Is there any evidence supporting the use of Risperdal (risperidone) in Tourette´s syndrome?/nRisper

Fråga: Is there any evidence supporting the use of Risperdal (risperidone) in Tourette´s syndrome?

Risperidone medication is considered in an 11-year-old boy with Tourette´s syndrome and autism. Therapy with amphetamine has been tried unsuccessfully.

Sammanfattning: Only two small open-label studies have addressed the use of risperidone in Tourette´s syndrome. Despite some positive results the clinical usefulness of risperidone in Tourette´s syndrome needs further analysis.

Svar: There are two open-label studies, indicating that risperidone may have therapeutic effect in Tourette´s syndrome (1). In the first study 7 children with chronic motor tic disorder or Tourette´s syndrome were treated with risperidone 1-2.5 mg/d for 11 weeks. Reduction in the frequency and intensity of tics was observed. Risperidone therapy with doses of 0.5-9 mg/d has been shown to be effective in a second study involving 38 patients suffering from Tourette´s syndrome (15 of them aged 8-15 years). None of the patients had responded earlier to other treatments. Twenty-two patients showed significant improvement, eight discontinued the treatment because of intolerable side effects, one suffered worsening of the tics and 7 showed no appreciable change. There was no information on distribution differences between adults and children. The most common side-effects in both studies were weight gain, tiredness and motoric disturbance, ie extrapyramidal symptoms, akathisia and tremor.

Two open clinical trials on the use of risperidone treatment of children with autistic disorders, ie not Tourette´s syndrome were located (2,3). Six children with autistic disorder (ages 5 to 9 years) showed improvement in symptomatology after eight weeks of treatment with 1.1 mg risperidone (2). In the second study ten children with autistic disorders (ages 4.5-10.8) were treated with 0.04-0.08 mg/kgxd and showed an improvement according to different psychiatric rating scales (3). Weight gain was the most common side-effect in both studies. 1 Toren P, Laor N, Weizman A: Use of atypical neuroleptics in child and adolescent psychiatry. J Clin Psychiatry 1998; 59: 644-656 2 Findling RL, Maxwell K, Wiznitzer M: An open clinical trial of risperidone monotherapy in young children with autistic disorder. Psychopharmacol Bull 1997; 33: 155-159 3 Nicolson R, Awad G, Sloman L: An open trial of risperidone in young autistic children. J Am Acad Child Adolesc Psychiatry 1998; 37: 372-376