Abstract: The objective of this study is to evaluate the effect of topiramate
on tics in patients with Tourette syndrome (TS). TS is a complex
neurobehavioral disorder that emerges in childhood with widely varying patterns
of intermittent involuntary/semivoluntary movements expressed as motor and
vocal tics. Although neuroleptics are effective anti-tic agents, side effects
such as tardive dyskinesia, weight gain, and hepatotoxicity can limit their
usefulness. Our use of topiramate followed reports of its effectiveness in
reducing involuntary movements in patients with essential tremor. Retrospective
patient record was audited using a standardized data collection form in a
general child neurology practice. Charts for topiramate-treated patients
meeting diagnostic criteria for TS were reviewed. Data for tics, behavior
disorders, medication history, and topiramate treatment were extracted. The
Shapiro tic severity scale was used to quantify change from baseline. Of 39
children/adolescents with TS treated with topiramate, tic severity was reduced
at least 50% in 23 (59%) patients, did not change in five (13%)
patients and worsened in two (5%) patients. Topiramate was discontinued and
not restarted due to side effects in seven (18%) patients. Topiramate
appears to be useful in suppressing tics in patients with TS, but double-blind,
randomized controlled studies are needed to document its efficacy.
