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Roessner V, Eichele H, Stern JS, et al. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part III: pharmacological treatment. Eur Child Adolesc Psychiatry. 2021;doi: 10.1007/s00787-021-01899-z.
Roessner, V., Eichele, H., Stern, J. S., Skov, L., Rizzo, R., Debes, N. M., Nagy, P., Cavanna, A. E., Termine, C., Ganos, C., Münchau, A., Szejko, N., Cath, D., Müller-Vahl, K. R., Verdellen, C., Hartmann, A., Rothenberger, A., Hoekstra, P. J., & Plessen, K. J. (2021). European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part III: pharmacological treatment. European child & adolescent psychiatry, . https://doi.org/10.1007/s00787-021-01899-z
Roessner, Veit, et al. "European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part III: pharmacological treatment." European child & adolescent psychiatry vol. (2021). doi: https://doi.org/10.1007/s00787-021-01899-z
Roessner V, Eichele H, Stern JS, Skov L, Rizzo R, Debes NM, Nagy P, Cavanna AE, Termine C, Ganos C, Münchau A, Szejko N, Cath D, Müller-Vahl KR, Verdellen C, Hartmann A, Rothenberger A, Hoekstra PJ, Plessen KJ. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part III: pharmacological treatment. Eur Child Adolesc Psychiatry. 2021 Nov 10; doi: 10.1007/s00787-021-01899-z. Epub 2021 Nov 10. PMID: 34757514.
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Eur Child Adolesc Psychiatry. 2021 Nov 10; doi: 10.1007/s00787-021-01899-z. Epub 2021 Nov 10.

European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part III: pharmacological treatment.

European child & adolescent psychiatry

Veit Roessner, Heike Eichele, Jeremy S Stern, Liselotte Skov, Renata Rizzo, Nanette Mol Debes, Péter Nagy, Andrea E Cavanna, Cristiano Termine, Christos Ganos, Alexander Münchau, Natalia Szejko, Danielle Cath, Kirsten R Müller-Vahl, Cara Verdellen, Andreas Hartmann, Aribert Rothenberger, Pieter J Hoekstra, Kerstin J Plessen

Affiliations

  1. Department of Child and Adolescent Psychiatry, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. [email protected].
  2. Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.
  3. Regional Resource Center for Autism, ADHD, Tourette Syndrome and Narcolepsy Western Norway, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
  4. Department of Neurology, St George's Hospital, St George's University of London, London, UK.
  5. Paediatric Department, Herlev University Hospital, Herlev, Denmark.
  6. Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
  7. Vadaskert Child Psychiatric Hospital and Outpatient Clinic, Budapest, Hungary.
  8. Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.
  9. Child Neuropsychiatry Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
  10. Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.
  11. Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany.
  12. Department of Neurology, Medical University of Warsaw, Warsaw, Poland.
  13. Department of Bioethics, Medical University of Warsaw, Warsaw, Poland.
  14. Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
  15. Department of Psychiatry, University Medical Center Groningen, Rijks Universiteit Groningen, GGZ Drenthe Mental Health Institution, Assen, The Netherlands.
  16. Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
  17. PsyQ Nijmegen, Parnassia Group, Nijmegen, The Netherlands.
  18. TicXperts, Heteren, The Netherlands.
  19. Department of Neurology, Sorbonne Université, Pitié-Salpetriere Hospital, Paris, France.
  20. National Reference Center for Tourette Disorder, Pitié Salpetiere Hospital, Paris, France.
  21. Clinic for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Gottingen, Gottingen, Germany.
  22. Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
  23. Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
  24. Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark.

PMID: 34757514 DOI: 10.1007/s00787-021-01899-z

Abstract

In 2011, the European Society for the Study of Tourette Syndrome (ESSTS) published the first European guidelines for Tourette Syndrome (TS). We now present an update of the part on pharmacological treatment, based on a review of new literature with special attention to other evidence-based guidelines, meta-analyses, and randomized double-blinded studies. Moreover, our revision took into consideration results of a recent survey on treatment preferences conducted among ESSTS experts. The first preference should be given to psychoeducation and to behavioral approaches, as it strengthens the patients' self-regulatory control and thus his/her autonomy. Because behavioral approaches are not effective, available, or feasible in all patients, in a substantial number of patients pharmacological treatment is indicated, alone or in combination with behavioral therapy. The largest amount of evidence supports the use of dopamine blocking agents, preferably aripiprazole because of a more favorable profile of adverse events than first- and second-generation antipsychotics. Other agents that can be considered include tiapride, risperidone, and especially in case of co-existing attention deficit hyperactivity disorder (ADHD), clonidine and guanfacine. This view is supported by the results of our survey on medication preference among members of ESSTS, in which aripiprazole was indicated as the drug of first choice both in children and adults. In treatment resistant cases, treatment with agents with either a limited evidence base or risk of extrapyramidal adverse effects might be considered, including pimozide, haloperidol, topiramate, cannabis-based agents, and botulinum toxin injections. Overall, treatment of TS should be individualized, and decisions based on the patient's needs and preferences, presence of co-existing conditions, latest scientific findings as well as on the physician's preferences, experience, and local regulatory requirements.

© 2021. The Author(s).

Keywords: Medication; Pharmacotherapy; Tics; Tourette syndrome; Treatment

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