Gilles de la Tourette Syndrome: symptomatic treatment based on evidence

The treatment of the Gilles de la Tourette syndrome has evolved from case r eports, clinical experience and more recently blinded trials usually in sma ll numbers of patients. We have reviewed the evidence available to clinicia ns. The oldest and still most widely prescribed drug, haloperidol, should n ow not be considered the firstline agent in children as other agents have s uperior adverse effects profiles. Symptomatic treatment should be targeted to the specific additional psychopathologies seen in the syndrome. For the treatment of ties, sulpiride, tiapride, possibly pimozide and in some cases clonidine may be considered first-line agents. Although a body of data sup ports pimozide, caution has to be exercised in relation to possible cardiac effects. Antidepressants and stimulants have an important place in the man agement of depression, obsessionality and attention deficit hyperactivity d isorder. The latter also responds to clonidine making it a rational first c hoice where ADHD coexists with GTS.There are a multitude of ether drugs adv ocated in the literature in addition to reports of neurosurgery and the nav el use of immune modulation. Therapeutic trials for GTS are challenging. Ho wever, further data from blinded trials are required before many of these t reatments can be considered to be mainstream treatment options.