Ecopipam
Ecopipam, a selective dopamine D1/D5 receptor antagonist, was found to reduce tics and was well tolerated in a randomised, placebo-controlled crossover study in children aged 7 to 17 years.[96]Gilbert DL, Budman CL, Singer HS, et al. A D1 receptor antagonist, ecopipam, for treatment of tics in Tourette syndrome. Clin Neuropharmacol. 2014 Jan-Feb;37(1):26-30.
http://www.ncbi.nlm.nih.gov/pubmed/24434529?tool=bestpractice.com
Omega-3 fatty acids
Clinical observations have suggested therapeutic effects for omega-3 fatty acids in Tourette's syndrome (Tourette's disorder). However, the only double-blind, placebo-controlled study on omega-3 fatty acids available does not show efficacy in Tourette's syndrome.[97]Gabbay V, Babb JS, Klein RG, et al. A double-blind, placebo-controlled trial of ω-3 fatty acids in Tourette's disorder. Pediatrics. 2012 Jun;129(6):e1493-500.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362909
http://www.ncbi.nlm.nih.gov/pubmed/22585765?tool=bestpractice.com
Repetitive transcranial magnetic stimulation therapy (rTMS)
A few preliminary studies of rTMS of the supplementary motor cortex have reported favourable outcomes in tics.[98]Mantovani A, Lisanby SH, Pieraccini F, et al. Repetitive transcranial magnetic stimulation (rTMS) in the treatment of obsessive–compulsive disorder (OCD) and Tourette’s syndrome (TS). Int J Neuropsychopharmacol. 2006 Feb;9(1):95-100.
https://academic.oup.com/ijnp/article/9/1/95/659473
http://www.ncbi.nlm.nih.gov/pubmed/15982444?tool=bestpractice.com
[99]Mantovani A, Leckman JF, Grantz H,et al. Repetitive transcranial stimulation of the supplementary motor area in the treatment of Tourette syndrome: report of two cases. Clin Neurophysiol. 2007 Oct;118(10):2314-5.
http://www.ncbi.nlm.nih.gov/pubmed/17709291?tool=bestpractice.com
However, other studies have found no significant difference between rTMS and sham treatments when targeting the motor, premotor, or supplementary motor cortex.[100]Münchau A, Bloem BR, Thilo KV, et al. Repetitive transcranial magnetic stimulation for Tourette syndrome. Neurology. 2002 Dec 10;59(11):1789-91.
http://www.ncbi.nlm.nih.gov/pubmed/12473773?tool=bestpractice.com
[101]Landeros-Weisenberger A, Mantovani A, Motlagh MG, et al. Randomized sham controlled double-blind trial of repetitive transcranial magnetic stimulation for adults with severe Tourette Syndrome. Brain Stimul. 2015 May-Jun;8(3):574-81.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4454615
http://www.ncbi.nlm.nih.gov/pubmed/25912296?tool=bestpractice.com
Cannabinoids
Several case reports of smoked cannabis and oral tetrahydrocannabinol (THC) suggest that cannabinoids may be effective for treating tics associated with Tourette's syndrome.[102]Kluger B, Triolo P, Jones W, et al. The therapeutic potential of cannabinoids for movement disorders. Mov Disord. 2015 Mar;30(3):313-27.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357541
http://www.ncbi.nlm.nih.gov/pubmed/25649017?tool=bestpractice.com
Two small placebo-controlled clinical trials evaluating oral THC identified significant improvements in tic symptoms when compared with placebo, supporting these initial clinical observations.[103]Müller-Vahl KR, Schneider U, Prevedel H, et al. Delta 9-tetrahydrocannabinol (THC) is effective in the treatment of tics in Tourette syndrome: a 6-week randomized trial. J Clin Psychiatry. 2003 Apr;64(4):459-65.
http://www.ncbi.nlm.nih.gov/pubmed/12716250?tool=bestpractice.com
[104]Müller-Vahl KR, Schneider U, Koblenz A, et al. Treatment of Tourette's syndrome with Delta 9-tetrahydrocannabinol (THC): a randomized crossover trial. Pharmacopsychiatry. 2002 Mar;35(2):57-61.
http://www.ncbi.nlm.nih.gov/pubmed/11951146?tool=bestpractice.com
Although Cochrane analysis has suggested that insufficient evidence exists for routine recommendation of cannabinoids for tic suppression, this treatment may have a role in treatment refractory cases.[53]Pringsheim T, Okun MS, Müller-Vahl K, et al. Practice guideline recommendations summary: treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology. 2019 May 7;92(19):896-906.
https://www.doi.org/10.1212/WNL.0000000000007466
http://www.ncbi.nlm.nih.gov/pubmed/31061208?tool=bestpractice.com
[102]Kluger B, Triolo P, Jones W, et al. The therapeutic potential of cannabinoids for movement disorders. Mov Disord. 2015 Mar;30(3):313-27.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357541
http://www.ncbi.nlm.nih.gov/pubmed/25649017?tool=bestpractice.com
[105]Curtis A, Clarke CE, Rickards HE. Cannabinoids for Tourette's syndrome. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD006565.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006565.pub2/full
http://www.ncbi.nlm.nih.gov/pubmed/19821373?tool=bestpractice.com