Clinical Effectiveness of Quetiapine in Children and Adolescents with Tourette's Syndrome

Mazlum Copur1; Baki Arpaci2; Turkay Demir1; Halis Narin3

Disclosures

Clin Drug Invest. 2007;27(2):123-130. 

In This Article

Materials and Methods

This retrospective study was conducted in Bakirkoy Dr Mazhar Osman Teaching and Research Hospital for Psychiatry and Neurology, Child Psychiatry Clinic, Istanbul, Turkey. Patients included in the study were 8-18 years old, had a diagnosis of Tourette's syndrome according to DSM-IV and had taken quetiapine for the treatment of Tourette's syndrome. We considered it suitable to give quetiapine to these subjects since we had observed less adverse effects in psychotic patients who received quetiapine.

Exclusion criteria included evidence of current major depression or psychotic symptoms, epilepsy or diagnosis of a psychotic disease.

The files of eligible patients were evaluated and a case report form (CRF) was completed for each patient. The CRF included the patient's sociodemographic data, medical history, the dosage of quetiapine that was being used currently and other drugs that had been used previously. The scale that was used for the evaluation of tics was the Turkish version of the YGTSS.[27] The scales used to evaluate ADHD were the Turkish Version of Conners' Teachers Rating Scales Short Version (CTRS-28)[28] [rated by teachers] and the Attention Deficit Hyperactivity Disorder Scale (ADHDS)[29] [rated by parents]. For patients who had a diagnosis of obsessive-compulsive disorder, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS)[30] score was also evaluated before treatment. The abovementioned questionnaires were routinely presented to all Tourette's syndrome patients in our clinic.

Physical examination, routine laboratory tests, serum prolactin level measurement and assessment of YGTSS score were conducted before treatment (baseline) and repeated at 4 and 8 weeks of the treatment period. Any adverse effects related to the study drug, concomitant medications (antipsychotics and other drugs) and concurrent illnesses were also recorded.

YGTSS is a clinical rating instrument designed to measure the number, frequency, intensity, complexity and interference of motor and phonic symptoms.[31] The number of tics was rated from 0 to 5 (0 = none, 1 = single tic, 2 = multiple tics, 3 = multiple tics [>5], 4 = multiple tics + at least one tic pattern and 5 = multiple tics + more than two tic patterns). The frequency of tics was rated from 0 to 5 (0 = none, 1 = very few, 2 = sometimes, 3 = often, 4 = almost always and 5 = always). The complexity of the tics was scored from 0 to 5 (0 = none, 1 = very few, 2 = mild, 3 = moderate, 4 = obvious and 5 = severe). The interference of tics with behaviour and speech was scored from 0 to 5 (0 = none, 1 = very few, 2 = mild, 3 = moderate, 4 = obvious and 5 = severe). The YGTSS yields three summary scores: total motor score (range 0-25), total phonic score (range 0-25), and an impairment score (range 0-50), which measures the overall burden caused by the tics.[2,11,12,14]

The CTRS-28 is a 28-item rating scale that measures inattention, overactivity and aggression. Each item is rated from 0 to 3 (0 = never, 1 = sometimes, 2 = often and 3 = very often) [range 0-84]. Scores were obtained from teachers' scoring of the average behaviour of the patient over the previous week.[32]

The ADHDS is a 26-item measure of inattention and hyperactive/impulsive symptoms (range 0-78) derived from DSM-IV. Each symptom was scored by the patient's parents on a scale of 0-3 (0 = never, 1 = sometimes, 2 = often and 3 = very often).[33]

Y-BOCS is a clinician-rated instrument for the measurement of severity of obsessive-compulsive symptoms. Obsessions and compulsions were rated on five separate scales yielding three summary scores: an obsession score (range 0-20), a compulsion score (range 0-20) and a total score (range 0-40).[30]

All data were analysed using descriptive statistics. Changes from baseline were analysed by parametric and non-parametric tests. p-Values <0.05 were regarded as statistically significant.

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