Recurrence of complex motor and vocal tics in an elderly woman responsive to opiates

A 73-year-old woman experienced recurrence of complex and motor tics in late adult life. Involuntary vocalizations that had a cough-like quality constituted the most distressing feature of her tick disorder. The latter was unresponsive to diverse pharmacological agents including neuroleptics, clonazepam, baclofen, phenytoin, and various nonnarcotic antitussive agents. Low dose oxycodone produced almost complete abolishment of the cough-like involuntary vocalizations. This report implicates derangement in the activity of the endogenous opioid system in the pathophysiology of Tourette's syndrome, and suggest that opiates may be prescribed in the therapy of TS patients otherwise recalcitrant to administration of haloperidol or other dopamine blocking agents.