Skip to main content

Advertisement

Log in

Tourette’s syndrome: Are stimulants safe?

  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Clinicians commonly encounter children with comorbid attention deficit hyperactivity disorder (ADHD) and the tic disorder Tourette’s syndrome. The pharmacologic treatment of children with this particular combination of conditions has been problematic because of long-standing warnings against using psychostimulants due to concerns about worsening tics. The basis for these warnings was anecdotal clinical observations. A recent group of placebo-controlled, double-blinded clinical trials have consistently shown that certain stimulants, particularly methylphenidate and dextroamphetamine, are effective, well tolerated, and safe when administered to treat ADHD in children with tics. Methylphenidate appears to be the best-tolerated stimulant compound, with tics often lessening during treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Physicians Desk Reference, edn 54. Montvale, NJ: Medical Economics Data; 2000.

  2. Kurlan R: Tourette’s syndrome: current concepts. Neurology 1989, 39:1625–1630.

    PubMed  CAS  Google Scholar 

  3. Singer HS, Walkup JT: Tourette syndrome and other tic disorders: diagnosis, pathophysiology and treatment. Medicine (Baltimore) 1991, 70:15–32.

    CAS  Google Scholar 

  4. Erenberg G, Cruse PR, Rothner AD: Tourette syndrome: an analysis of 200 pediatric and adolescent cases. Clev Clin Q 1986, 53:127–131.

    CAS  Google Scholar 

  5. Hagin RA, Kugler J: School problems associated with Tourette’s syndrome. In Tourette’s Syndrome and Tic Disorders. Edited by Cohen DJ, Bruun RD, Leckman JF. New York: John Wiley and Sons; 1988:223–236.

    Google Scholar 

  6. Kurlan R, Fett K, Parry K, et al.: School problems in Tourette’s syndrome [abstract]. Ann Neurol 1991, 30:275–276.

    Article  Google Scholar 

  7. Walkup IT, Kahn S, Schuerholz L: Phenomenology and natural history of tic-related ADHD and learning disabilities. In Tourette’s Syndrome: Tics, Obsessions, Compulsions. Edited by Leckman JF, Cohen DJ. New York: Wiley; 1999:63–79.

    Google Scholar 

  8. Comings DE, Comings BG: Tourette syndrome: clinical and psychological aspects of 250 cases. Am J Hum Genet 1985, 37:435–450.

    PubMed  CAS  Google Scholar 

  9. Comings DE, Comings BG: A controlled study of Tourette syndrome, I: attention-deficit disorder, learning disorders, and school problems. Am J Hum Genet 1987, 41:701–751.

    PubMed  CAS  Google Scholar 

  10. Sverd J, Curley AD, Jandorf L, Volker L: Behavior disorder and attention deficits in boys with Tourette syndrome. J Am Acad Child Adolesc Psychiatry 1988, 27:413–417.

    Article  PubMed  CAS  Google Scholar 

  11. Parks S, Como PG, Cui L, Kurlan R: The early course of the Tourette’s syndrome clinical spectrum. Neurology 1993, 43:1712–1715.

    Google Scholar 

  12. Singer H: Gilles de la Tourette’s disease. Am J Psychiatry 1963, 120:80–81.

    PubMed  CAS  Google Scholar 

  13. Robertson MM, Eapen V: Pharmacologic controversy of CNS stimulants in Gilles de la Tourette’s syndrome. Clin Neuropharmacol 1992, 15:408–425.

    Article  PubMed  CAS  Google Scholar 

  14. Erenberg G, Cruse RP, Rothner AD: Gilles de la Tourette’s syndrome: effect of stimulant drugs. Neurology 1985, 35:1346–1348.

    PubMed  CAS  Google Scholar 

  15. Price PA, Leckman JF, Pauls DL, et al.: Gilles de la Tourette’s syndrome. Neurology 1986, 36:232–237.

    PubMed  CAS  Google Scholar 

  16. Golden GS: The effect of central nervous system stimulants on Tourette syndrome. Ann Neurol 1977, 2:69–70.

    Article  PubMed  CAS  Google Scholar 

  17. Lowe TL, Cohen DJ, Detlor J, et al.: Stimulant medications precipitate Tourette’s syndrome. JAMA 1982, 247:1729–1731.

    Article  PubMed  CAS  Google Scholar 

  18. Singer HS, Butler IJ, Tune LE, et al.: Dopaminergic dysfunction in Tourette syndrome. Ann Neurol 1982, 12:361–366.

    Article  PubMed  CAS  Google Scholar 

  19. Shapiro AK, Shapiro E: Do stimulants provoke, cause, or exacerbate tics and Tourette syndrome? Compr Psychiatry 1981, 22:265–273.

