Vocal tics

Tourette s syndrome, a heterogeneous behavioral disorder associated with motor and vocal tics of variable form and severity, can be effectively treated with haloperidol. Antipsychotics can also be employed to control disturbed behavior in senile dementia or Alzheimer s disease, since they decrease confusion, agitation, and hyperactivity. Most of these drugs also exhibit a strong antiemetic effect and can sometimes be used clinically for this purpose. 

Tourette s syndrome. A syndrome of facial and vocal tics with onset in childhood, progressing to generalized jerking movements in any part of the body, with echolalia and coprolalia. 

Unlabeled Uses Chronic motor or vocal tic disorder, Tourette s disorder... 

Sydenham s chorea and TS share common anatomic areas—the basal ganglia of the brain and the related cortical and thalamic sites. Furthermore, some SC patients display motor and vocal tics, OC, and ADHD symptoms, suggesting the possibility that at least in some instances these disorders share a common etiol-... 

Borcherding, B.G., Keysor, C.S., Rapoport, J.L., Elia, J., and Amass, J. (1990) Motor/vocal tics and compulsive behaviors on stimulant drugs is there a common vulnerability Psychiatry Res 33 83-94. 

If these measures fail, clonidine, fluphenazine, clonazepam, or carbamazepine should be tried. The pharmacologic properties of these drugs are discussed elsewhere in this book. Clonidine reduces motor or vocal tics in about 50% of children so treated. It may act by reducing activity in noradrenergic neurons in the locus coeruleus. It is introduced at a dose of 2-3 mcg/kg/d, increasing after 2 weeks to 4 mcg/kg/d and then, if required, to 5 mcg/kg/d. It may cause an initial transient fall in blood pressure. The most common adverse effect is sedation other adverse effects include reduced or excessive salivation and diarrhea. Phenothiazines such as fluphenazine sometimes help the tics, as do dopamine... 

TOURETTE S SYNDROME A chronic tic disorder involving multiple motor and/or vocal tics that cause distress or significant impairment in social, occupational, or other important areas of functioning. 

Tardive Tourette s syndrome is characterized by multiple motor and vocal tics. 

A possible interaction of risperidone with tetracycline has been reported in a 15-year-old adolescent with Asperger s syndrome, Tourette s syndrome, and obsessive-compulsive disorder (274). Acute exacerbation of motor and vocal tics occurred when tetracycline 250 mg bd was introduced for acne withdrawal of tetracycline resulted in an improvement in the tics. 

A 5-year-old Chinese boy developed motor and vocal tics. His parents had given him a Chinese herbal spray to treat mouth ulcers. The spray contained mercury 878 ppm. Mercury poisoning was confirmed by the blood mercury concentration (183 nmol/1, normal value for adults under 50 nmol/1). 

A retrospective survey yielded five cases of tics in three men and two women aged 2.5-12 years) within the first 10 months of therapy (4-17 mg/kg/day) (32). Four had simple motor tics and one had mostly vocal tics (gasping sounds) with normal laryngoscopic evaluation. In three cases the tics resolved completely within 1 month of drug withdrawal and recurred in two after reintroduc-tion. A fourth had gradual improvement over 4 months after withdrawal in the fifth, simple motor tics improved spontaneously with a reduction in dose. 

A 5-year-old Chinese boy developed oral ulceration, mainly affecting the left lateral aspect of his tongue, and 5 weeks later motor and vocal tics. Herpetic ulceration was diagnosed and confirmed by the isolation of... 

It is well recognized that in vulnerable individuals, methylphenidate can induce or aggravate Tourette s syndrome, most often characterized by motor tics and occasionally vocal tics (21). Moreover, obsessive-compulsive symptoms caused by methylphenidate have also been reported (22,23). However, it is not clear whether explosive episodes associated with Tourette s syndrome are an integral part of the disorder or occur as part of a co-morbid disorder, predominantly ADHD or obsessive-compulsive disorder. In this case the explosive episodes coincided with a period of treatment with methylphenidate. In view of the extreme, sudden, discrete nature of the outbursts and the temporal relation to treatment, it was concluded that the episodes were behavioral problems caused by methylphenidate, rather than a feature of the underlying ADHD. 

Tourette s disorder presents with both motor and vocal tics, which are present during childhood, plateau during adoles-cence, and may continue during adulthood with a fluctuat-... 

Once considered rare, Tourette s disorder is present in0.7%tol.l%of boys and 0.4% of girls." " " The essential features of this CNS disorder are multiple motor tics and one or more vocalizations. A tic is a sudden, rapid, recurrent, nomhythmic, stereotyped motor movement or vocalization. See Table 61-6 and the accompanying references for examples of motor and vocal tics." " The clinical presentation may vary from barely noticeable to debilitating, and the type of tic expressed may change over time. " " ... 

Presence of both motor and vocal tics is necessary for more than 1 year before the diagnosis of Tonrette s disorder is made. The median age of onset of motor tics is 6 years, with an average delay in diagnosis of 6.8 years. " " ... 

Onset before age 1 8 years Multiple motor or one or more vocal tics present Motor and vocal tics do not need to occur concurrently ... 

Haloperidol (brand name Haldol) A high-potency antipsychotic drug used for the treatment of schizophrenia that can also be used to treat the neurological condition of Tourette s syndrome, which involves both motor and vocal tics. 

Clonidine has beeu reported to ameliorate motor or vocal tics in roughly 50% of children so treated. It may act by reducing activity in noradrenergic neurons arising in the locus ceruleus. 

Observational stndies In an open extension study of tetrabenazine in 75 patients with Huntington s chorea for up to 80 weeks, three participants withdrew because of adverse events, including depression, delusions with associated previous suicidal behavior, and vocal tics [74 ]. When mild and unrelated adverse events were excluded, the most common adverse events were sedation/somno-lence ( = 18), depressed mood (17), anxiety (13), insomnia (10), and akathisia (9). Parkinsonism and dysphagia scores were significantly increased at week 80 compared with baseline. 

Tourette syndrome (TS) is a disorder characterized by waxing and waning motor and vocal tics. It has been known for some time that the frequency and intensity of tics in those with TS are promoted by stress and anxiety. Recently, however, it was shown that caffeine- and thein-containing drinks, preservatives used in food, refined sugar, and synthetic sweeteners increase tics in TS patients [116], The chemical compositions of these tic promoters suggest that other organic compounds may also act this way. Research is ongoing in this area. 

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