![]() ![]() Regarding TS, the situation mentioned in our 2011 article with “…only a limited number of studies on pharmacological treatment options for TS met rigorous quality criteria…” still holds true. In general, clinical guidelines rely on the combination of information from controlled clinical trials (including their shortcomings) and clinical (consensus-based) knowledge, given the lack of sufficiently comprehensive and detailed evidence. The present guideline provides clinicians an update of recommendations for the pharmacological treatment of TS in Europe using evidence from clinical trials and clinical expertise. The first European clinical guidelines for Tourette Syndrome (TS Footnote 1) were published in 2011 by working groups of the European Society for the Study of Tourette Syndrome (ESSTS) and provided recommendations for the assessment and treatment of TS based on existing guidelines, meta-analyses, reviews, clinical trials, and case studies up to that point. Overall, treatment of TS should be individualized, and decisions based on the patient’s needs and preferences, presence of co-existing conditions, latest scientific findings as well as on the physician’s preferences, experience, and local regulatory requirements. In treatment resistant cases, treatment with agents with either a limited evidence base or risk of extrapyramidal adverse effects might be considered, including pimozide, haloperidol, topiramate, cannabis-based agents, and botulinum toxin injections. This view is supported by the results of our survey on medication preference among members of ESSTS, in which aripiprazole was indicated as the drug of first choice both in children and adults. Other agents that can be considered include tiapride, risperidone, and especially in case of co-existing attention deficit hyperactivity disorder (ADHD), clonidine and guanfacine. ![]() ![]() The largest amount of evidence supports the use of dopamine blocking agents, preferably aripiprazole because of a more favorable profile of adverse events than first- and second-generation antipsychotics. Because behavioral approaches are not effective, available, or feasible in all patients, in a substantial number of patients pharmacological treatment is indicated, alone or in combination with behavioral therapy. The first preference should be given to psychoeducation and to behavioral approaches, as it strengthens the patients’ self-regulatory control and thus his/her autonomy. Moreover, our revision took into consideration results of a recent survey on treatment preferences conducted among ESSTS experts. We now present an update of the part on pharmacological treatment, based on a review of new literature with special attention to other evidence-based guidelines, meta-analyses, and randomized double-blinded studies. In 2011, the European Society for the Study of Tourette Syndrome (ESSTS) published the first European guidelines for Tourette Syndrome (TS). ![]()
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