Tourette's Syndrome Revisted - learn about Tourette's and how it affects those who suffer from this disorder. Steven Pavlakis MD Pediatric Neurology Medical School: Brown University Resident/Fellowship: Columbia Presbyterian Medical Center DrMDK.com
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Male: I heard at National Public Radio, a broadcast about Tourette syndrome. It is pretty interesting. A guy claimed that Tourette gets better with time and a lot of the drugs you think are working just got better on its own. I don’t know if that is any merit. They talked about adult onset Tourette’s. He did not believe it. He thought they would probably have symptoms in their adolescent years not diagnosed and then someone was able to put the picture together later on. Are those two points valid? Dr.: Yes. This is the answer to that. The first answer is, do medications really make a huge difference? The answer is, we think so. The trials are not great even in Tourette’s. You know, in very severe Tourette’s, there was a study of double blind sided, done that was so small back in the 80’s that showed that one of the main drugs that we used was Catapres(Clonidine) it does not work. Male: That was an evidence based study. Dr.: An evidence based study. It was very small, it was borderline powered and that the only problem with that study was they were very severe Tourette’s patients. And I think we all agree that that doesn’t work. In milder cases, Catapres and Clonidine have an effect and there has been data to suggest they do work. Subsequently a pretty good data actually, pretty compelling data, and evidence based good studies. In very severe cases, they probably don’t work terribly well. There is no evidence these medications for example make any long-term difference. The major tranquilizers, specifically, Resperidals are approved for Tourette’s and that does work and there is evidence based stated that it works. Male: Works and making a little bit more comfortable to kids? Dr.: That is correct, only when they are on. Male: Not cured? Dr.: It does not cure at all and it is only used as a symptomatic treatment if the tics are affecting a child in school or socially or they are hurting, if the tic actually hurt the child. So there is really no evidence that it makes a long-term difference. Furthermore, tics are very complicated and that they come and go. So if I start you on a medicine, you are better, is that the medicine or is it just stopping. Male: Very difficult. Dr.: It is very common for example, late August I get calls from kid’s parents that have tics and they will call “The tics are worse” and the first thing I say, we are trying not to treat children with tics for that reason. Let us wait until the middle of September and see what happens and typically they get better by the time they get in to class and things settle down. So that is always a peak month for tics and I try not to treat them. So if I treated all those kids on August 20th, you know, 80% of them are better by September 20th and I would have said “Gee! The medicine is wonderful.” And it really has nothing to do with it. Male: It is not an honest answer. Dr.: The second part of the question is actually interesting. We were always taught that tics do not start after AGT and I am not sure about if it is true. But the problem is that a lot of people have tics and we don’t know it and even we, most of us have tics of some sort and the question is what do, what was a tic and what wasn’t. I think tics can start in adults but the dogma is that they do not, they all start before age 18. Male: If you look carefully in the history, you probably would find an adult onset patient, you probably will find some indicator in adolescent, there was something there, maybe not fully appreciated. So maybe it started there and went down, kept quiet and came back later? Dr.: That is the dogma. But we don’t really know that. For example, I will see children with tics and usually one of the parents will have tics and they never knew they had tics. Male: And one other thing that you brought up, a lot have excessive compulsive disorders and Tourette’s at the same time? Dr.: People have tics or Tourette’s, which is a compulsive motor movement and if you

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