Ziprasidone, a novel antipsychotic, may be effective in diminishing motor and vocal tics in children and adolescents with Tourette's syndrome or chronic tic disorder, said Dr. Floyd R. Sallee, professor of psychiatry and pediatrics at Children's Hospital Medical Center in Cincinnati, and his associates.
They reported the results of a 56-day pilot study involving 24 patients aged 7-17 years who were randomly assigned to receive oral ziprasidone or placebo twice daily (J. Am. Acad. Child Adolesc. Psychiatry 39[3]:292-99, 2000). All had tic symptoms judged severe enough to warrant treatment with psychotropic medication. Twenty also had diagnoses secondary to Tourette's syndrome or chronic tic disorder, including attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), oppositional defiant disorder, and conduct disorder.
At the conclusion of treatment, the decline in tic severity was significantly greater in the ziprasidone group (39%) than in the placebo group (16%). Moreover, blinded scoring of videotaped tic behavior showed a 50% improvement in the number of motor and vocal tics and a 54% improvement in the distribution, intensity, and frequency of tics for the ziprasidone group, compared with 4% and 1% improvements, respectively, for the placebo group.
These benefits appear to be somewhat smaller than those achieved with the traditional neuroleptics pimozide and haloperidol, but the risk of intolerable side effects appears smaller with ziprasidone, Dr. Sallee and his associates said.
All subjects in the ziprasidone group and nearly 60% of those in the placebo group reported side effects, usually mild to moderate transient sedation that resolved when the dose was reduced. One case each of somnolence and akathisia occurred in subjects taking ziprasidone, but neither case was considered severe enough to warrant discontinuation of the drug.
There were no acute dystonic reactions or parkinsonian symptoms. "Thus, in this limited sample, ziprasidone also appeared to be associated with a low risk of extrapyramidal effects," they noted.
There also was no appreciable weight gain with ziprasidone, a "significant and difficult issue" with traditional neuroleptics, the researchers added.
In addition to tic-related benefits, ziprasidone was associated with a 27% decline in obsessive-compulsive symptoms in the subjects who had such symptoms at entry into the study. In contrast, there was a 5% increase among those taking placebo.
"Although the sample size (n = 5 subjects per group) is too small to permit firm conclusions, future studies should examine the potential effectiveness of ziprasidone as an antiobsessional agent both in patients with primary OCD and in patients with combined Tourette's syndrome and OCD," Dr. Sallee and his associates said.
COPYRIGHT 2000 International Medical News Group
COPYRIGHT 2001 Gale Group
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