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Topiramate in Treatment of Tourette Syndrome

Objectives:To describe the efficacy and safety of topiramate in the treatment of Tourette syndrome (TS). Methods:Charts of subjects whose conditions were diagnosed as tic disorders seen at our clinic from 2003 to 2007 were retrospectively reviewed. Patients who met diagnostic criteria for TS and were started on topiramate at our clinic with at least 1 follow-up visit after beginning topiramate were included. The efficacy of topiramate on a subjective scale, the global impression of response (0 = no response/worse, 1 = mild improvement, 2 = moderate improvement, 3 = marked improvement), and adverse effects were recorded for analysis. Results:Of 453 subjects, 367 met diagnostic criteria for TS and 41 (11.1%; 34 males) were treated with topiramate for tics for 9.43 ± 7.03 months (range, 1-27 months). Mean age at onset of tics was 6.93 ± 2.78 years (range, 2-14 years) and at start of topiramate treatment was 14.83 ± 5.63 years (range, 9-27 years). The average efficacy on tics was 2.15 ± 1.11, and 75.6% (n = 31) of subjects had moderate to marked improvement and adverse effects included cognitive/language problems (24.4%, n = 10) and aggression or mood swings (9.8%, n = 4). Conclusions:This retrospective chart review suggests that topiramate can be used for tics in TS with at least moderate efficacy and typical adverse effects. Randomized controlled trials are needed.