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6 Drug treatment of older patients presenting to a tic disorder clinic, a descriptive study
  1. Sophia G Raymond1,
  2. Jeremy S Stern2,
  3. Helen Simmons2
  1. 4th yr medical student at St. George’s University of London


Aims Drugs such as neuroleptics are known to have varying efficacy in the management of Tourette’s syndrome, and there is a particular lack of research about their efficacy when used for older patients presenting for treatment for the first time. Therefore, in this study, we aim to describe the outcomes of drug treatment in patients aged 40 years and older who presented to a Tic Disorder clinic.

Method The Tic Disorder clinic letter database was used to search for patients who presented to the clinic aged 40+. Clinical information gleaned from the letters including age of onset, severity of symptoms, comorbidities and treatments offered was recorded in an Excel spreadsheet. Those patients with incomplete data were removed from the sample. The spreadsheet data was then used to describe the severity of tics in this cohort and the effectiveness of drugs for all patients who used them.

Results There were a total of 33 patients aged 40+ who presented to the Tic Disorder Clinic, that we could find a set of clinical notes on. Male: female ratio = 26:7 Tic severity was calculated from either clinical comment, or in most cases, the Yale Global Tic Severity Score (YGTSS). YGTSS of 1–19 is mild, 20–39: moderate and 40–50: severe. Patients with tics since childhood: 75.8%, late onset tics >40 yrs: 15.2%, unknown: 9%. 63.6% have had obsessionality, a common comorbidity of GTS, and 42.4% suffer with two or more psychiatric comorbidities. 25/33 patients tried drugs for tics, whether before or at presentation to this clinic. 40% of them found drugs beneficial; 60% did not, or experienced adverse reactions or were lost to follow up (see bar chart).

Conclusions Overall, even though this study shows that medications for tics is more likely to be unsuccessful or cause adverse effects, it was still effective in a substantial proportion of patients and thus may be a good intervention for some. The study also suggests that this may be more difficult cohort to monitor due to the frequency of absences to follow up.

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