Phonic tic

P/moz/de Treatment of simple tics or tics other than those associated with Tourette disorder in combination with drugs (eg, pemoline, methylphenidate, amphetamines) that may cause motor or phonic tics until it is determined whether or not the drugs, rather than Tourette disorder, are responsible for the tics. 

Tourette disorder- For suppression of motor and phonic tics in patients with Tourette disorder who have failed to respond satisfactorily to standard treatment. Pimozide is not intended as a treatment of first choice, nor is it intended for the treatment of tics that are merely annoying or cosmetically troublesome. Pimozide should be reserved for use in Tourette disorder patients whose development or daily life function is severely compromised by the presence of motor and phonic tics. 

Tic disorders are chronic conditions that are frequently associated with difficulties in self-esteem, family life, social acceptance, or school or job performance that are directly related to the presence of motor and/or phonic tics. Although tic symptoms have been reported since antiquity, systematic study of individuals with tic disorders dates from the nineteenth century. 

Tourette s syndrome is a well-studied condition, characterized by motor and phonic tics and by behavioral and psychological problems. While many neurotransmitters were implicated in the etiology of this disorder, it is now believed that the dopaminergic system and noradrenergic systems are involved. Two major clinical trials (Shapiro et ah, 1989 Sallee et al, 1997) indicated that haloperidol and pimozide reduced the severity of tics by 65%. However, these medications are associated with side effects (including possible cognitive impairment, sedation, dysphoria, and tardive dyskinesia) that may limit their effectiveness in children with MR. 

A 37-year-old woman developed Tourette s syndrome at 9 years of age, with motor and phonic tics. At 25 she began to smoke heroin weekly. After 3 months, her motor tics became uncontrollable and she began to have coprolalia for the first time at a rate of about 10 words per minute. Heroin was withdrawn over 6 months but her motor tics and coprolalia did not improve, despite various drug treatments. Six months later she smoked heroin again and was readmitted with violent motor tics and constant coprolalia. She was sedated and her condition improved slightly, after which she was given sulpiride 600 mg/day and clonazepam 4 mg/day. She made a partial recovery with inadequate control of motor tics. 

Suppression of motor and phonic tics in patients with Tourette Disorder who have faiied to respond satisfactoriiy to standard treatment... 

Pimozide (diphenylbutylpiperidine, an antipsychotic, 1 to 2 mg daily in divided doses) is indicated in suppression of severe motor and phonic tics in patients with Gilles de la Tourette s syndrome. Pimozide s mechanism of action in Gilles de la Tourette s syndrome is unknown. It is thought to exert its effects by postsynaptic and/or presynaptic blockade of CNS dopamine receptors, thus inhibiting dopamine-mediated effects. Pimozide also has anticholinergic, antiemetic, and anxiolytic effects, and produces alpha blockade. 

Tics/Tourette s syndrome Yale Global Tic Severity Scale 42 items rated 0—5 for 4 types tics simple vs. complex X motor vs. phonic 15 to 20 minutes Cl with Ch/A Leckman et ah, 1989... 

Combined phonic and motor tics occurred in a 7-year-old boy with Down s syndrome when he took carbamazepine 19 mg/kg for suspected focal epilepsy (19). Carbamazepine concentrations were within the usual target range. The symptoms resolved completely after withdrawal. 

Holtmann M, Kom-Merker E, Boenigk HE. Carbamazepine-induced combined phonic and motor tic in a boy with Down s syndrome. Epileptic Disord 20002(1) 39-40. 

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