    Article  PubMed  CAS  Google Scholar 

  20. Konkol RJ, Fischer M, Newby RF: Double-blind, placebo-controlled stimulant trial in children with Tourette;s syndrome and attention deficit-hyperactivity disorder [abstract]. Ann Neurol 1990, 28:424.

    Google Scholar 

  21. Sverd J, Gadow KG, Paolicelli LM: Methylphenidate treatment of attention-deficit hyperactivity disorder in boys with Tourette’s syndrome. J Am Acad Child Adolesc Psychiatry 1989, 28:574–579.

    Article  PubMed  CAS  Google Scholar 

  22. Gadow KG, Nolan EE, Sverd J: Methylphenidate in hyperactive boys with comorbid tic disorder 1. Short-term behavioral effects in school settings. J Am Acad Child Adolesc Psychiatry 1992, 31:462–471.

    Article  PubMed  CAS  Google Scholar 

  23. Caine ED, Ludlow CL, Polinsky RJ, Ebert MH: Provocative drug testing in Tourette’s syndrome: d- and l-amphetamine and haloperidol. J Am Acad Child Psychiatry 1984, 23:147–152.

    Article  PubMed  CAS  Google Scholar 

  24. Feinberg M, Carroll BJ: Effects of dopamine agonists and antagonists in Tourette’s disease. Arch Gen Psychiatry 1979, 44:1025–1026.

    Google Scholar 

  25. Meyeroff JL, Snyder SH: Gilles de la Tourette’s disease and minimal brain dysfunction: amphetamine isomers reveal catecholamine correlates in an affected patient. Psychopharmacologia 1973, 29:211–220.

    Article  Google Scholar 

  26. Goetz CG, Tanner CM, Wilson RS, et al.: Clonidine and Gilles de la Tourette’s syndrome: double-blind study using objective rating methods. Ann Neurol 1987, 21:307–310.

    Article  PubMed  CAS  Google Scholar 

  27. Singer HS, Brown J, Quaskey S, et al.: The treatment of attention-deficit hyperactivity disorder in Tourette syndrome: a double-blind placebo-controlled study with clonidine and desipramine. Pediatrics 1995, 95:74–81.

    PubMed  CAS  Google Scholar 

  28. Leckman JF, Hardin MT, Riddle MA, et al.: Clonidine treatment of Gilles de la Tourette syndrome. Arch Gen Psychiatry 1991, 48:324–328.

    PubMed  CAS  Google Scholar 

  29. Fenichel RR: Post-marketing surveillance identifies three cases of sudden death in children during treatment with clonidine and methylphenidate. J Child Adolesc Psychopharmacol 1995, 5:155–156.

    Google Scholar 

  30. Popper CW: Combining methylphenidate and clonidine: news reports about sudden death. J Child Adolesc Psychopharmacol 1995, 5:157–166.

    Article  Google Scholar 

  31. Gadow KD, Sverd J, Sprafkin J, et al.: Efficacy of methylphenidate for ADHD in children with tic disorder. Arch Gen Psychiatry 1995, 52:444–455.

    PubMed  CAS  Google Scholar 

  32. Gadow KD, Sverd J, Sprafkin J, et al.: Long-term methylphenidate therapy in children with comorbid attention-deficit hyperactivity disorder and chronic multiple tic disorder. Arch Gen Psychiatry 1999, 56:330–336.

    Article  PubMed  CAS  Google Scholar 

  33. Castellanos FX, Giedd JN, Elia J, et al.: Controlled stimulant treatment of ADHD and comorbid Tourette’s syndrome: effects of stimulant and dose. J Am Acad Child Adolesc Psychiatry 1997, 36:589–596.

    Article  PubMed  CAS  Google Scholar 

  34. The Tourette’s Syndrome Study Group: Treatment of ADHD in children with tics: a randomized controlled trial. Neurology 2002, 58:527–536.This double-blind, placebo-controlled study involving 136 children with attention deficit hyperactivity disorder (ADHD) and tics found that tics lessened during treatment with methylphenidate (MPH) or clonidine, both drugs were effective for ADHD, and that the most effective treatment was combined use of MPH and clonidine.

    Google Scholar 

  35. Kurlan R: Methylphenidate to treat ADHD is not contraindicated in children with tics. Mov Disord 2001, 17:5–6.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kurlan, R. Tourette’s syndrome: Are stimulants safe?. Curr Neurol Neurosci Rep 3, 285–288 (2003). https://doi.org/10.1007/s11910-003-0004-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11910-003-0004-2

Keywords

Navigation