Treatment of Tics

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.

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