St George's Hospital, Department of Neurology, Atkinson Morley Wing, Blackshaw Rd, London, SW17-0QT, UK.
OBJECTIVE: These cases illustrate that a new neuroleptic, aripiprazole, may be an effective treatment for the motor and vocal tics of Tourette Syndrome (TS), even in younger people. METHOD: A case series of 11 consecutive patients with TS (age range 7-50 years; M = 7) who were felt to require neuroleptic medication, were treated with aripiprazole, the majority of whom had been refractory to treatment with other neuroleptics, and in one case, Habit Reversal Training as well. RESULTS: Ten out of the 11 patients who were treated with aripiprazole improved, although to differing degrees. The only individual who showed no response was treated for only 1 month with a low dose (5 mg). Eight of the patients had been treated with many typical and atypical neuroleptics without success, and which had also given unacceptable side effects, resulting in them being unable to function at times. One was also unresponsive to previous Habit Reversal Training. The response to aripiprazole was dramatic and quick in five patients; in the rest (5/10) the response was less dramatic. In the majority of patients, response was sustained. The successful aripiprazole doses were between 10-20 mg daily. Side effects were mild and transient. This, to the best of our knowledge, is the first case series of patients with TS successfully treated with aripiprazole in the United Kingdom, and one of the few to date in the English Scientific literature. Our patients are also the first cases reported, in which the patients were assessed and whose improvement was monitored using standardised schedules and rating scales, such as the Yale Global Tic Severity Rating Scale and MOVES. Aripiprazole was licensed for use in patients with schizophrenia in the European Union in June 2004. We discuss possible reasons for these dramatic and idiosyncratic responses to aripiprazole. CONCLUSION: We suggest that aripiprazole may well be useful for individuals with TS as response to it is often quick, dramatic, sustained and with few generally mild and transient side effects.