From the Guidelines
Treatment for patients with tic disorders should prioritize behavioral interventions, such as Comprehensive Behavioral Intervention for Tics (CBIT) and Habit Reversal Training, as first-line approaches, with medication management considered for cases with significant impairment or comorbidities, according to the most recent evidence 1.
Overview of Treatment Options
Treatment options for patients with tic disorders include both behavioral and pharmacological approaches.
- Behavioral interventions are typically first-line, with Comprehensive Behavioral Intervention for Tics (CBIT) and Habit Reversal Training showing effectiveness in reducing tic severity.
- These therapies teach patients to recognize premonitory urges and develop competing responses.
Pharmacological Management
For medication management,
- alpha-2 adrenergic agonists like clonidine (0.1-0.3 mg/day) and guanfacine (1-4 mg/day) are often used first for mild to moderate tics, particularly in children with comorbid ADHD, as supported by recent studies 1.
- For more severe tics, antipsychotics may be prescribed, including risperidone (0.5-3 mg/day), aripiprazole (2-15 mg/day), or pimozide (1-4 mg/day), which work by blocking dopamine receptors but carry risks of metabolic and movement side effects.
- Topiramate (25-200 mg/day) and botulinum toxin injections for focal tics are alternative options.
Individualized Treatment Approach
Treatment should be individualized based on
- tic severity,
- impairment,
- comorbidities, and
- patient preferences. Medication should start at low doses and titrate slowly to minimize side effects.
Supportive Care
Supportive care including
- education,
- stress management, and
- treating comorbid conditions like anxiety or ADHD is essential for comprehensive management of tic disorders, as highlighted in recent guidelines 1.
From the FDA Drug Label
Patients with HD who express suicidal ideation should be evaluated immediately. 5. 2 Clinical Worsening and Adverse Effects Huntington’s disease is a progressive disorder characterized by changes in mood, cognition, chorea, rigidity, and functional capacity over time. In a 12-week controlled trial, tetrabenazine was also shown to cause slight worsening in mood, cognition, rigidity, and functional capacity Whether these effects persist, resolve, or worsen with continued treatment is unknown. Prescribers should periodically re-evaluate the need for tetrabenazine in their patients by assessing the effect on chorea and possible adverse effects, including depression and suicidality, cognitive decline, parkinsonism, dysphagia, sedation/somnolence, akathisia, restlessness, and disability
The treatment options for patients with tic disorders are not directly addressed in the provided drug label for tetrabenazine. The label primarily discusses the treatment of chorea associated with Huntington's disease.
- Key points:
- Tetrabenazine is used to treat chorea associated with Huntington's disease.
- The label does not provide information on the treatment of tic disorders.
- Tetrabenazine can cause adverse effects such as depression, suicidality, cognitive decline, parkinsonism, and sedation/somnolence.
From the Research
Treatment Options for Tic Disorders
The treatment options for patients with tic disorders can be categorized into behavioral interventions and pharmacological treatments.
- Behavioral interventions include:
- Pharmacological treatments include:
Efficacy of Treatment Options
Research has shown that behavioral interventions, particularly CBIT and HRT, are effective in reducing tic severity in patients with tic disorders 3, 4, 5. Pharmacological treatments, such as antipsychotics and alpha agonists, have also been shown to be effective in reducing tic severity 6, 7.
- A study found that CBIT has demonstrated acute and durable efficacy when delivered alone or in combination with medication, in person, or via telehealth, and in the presence or absence of common comorbid conditions 4.
- Another study found that behavioral therapies, including CBIT, HRT, and ERP, have high-quality evidence for face-to-face one-on-one treatment, and data suggesting that one-on-one treatment by videoconference provides similar benefit 5.
- A review of the literature found that antipsychotics and alpha agonists are effective in reducing tic severity, but may have varying side effects and efficacy in different age groups of children 7.
Delivery of Treatment Options
Treatment options can be delivered in various formats, including: