aripiprazole) could be useful. Conclusion Level A of evidence supported the use of noradrenergic agents (clonidine). Reuptake inhibitors (atomoxetine) and stimulants (methylphenidate) could be, also used for the treatment of TS and comorbid ADHD. Taking into account the risk–benefit profile, clonidine could be used as the first line treatment. However only few studies meet rigorous quality criteria in terms of study design and methodology; most trials have low statistical power due to small sample size or short duration. Treatment should be “symptom targeted” and personalized for each patient.