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Life's A Twitch! Celebrating 15 years.
1998 - 2018
Life's A Twitch! Celebrating 15 years.

 

Question 51: I'm a cardiologist and recently realized my 7yo sons ticks are due to TS. His case is mild, exaggerated startle, throat clearing, humming, and scratching, no ADHD or OCD Sx. (He's well adjusted and a good student). There is no [family history] of tics just the usual mild nuerotics and OCD's. At 10day old he had a bad case of RSV pneumonia and received Ribavirin. Have you heard of any association there? (medline search=0).

Second do Clonidine and Guanafacine really suppress ticks (one article said not)? or only ADHD and sleep disorders neither of which he has. D.


Good evening Dr. D!

There is no FH of tics just the usual mild nuerotics and OCD's.

Given the genetic theories that fit what we know about TS so far, this isn't surprising. You may be interested in reading a book by Dr. David E. Comings (Tourette Syndrome & Human Behavior, 1990, Hope Press). It is getting a little dated now but Dr. Comings had some revolutionary ideas in this area that have taken 10 years to get in "vogue".

he had a bad case of RSV pneumonia and received Ribavirin. Have you heard of any association there? (medline search=0).

I have not, however there is some intriguing research being done linking Group Alpha Beta Hemolytic Streptococcus (GABHS) infection with TS symptoms. I have a review of this research on my website at www.lifesatwitch.com/Research.html (the article is entitled Sydenham's Tourettic PANDAS).


Second do Clonidine and Guanafacine really suppress ticks

These antihypertensives are not directly indicated for tics (Drug Information for Mental Health, 2001), however the "scuttlebutt" from those in the field that have prescription privileges is that one tends to see tic reduction in about 50% of cases. My understanding is that this class of drugs works more "downstream" (at least in terms of TS symptoms) than do the antipsychotics -- given that tics are exacerbated by stress, it follows that a drug that DE-stresses will have beneficial impact. Besides having side-effects that are a little easier to accept, this class of drugs is popular because, as you note, they also treat ADHD symptoms which more often than not co-occur with TS. It is still a popular misconception that traditional stimulant medications (used in the treatment of ADHD) can
"cause" or "worsen" tics, and so clonidine seems a safer bet for many. While the clonidine may not help the tics, the logic goes, at least it won't worsen them while addressing the ADHD symptoms.

A (very) recent paper may be of interest to you:

The Tourette's Syndrome Study Group (2002). Treatment of ADHD in children with tics: A randomized controlled trial. Neurology, 58, 527-536.

The study found that methylphenidate and clonidine, alone or in combination, are effective for ADHD and do not worsen comorbid tics.

Thank you for your intriguing questions -- I hope my answers are of some help to you.

All the best to both you and your son sir........

Dr. Dunc.

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http://www.lifesatwitch.com/response51.html
Last updated on March 25, 2022

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