Optimizing behavior therapy for youth with Tourette's disorder.

Area of Science:

• Neuroscience
• Psychiatry
• Pharmacology

Background:

• Tourette's Disorder (TD) is a neurological condition characterized by distressing and impairing tics.
• Current first-line behavioral therapies for TD, such as habit reversal training (HRT), may have limited efficacy for some patients.
• There is a need for novel therapeutic strategies to improve tic reduction in Tourette's Disorder.

Purpose of the Study:

• To investigate the efficacy of augmenting HRT with D-cycloserine (DCS) for reducing tic severity in youth with TD.
• To evaluate DCS as a potential enhancer for behavioral interventions in Tourette's Disorder treatment.
• To conduct a placebo-controlled, quick-win/fast-fail trial assessing DCS-augmented HRT.

Main Methods:

• Twenty youth diagnosed with TD participated in a randomized, placebo-controlled trial.
• Participants received a single session of HRT targeting two bothersome tics, augmented with either 50mg of DCS or a placebo.
• Assessments of tic severity, premonitory urges, and comorbidities were conducted at baseline and one week post-treatment by masked independent evaluators.

Main Results:

• A significant Treatment Group by Time Interaction favored DCS-augmented HRT (p < 0.01), indicating greater tic severity reduction.
• While initial differences at the treatment visit were small (d=0.27), the DCS group showed significantly lower targeted tic severity at posttreatment (d=1.30, p < 0.001) compared to placebo.
• These results suggest a preliminary enhancement of tic reduction when HRT is augmented with DCS.

Conclusions:

• Augmenting habit reversal training with D-cycloserine shows preliminary efficacy in reducing tic severity in youth with Tourette's Disorder.
• DCS may serve as a valuable adjunct to behavioral therapy for improving treatment outcomes in TD.
• Further research is warranted to confirm these findings and explore the therapeutic potential of DCS in Tourette's Disorder management.