Athetosis, dystonia, tics Domina Petric, MD

Katzung, Masters, Trevor. Basic and clinical pharmacology. Athetosis and dystonia There is no satisfactory medical treatment. Some patients respond to levodopa medication: dopa-responsive dystonia. Some patients with dystonia respond to diazepam, amantadine, antimuscarinic drugs in high dose, carbamazepine, baclofen, haloperidol or phenothiazines. Katzung, Masters, Trevor. Basic and clinical pharmacology.

Katzung, Masters, Trevor. Basic and clinical pharmacology. Athetosis Katzung, Masters, Trevor. Basic and clinical pharmacology.

Katzung, Masters, Trevor. Basic and clinical pharmacology. Patients with focal dystonias (blepharospasm, torticollis) often benefit from injection of botulinum toxin into the overactive muscles. Deep brain stimulation may be helpful in medically intractable cases. Katzung, Masters, Trevor. Basic and clinical pharmacology.

Katzung, Masters, Trevor. Basic and clinical pharmacology. Chronic multiple tics: Gilles de la Tourette´s syndrome. Symptomatic treatment for severe disorder. Tics Education of patients, family and teachers is important! Katzung, Masters, Trevor. Basic and clinical pharmacology.

Katzung, Masters, Trevor. Basic and clinical pharmacology. A common pharmacologic approach is haloperidol. Start dose: 0,25 or 0,5 mg daily. Gradual dose increase: by 0,25 mg every 4 or 5 days. Total daily maintenance dose: 3-8 mg. Katzung, Masters, Trevor. Basic and clinical pharmacology.

Katzung, Masters, Trevor. Basic and clinical pharmacology. Adverse effects of haloperidol: extrapyramidal movement disorders, sedation, dryness of the mouth, blurred vision, gastrointestinal disturbances. Katzung, Masters, Trevor. Basic and clinical pharmacology.

Katzung, Masters, Trevor. Basic and clinical pharmacology. HALOPERIDOL PIMOZIDE TICS OTHER CLONIDINE GUANFACINE Katzung, Masters, Trevor. Basic and clinical pharmacology.

Katzung, Masters, Trevor. Basic and clinical pharmacology. Tics Pimozide is dopamine receptor antagonist. It may be helpful in patients as a first-line treatment or in those who are either unresponsive to or intolerant of haloperidol. Start dose: 1 mg/day. Dosage is increased by 1 mg every 5 days. Most patients require 7-16 mg/day. It has similar side effects to haloperidol. Pimozide may also cause irregularities of cardiac rhythm. Katzung, Masters, Trevor. Basic and clinical pharmacology.

Katzung, Masters, Trevor. Basic and clinical pharmacology. Tics Certain α-adrenergic agonists may be preferred as an initial treatment: these agents are less likely to cause extrapyramidal side effects than neuroleptic agents. Clonidine reduces motor or vocal tics in about 50% of children so treated. Reduction of activity in noradrenergic neurons of locus caeruleus. Start dose: 2-3 mcg/kg/day. Dose is increased after 2 weeks to 4 mcg/kg/day. It may cause initial transient fall in blood pressure. Katzung, Masters, Trevor. Basic and clinical pharmacology.

Katzung, Masters, Trevor. Basic and clinical pharmacology. Tics The most common adverse effect of clonidine is sedation. Other adverse effects include reduced or excessive salivation and diarrhea. Guanfacine (α-agonist) Katzung, Masters, Trevor. Basic and clinical pharmacology.

Katzung, Masters, Trevor. Basic and clinical pharmacology. Tics Phenotiazines (fluphenazine) Atypical antipsychotics (risperidone, aripiprazole): patients with significant behavioral problems. Clonazepam, carbamazepine Injection of botulinum toxin A at the site of problematic tics Treatment of associated attention deficit disorder: clonidine patch, guanfacine, pemoline, methylphenidate, dextroamphetamine Obsessive-compulsive disorder: SSRIs, clomipramine Deep brain stimulation Katzung, Masters, Trevor. Basic and clinical pharmacology.

Katzung, Masters, Trevor. Basic and clinical pharmacology. Literature Katzung, Masters, Trevor. Basic and clinical pharmacology. Medscape.com Katzung, Masters, Trevor. Basic and clinical pharmacology.