Future therapies of Tourette syndrome

Currently available pharmacologic therapies for Tourette syndrome often are characterized by limited effectiveness and unacceptable side effect profiles. In recent years, however, a series of new approaches have emerged which may lead to novel, more effective, and better tolerated treatments of tics and associated behavioral problems. Especially promising is the wide range of new atypical antipsychotic medications with unique and diverse receptor affinity profiles that are entering clinical practice. Over the next few years, intensive research efforts will be required to characterize the effect of the new atypical antipsychotics in patients with Tourette syndrome and related disorders, and to determine which sets of symptoms and which subgroups of patients best respond to particular agents. In the near future, corticotropin-releasing factor antagonists and agents which act on excitatory amino acid neurotransmitter systems also will become available and may provide treatment interventions, which theoretically could alter the long term course and outcome of Tourette syndrome. In addition, nonpharmacologic interventions, such as immunologic and behavior therapies, are receiving increasing attention and may provide an alternative or supplement to medication for selected subgroups of Tourette syndrome patients.