Affiliations: Department of Pediatrics, University of Michigan
Medical School, Ann Arbor, MI, USA | Oakwood Healthcare System, Dearborn, MI, USA | Department of Pediatric Neurology, Neuroscience
centre, King Fahad Medical City, Riyadh, Saudi Arabia
Note:  Correspondence: Dr. Yasser Awaad, MD, Msc, FAAN, FAAP,
Pediatric Neurology Department, King Fahad Medical City, Riyadh, Saudi Arabia.
Tel.: +966 1288 9999; Fax: +966 1288 9999; E-mail: [email protected]
Abstract: Some drugs currently used to treat tics have drawbacks, including
the risk of side effects such as tardive dyskinesia. Therapeutic options with
better safety profiles are needed. Levetiracetam is an antiepileptic drug with
atypical GABAergic effects that might be beneficial for this indication. To
evaluate the effect of levetiracetam on motor and focal tics, behavior, and
school performance in children and adolescents with tics and Tourette syndrome.
Twenty-four patients, age 6–18 years, with tics and Tourette syndrome were
enrolled in this prospective, double-blinded placebo randomized study for 8
weeks. Each group had 12 patients. The initial starting dose of levetiracetam
was 250 mg. The dosage was titrated over 3 weeks to 1,000 to 2,000 mg. Clinical
outcomes were assessed with the Clinical Global Impression Scale, Yale Global
Tic Severity Scale, and Revised Conners' Scale. Ten out of 12 patients in the
levetiracetam group showed improvements based on all of the scales used and
four patients improved with regard to behavior and school performance. Two
patients dropped out. Nine patients out of 12 patients in the placebo group
showed no improvement, one patient showed a great placebo effect, and two
patients dropped out of the study. Levetiracetam was generally well tolerated.
Two patients discontinued because of exaggeration of pre-existing behavioral
problems. Levetiracetam may be useful in treating tics in children and
adolescents. Given its established safety profile, levetiracetam is a candidate
for additional evaluation.
Keywords: Levetiracetam, Tourette syndrome, tics, adolescents, children