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Differential effects of transdermal nicotine on microstructured analyses of tics in Tourette's syndrome: an open study

Background. The treatment of Tourette's syndrome (TS) is often unsatisfactory. However, there is some evidence that transdermal nicotine patch (TNP) application may improve tics of non-smoking TS patients who are refractory to haloperidol treatment. Methods. In this open study we applied two 10 mg TNP for 2 consecutive days to four TS patients whose symptoms were not controlled by haloperidol and to a never-medicated TS patient, all of whom are non-smokers. The Yale Global Tic Severity Scale (YGTSS) and a quantified video-taped micro-structured analysis of tics (head-shake tics, eye-blinks, vocal tics, facial grimace and other body tics) were both carried out to assess the change after the application of TNP. Results. TNP application significantly reduced the YGTSS by an average of 50%, with no reported side-effects, for up to 4 weeks but not 16 weeks, as compared with TNP-free period. Consistent with these results, the total counts of tics also showed a significant decrease for up to 4 weeks after the TNP application. Conclusion. TNP application differentially affected individually quantified tics, which may suggest a differential role of nicotinic receptors in the generation of different tics.