Causal (cause-related) therapy is not possible.
Therapy goals
- Symptomatic therapy: tic reduction.
- Therapy of comorbidities (concomitant diseases) – see under the respective disease.
Therapy recommendations
- To date, few controlled trials of drug treatment for tics are available.
- The following neuroleptics (dopamine receptor antagonists) are used in the treatment of tics:
- Classical antipsychotics (KAP).
- Haloperidol, pimozide
- Both agents have more side effects than newer atypical antipsychotics (AAPs). Therefore, haloperidol and pimozide are now considered only as backup agents for severe tics.
- Caveat: Haloperidol is the only approved agent for the therapy of tics, so for the other agents an off-label use prescription (off-label use of a drug) is made!
- Atypical antipsychotics (AAP).
- Risperidone (first-line agent in children and adults (in Europe))
- Caveat: Because risperidone often leads to side effects such as fatigue and weight gain, the following benzamides are used as alternatives in Germany:
- Tiapride – especially in children.
- Sulpiride – in children and adults
- Caveat: Because risperidone often leads to side effects such as fatigue and weight gain, the following benzamides are used as alternatives in Germany:
- If treatment with risperidone, sulpiride or tiapride is not sufficiently effective or has too many side effects, the use of aripiprazole (in children and adults) is recommended.
- Other atypical antipsychotics such as amisulpride, olanzapine, quetiapine, ziprasidone play only a minor role in the treatment of tics.
- Risperidone (first-line agent in children and adults (in Europe))
- Classical antipsychotics (KAP).
- Other reserve agents include:
- Tetrabenazine – dopamine memory depleter.
- Topiramate – antiepileptic drug
- Pergolide – dopamine receptor agonist.
- Dopamine receptor antagonist dosing should be started gradually and slowly increased until desired effect is achieved. Fluctuations in tics must be considered during the course → dose adjustment!
- In individual cases, botulinum toxin (locally injected) or cannabis drugs such as tetrahydrocannabinol (RHC, dronabinol) can be used.
- If attention-deficit/hyperactivity disorder (ADHD) coexists, adrenergic agonists may be considered, which also have a weak tic-reducing effect:
- Clonidine, guanfacine
Other notes
- Complete symptom freedom cannot be achieved, only tic reduction (up to 50%).
