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Topiramate for Tourette's syndrome in children: a meta-analysis
Chun-Song Yang1, Ling-Li Zhang, Li-Nan Zeng
1Department of Pharmacy, West China Second Hospital, Sichuan University, Chengdu, China.
Insights
Topiramate shows potential for treating Tourette syndrome in children, but more high-quality studies are needed. Current evidence suggests it may improve tic symptoms, though common side effects like drowsiness and appetite loss occur.
Area of Science:
- Neurology
- Pediatric Neurology
- Pharmacology
Background:
- Tourette syndrome is a neurological disorder characterized by repetitive, involuntary movements and vocalizations called tics.
- Current pharmacological treatments for Tourette syndrome have limitations, necessitating the exploration of alternative therapeutic options.
- Topiramate, an anticonvulsant medication, has shown potential in managing various neurological conditions.
Purpose of the Study:
- To systematically evaluate the efficacy and safety of topiramate in pediatric patients diagnosed with Tourette syndrome.
- To synthesize evidence from randomized controlled trials (RCTs) to determine the effectiveness of topiramate compared to control treatments.
Main Methods:
- A comprehensive literature search was conducted across multiple databases, including Cochrane Library, PubMed, Embase, and others, to identify relevant RCTs.
- Two independent reviewers selected trials, assessed their quality using the Cochrane Handbook, and extracted pertinent data.
- Data from included trials were analyzed using meta-analysis techniques to assess treatment outcomes and adverse events.
Main Results:
- Fourteen RCTs involving 1003 children (ages 2-17) were included, with most trials exhibiting poor methodological quality.
- Meta-analysis of three trials indicated a significant improvement in tic symptom severity, as measured by the Yale Global Tic Severity Scale, in the topiramate group.
- However, meta-analysis of nine trials found no significant difference in the percentage of patients achieving at least 50% tic reduction between topiramate and control groups. Common adverse events included drowsiness, appetite loss, cognitive dysfunction, and weight loss.
Conclusions:
- While preliminary evidence suggests topiramate may be beneficial for tic symptom control in children with Tourette syndrome, the overall quality of existing studies is low.
- The findings are promising but insufficient to recommend the routine use of topiramate for this population.
- Further high-quality, placebo-controlled trials are warranted to definitively establish the efficacy and safety profile of topiramate in pediatric Tourette syndrome management.
Objectives:
To assess the efficacy and safety of topiramate for children with Tourette syndrome.
Methods:
Randomized controlled trials evaluating topiramate for children with Tourette syndrome were identified from the Cochrane library, PubMed, Cochrane Central, Embase, CBM, CNKI, VIP, WANG FANG database, and relevant reference lists. Two reviewers independently selected trials, assessed trial quality, and extracted the data. Disagreement was resolved by discussion. Quality assessment referred to the Cochrane Handbook for Systematic Reviews of Interventions (version 5.0.1.).
Results:
Fourteen trials involving 1003 patients were included, of which 720 cases were male (71.8%). Ages were 2 to 17 years old. The general quality of included randomized controlled trials was poor. All trials were positive drug-controlled (12 randomized controlled trials used haloperidol as control, 2 used tiapride). The follow-up period was from 20 days to 12 months. Meta-analysis of 3 trials (n = 207), in which tics symptoms control was assessed by Yale Global Tic Severity Scale, suggested that there was significant difference in the mean change of Yale Global Tic Severity Scale score during the treatment period (mean difference = -7.74, 95% CI [-10.49, -4.99], I(2) = 0) between topiramate and control groups. Meta-analysis of 9 trials (n = 668) evaluating tics symptoms control ≥ 50% suggested that there was no significant difference in reduction of tics between topiramate and control group during the treatment period (relative ratio = 1.36, 95% CI [0.90, 2.06], I(2) = 0). Adverse events were reported in 13 trials. Drowsiness (3.3-16%), loss of appetite (4-16.7%), cognitive dysfunction (7.89-12.5%), and weight loss (6-10.5%) were common adverse events.
Conclusions:
The current evidence is promising but not yet sufficient to support the routine use of topiramate for Tourette syndrome in children due to low quality of the study designs. It deserves to confirm in further high-quality, placebo-controlled trials.
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