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Tick: treatment
Last reviewed: 20.11.2021
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Although the neochemical substratum underlying the tics remains unknown, it was noted a while ago that small doses of dopamine D2 receptor antagonists or drugs blocking the accumulation of dopamine in vesicles (eg, reserpine and tetrabenazine) are able to effectively inhibit tics. To reduce tics, agonists of alpha2-adrenoreceptors clonidine and guanfacine, as well as benzodiazepine clonazepam, can also be used. In any case, the treatment is symptomatic and does not have a significant effect on the course of the disease. Many patients do not need to take any medications. Teak treatment should be carried out in the event that tics substantially interfere with learning, establishing social relationships, and finding work. Medicines rarely completely eliminate tics, and their side effects can be very significant. Explaining the essence of the disease to family members, teachers, employers can sometimes solve many problems. Only if non-pharmacological measures are insufficient, medications are prescribed.
Since there is a risk of developing long-term side effects when using dopamine receptor antagonists, it is rational to start treatment with other drugs, although their effectiveness is not so high. For this reason, the drug of first choice is often clonidine. Although there are conflicting reports about the effectiveness of this drug, it does not cause long-term side effects. Treatment should begin with a low dose (0.05 mg 2 times a day), then gradually increase it for several weeks until a therapeutic effect is obtained or side effects are manifested. It is important to warn the patient of a sudden discontinuation of the drug, which can lead to headaches and high blood pressure.
If clonidine is ineffective, trial treatment with tetrabenazine is possible, since this drug is effective in many patients, but unlike neuroleptics, it probably does not cause tardive dyskinesia. The initial dose is 25 mg once a day, then it is increased to 25 mg 3 times a day. Reserpine is rarely used because of the risk of hypotension and depression. Almost all dopamine receptor antagonists are effective in ticks, but pimozide, haloperidol and fluphenazine are most popular. Pimozide has a lesser adverse effect on cognitive function than haloperidol and antipsychotics with a pronounced cholinolytic effect. Clozapine, apparently, is not effective in ticks. In recent years, risperidone has been used to treat tics, which is quite effective in some patients, but the experience of its use is still not large enough. The general strategy is that the treatment starts with a minimum dose, which the patient takes 2-3 weeks, then the dose is gradually increased until a therapeutic effect or side effect is obtained. When treating neuroleptics, one should always keep in mind the possibility of developing tardive dyskinesia. In this connection, the patient should be informed of this possibility and a regular observation should be made after him.
Treatment of obsessive-compulsive disorder, often accompanying Tourette's syndrome, involves the use of fluoxetine, clomipramine or other serotonin reuptake inhibitors. This class of drugs is effective in behavioral disorders associated with Tourette's syndrome.