[Gilles de la Tourette syndrome associated with epileptiform discharges: report of three cases]

This report presents the clinical observation of 3 cases of Gilles de la Tourette Syndrome (GTS) with epileptiform discharge of electroencephalogram (EEG). During the past 2 years (1986-1987), 8 cases of GTS were diagnosed in the pediatric department of National Taiwan University Hospital. Three of them presented epileptiform discharges. Diffuse bilateral parieto-occipital spikes in waking and light sleep periods were noted in case 1, who was a 10-year-old girl. Case 2 was a 9-year-old boy, his EEG showed sporadic spikes over right fronto-central area during light sleep. In case 3, a 6-year-old boy, frequent sharps and spikes appeared in left centro-temporal area in waking and sleep EEG. Case 3 had received antiepileptic therapy. The EEG recovered to normal, the symptoms of the involuntary movement became more prominent. All of the 3 cases improved significantly after haloperidol monotherapy. Based on the clinical observations and literature review, we noted that the incidence of epileptiform discharge in GTS was higher than that in nonepileptic normal population. Although some authors suggested that a seizure state possibly play a subtle role in the genesis of Tourette's symptoms, this inference was not supported by our experience. We observed that haloperidol was effective to this syndrome with or without epileptiform discharge. Therefore, antiepileptic agents, which might alter the metabolism of dopamine, was not recommended for treating GTS patients.