Quetiapine treatment of children with Tourette's syndrome: report of two cases.

Two children with Tourette's syndrome and comorbid disorders were treated with quetiapine, an atypical antipsychotic successfully used in patients with psychoses and schizophrenia with low incidence of extrapyramidal side effects. Clinical observations and standardized rating scales suggested that this drug produced beneficial effects on tics and other symptoms. Adverse effects (at low doses) were minimal. Because it was suggested that tic efficacy of the newer antipsychotics was related to higher D2 occupancy (with the exception of quetiapine and clozapine, which have relatively low D2 activity), it is hypothesized that tic patients are D2 sensitive and need lower doses of medications. These children were treated naturalistically and were reported retrospectively because of their encouraging outcomes. However, these findings should be interpreted with caution, because no contrast groups, drug withdrawal, or placebo were utilized. Controlled studies are needed to determine the efficacy of quetiapine in the treatment of Tourette's syndrome.

Clinical differences between subjects with familial and non-familial Tourette's syndrome: a case series.

OBJECTIVE: As many as 35 percent of Tourette's Syndrome patients do not acquire this disorder genetically. Since there has been little research conducted in this area, the purpose of this study was to compare the clinical differences between two groups of patients with Tourette's Syndrome (TS), one with family history of TS and one without. METHOD: Using data of eight previously diagnosed TS patients, the authors made comparisons of clinical and sociodemographic variables between a group of three patients with family history of TS and five with no family history. RESULTS: There were no differences in clinical presentation, current age, age at diagnosis, gender, and socioeconomic status. There were differences in birth history, developmental milestones, I.Q., and neurological findings between patients with family history and no family history of TS. CONCLUSIONS: Our findings support the need for testing the hypothesis of a multidetermined origin of TS, a disorder in which hereditary, neuropsychological, and environmental factors play a role.

Emergence of motor and vocal tics during imipramine administration in two children.

ABSTRACT Two children with major depression experienced the emergence of motor and vocal tics after 2-3 weeks on imipramine at doses of 75-100 mg daily. The tics did not show any sign of subsiding for 9-10 days following the discontinuation of imipramine, but subsequently responded to treatment with haloperidol. Case 1 involved an 8-year-old child with depression, attention-deficit hyperactivity disorder (ADHD), other behavioral problems, and a history of a single febrile seizure. His family history was positive for tics, depression, anxiety, and seizures. He was found to have a toxic plasma level of the tricyclic antidepressant. Case 2 involved a 13-year-old child with depression, ADHD, behavioral problems, obsessive compulsive symptoms, intellectual deficit, developmental delays, grand mal seizures, and concomitant use of phenytoin. The child had previously developed tics while receiving methylphenidate. The family history was positive for tics, depression, obsessive compulsive symptoms, suicide, and alcohol abuse. The child had a subtherapeutic plasma level of the antidepressant. It is suggested that tricyclic antidepressants may precipitate tics consistent with the symptoms of Tourette's syndrome in genetically vulnerable children. Although this possibility has been suggested in the literature, these are the first two documented cases of this phenomenon. Speculating from these two cases, ADHD may be a risk factor for the appearance of imipramine-induced tic symptoms in depressed children.

Tourette's syndrome and anophthalmia in a girl: complex differential diagnosis.

This is a report of a 15 year old girl with anophthalmia who met the DSM-III criteria for Tourette's Syndrome (TS). The case presented a complex differential diagnosis with previous diagnoses of behaviour disorder and schizophrenia, complicated by the issues of blindness, pharmacological, and environmental factors. Once the diagnosis was made, and due to intricate biopsychosocial interactions, a comprehensive treatment approach was adopted with good results. The authors comment on the non-existence of studies about the incidence of TS in blind children and recommend the discrimination between the motor behaviour of the tic disorder versus mannerisms associated with blindness. Thus a reasonable degree of suspicion is warranted in the treatment of blind children with severe behavioural disturbances.

Iatrogenic behavioral and psychiatric symptoms in children with partial complex seizures.

Reports are presented of two children with partial complex seizures (PCS) who had a variety of behavioral and psychiatric symptoms that were related to toxic serum levels of anticonvulsants. Anticonvulsant toxicity should be considered in the differential diagnosis of psychiatric symptoms in all children with convulsive disorders. The traditional view that the psychomotor spells have behavioral and psychiatric components increases the complexity of the differential diagnosis. PCS in children present differences in symptomatology and more difficulties in diagnosis and treatment compared with adults.

Treatment approach in a child with hysterical seizures superimposed on partial complex seizures.

This article reports the case of a 9 1/2 year old child with a history of psychomotor epilepsy which was uncontrolled by multiple anticonvulsant medications. When admitted to the psychiatric inpatient service, he was treated with a combination of pharmacological, behavioural and psychodynamically oriented approaches. A period of intensive family counseling was conducted to clarify the parents' concerns about causality of the seizures and methods for dealing with them. This combined approach led to a complete cessation of reported seizures and a decreased number and dosage of anticonvulsant medications. The authors discuss the reluctance of some physicians to accept the co-existence of neurogenic and psychogenic seizures in a given patient. Patients with pharmacologically uncontrolled seizures must be identified and accurately diagnosed (neurogenic and/or psychogenic) to prevent complication such as over-medication and to administer appropriate treatment. Multiple disciplinary therapy including psychodynamic, pharmacological, behavioural and educational approaches should be implemented.