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A CASE WITH GILLES DE LA TOURETTE'S SYNDRSOME: RECURRENT REFRACTORINESS TO HALOPERIDOL, AND UNSUCCESSFUL TREATMENT WITH L-DOPA

A 38-year-old patient with the characteristic symptoms of Gilles de la Tourette's syndrome including motor tics and explosive utterances had been treated with both psychotherapy and haloperidol. Haloperidol gave complete relief of symptoms, but after 5 years the symptoms returned despite increase in the dosage to 20 mg/day. The patient was admitted to a psychiatric ward, withdrawn from all medicines and then treated with chlorpromazine at a level of 900 mg/day; in addition, L-dopa was started and increased to 6 g/day over 7 weeks. The chlorpromazine-L-dopa treatment produced no significant change in symptoms. During the eighth week, these medicines were discontinued and haloperidol was again started. Within 3 weeks of resuming haloperidol, all explosive utterances and tics were absent. This case report suggests that the symptoms of Gilles de la Tourette's syndrome can become reversibly refractory to haloperidol and that treatment with L-dopa and chlorpromazine is ineffective in this syndrome.