Tourettes Syndrome

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Tourettes Syndrome

• Heather Roden

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What is Tourette Syndrome?

• Malfunction of neurotransmitters in the basal
  ganglia

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Symptoms

• Involuntary movements
• Uncontrollable vocal sounds
• Clear throat, cough, sniff, grunt, yelp,
• bark, shout
• Coprolalia involuntarily shout obscenities
• Echolalia repeat words of other people
• Tics
• Facial tics such as eye blinking, nose twitching,
  neck stretching, foot stamping, body twisting and
  bending

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Classification of Tics

• Simple
• Sudden, brief movements
• Occur in an isolated area
• repetitive
• Complex
• Involves several muscle groups
• Tics may become worst when the patient is stressed

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Other Symptoms

• Obsessive compulsive behavior
• Attention deficit disorder
• Learning disabilities dealing with reading,
  writing, math and perceptual problems

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Theories to explain the cause of Tourette Syndrome

• Genetic theory
• TS is autosomal dominant may be caused by a
  mutation of a gene affecting the metabolism of
  neurotransmitters such as dopamine, serotonin and
  norepinephrine
• Postinfectious Theory
• Streptococcal infection results in formation of
  brain directed antineuronal antibodies that
  causes the tic disorder
• Abnormality in structural and functional
  relationship between the left and right side of
  the brain, especially in the basal ganglia
• Sex hormones may mediate the abnormal development
  of specific brain regions, especially the basal
  ganglia and limbic system

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• Who is at risk?
• All ethnic groups
• Occurs in males 3-4 times more than in females
• Statistics
• 200,000 Americans have TS
• 1 out of 200 people show symptoms
• Patients live a normal life span

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How is Tourettes diagnosed?

• Motor and phonic tics must be present for at
  least one year
• Clinical diagnosis, therefore no laboratory test
  or blood test to diagnose the disorder
• Laboratory test are used to rule out other
  disorders

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The order in which to treat TS
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Pharmaceutical treatments

• No cure for Tourette syndrome
• There are many medications to treat the symptoms,
  therefore it depends on which symptoms are
  limiting the patient
• May require more than one medication at
  different dosage depending on the patients
  conditions

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Clonidine

• Antihypertensive agent
• Generic Names
• Catapres
• Catapresan
• Clonidural
• Epiclodina
• Paracefan
• Pertenso
• Velaril

• Uses
• Tourette syndrome
• Narcotic/Nicotine withdrawal
• Prevent migraines
• Treat HBP
• ADD
• Anxiety

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Dosage and

• Adults orally
• 0.1 mg twice daily
• 0.2 1.2 mg/day in in several doses
• Adults skin patch
• 1-3 mg weekly
• Children orally and skin patch
• 0.15 0.4 mg/ day
• Cost/mo 12 for 0.2 mg twice a day

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Clonidine

• Absorbed in the intestine and skin
• 50 is metabolized in liver
• Half life of 6 24 hrs max of 41 for patients
  with renal impairment

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Mechanism of action

• Alpha 2 agonist that mimics adrenaline and
  noradrenalin at synaptic nerve terminals
• It stimulates receptors in the brain that monitor
  neurotransmitter levels in the blood
• These receptors have a negative feed back loop
  that decrease the production of neurotransmitters
  
• The brain now believes that there are more
  neurotransmitters then there really is
• In short Clonidine causes the brain to reduce
  its signals to the brain to lower the production
  of neurotransmitters
• Causing lower heart rate, blood pressure
• Gradually increase/decrease dosage

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Side Effects of Clonidine

• Common
• Drowsiness
• Dry mouth
• Dizziness
• Headache
• Constipation
• Rashes (skin patches)
• Decreased blood pressure

• Infrequent
• Depression
• Anxiety
• Fatigue
• Nausea
• Anorexia
• Sleep disturbances
• Dry, itching, burning eyes

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Interactions with other drugs

• Antidepressants
• Antipsychotic
• Dopaminergic antiparkinsian drugs
• Immunosuppressant
• Alcohol and drugs

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Haloperidol

• 3rd line of treatment
• Neuroleptic drug
• Cost 32 for 30 5mg pills

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Haloperidol

• Doses for adults
• Oral 0.5 5 mg twice or three times daily
• Max 100mg/day
• Intramuscular injection 2 30 mg
• Intravenous up to 30 mg
• Doses for children over 3 yrs old
• 25-50 ug/kg per body weight daily
• Max 150 ug/kg

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Haloperidol

• Absorption
• In gastrointestinal tract
• First pass effect in liver for oral metabolized
  by oxidative N-dealkylation
• Injections are hydrolyzed to haloperidol???
• Bounds to plasma proteins (90) and can cross the
  BBB
• Half life is 13 40 hrs

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Do not use Haldol with

• If you have
• Parkinson's
• Bipolar
• Urination problems
• Seizures
• Are breast feeding

• Alcohol or drugs
• Beta blockers
• Methyldopa
• indomethacin

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Side effects of Haloperidol

• Dizzines
• Drowsiness
• Difficulty urinationg
• Sleeping disturbances
• Headache
• Jaundice
• Restlessness

• Rare side effects
• Females produce prolactin results in unwanted
  breast milk, missed periods, difficult becoming
  pregnant
• Males dec sexual ability, inability to produce
  sperm, enlarged breast
• Tardive dyskinesia

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Mechanism of action for Haloperidol

• Is a non-selective drug, therefore can bind to a
  variety of receptors
• Dopamine D1,D2, 5-HT2, H1, and alpha-2-receptors
• Antagonism of dopamine receptors

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Mechanism of Action
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Bibliography

• Berkow, Robert, Amark Beers, and Andrew
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  1997.
• Griffith MD, Winter. Complete Guide to
  Perscription and Nonperscription Drugs. 2006 ed.
  New York, NY Penguin Group USA Inc., 2005.
• Higa de Landoni, Julia. "Haloperidol." 13 Aug
  1992. Division Toxicologia HOspital de Clinicas
  San Martin. 28 Mar 2007 lthttp//www.inchem.org/d
  ocuments/pims/pharm/haloperi.htmPartTitle5.20RO
  UTES20OF20ENT RYgt.
• Malseed, Roger. Pharmacology Drug Therapy and
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  Lippincott, 1990.
• Martindale The Complete Drug Reference.
  MICROMEDEX. Piedmont Hospital Medical Database.
  2006
• "The Mechanism of Action of First-generation
  Neuroleptics." The Lundbeck Institute. 28 Mar
  2007 http//www.cnsforum.com/imagebank/item/Drug_
  neurolep_typical/default.aspx
• "Tourette Syndrome." Wickipedia. 28 Mar 2007
  lthttp//en.wikipedia.org/wiki/Tourette_syndromegt.
• What is Tourette Syndrome?. U.S. National
  Institutes of Health. 28 Mar 2007
  lthttp//www.webmd.com/brain/tourette-syndrome-ove
  rview?page1gt.

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Questions ? ? ?