- A.
Patients with simple motor tics can sometimes achieve acceptable symptom control with botulinum toxin injections, particularly if the areas injected involve the face (e.g., blinking tics, or tics involving the mouth or lower face). The main side effects include pain at the injection sites and excessive, undesired weakness of the area injected. Conservative dose escalation through subsequent injection trials is recommended.
- B.
Clonidine and other α-agonists like guanfacine can be successful in controlling tics in children ( Table 87.1 ). They tend to cause sedation, but at times this side effect is desired in children with comorbid hyperactivity or agitation.
Table 87.1
Medications Useful in Treatment of Tics
Medication
Starting dose
Titration
Max dose
Guanfacine
1 mg qhs
Increase by 1 mg every week, can be used qhs or bid
4 mg daily
Clonidine
0.1 mg daily
Increase 0.1 mg weekly
0.2 mg tid
Topiramate
25 mg daily
Increase by 25 mg weekly in bid fashion
100 mg bid
Clonazepam
0.5 mg daily
Increase by 0.5 mg weekly in bid fashion
2 mg bid
Risperdal
0.5 mg daily
Increase by 0.5 mg weekly in bid fashion
3 mg bid
Tetrabenazine
12.5 mg daily
Increase by 12.5 mg weekly in tid fashion
75 mg tid Related posts:
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