Brief Alert
Tourette Syndrome: Don’t Spare the Pimozide
Source: Tourette Syndrome Study Group. Short term versus longer term Pimozide therapy in Tourette’s Syndrome: A preliminary study. Neurology 1999;52:874-877.
Pimozide is a potent neuroleptic widely used for more than a decade to treat vocal and motor tics in Tourette Syndrome (TS). Considering the potential long-term risks of neuroleptics, is it rational to treat only when tics are out of control, discontinuing treatment once tics disappear? The Tourette Syndrome Study Group (TSSG) suggests not.
The TSSG examined 10 patients with TS who had achieved stable tic control with Pimozide. Six were maintained on the medication and four were withdrawn over a 12-day period. The patients withdrawn from Pimozide relapsed and regained their prominent tics within a median of 37 days and a maximum of about 90 days. The end point of the continuation group for more treatment was 239 days. Two treated patients dropped out at 0 and 210 days arbitrarily. Four, however, lasted ± 100, 90, and 235 days. The results differed at the P = 0.02 level.
The TSSG advocates long-term (up to 12 months or more) Pimozide therapy in stabilized patients. Although Pimozide has a theoretical risk for tardive dyskinesia, two prior studies by Mesulam and colleagues (Mesulam MM, et al. Neurology 1987; 37:1828-1833) and Regeur and colleagues (Regeur L, et al. J Neurol Neurosurg Psychiatr 1986;49:791-795), each involving about 60 patients with TS on long-term Pimozide therapy, reported that not a single case of tardive dyskinesia was observed.
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