Ecopipam
Ecopipam, um antagonista seletivo do receptor de dopamina D1/D5, demonstrou reduzir os tiques e foi bem tolerado em um estudo cruzado randomizado e controlado por placebo em crianças de 7 a 17 anos.[95]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
Ácidos graxos ômega-3
Observações clínicas sugerem efeitos terapêuticos dos ácidos graxos ômega-3 na síndrome de Tourette (transtorno de Tourette). No entanto, o único estudo duplo-cego controlado com placebo disponível não demonstra a eficácia dos ácidos graxos ômega-3 na síndrome de Tourette.[96]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
Terapia por estimulação magnética transcraniana repetitiva (EMTr)
Alguns estudos preliminares de EMTr do córtex motor suplementar relataram desfechos favoráveis em tiques.[97]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
[98]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
No entanto, outros estudos não encontraram diferenças entre EMTr e tratamentos simulados no que tange aos córtices motor, pré-motor ou motor suplementar.[99]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
[100]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
Canabinoides
Vários relatos de caso sobre consumo de cannabis e tetraidrocanabinol (THC) por via oral sugerem que canabinoides podem ser efetivos no tratamento de tiques associados a síndrome de Tourette.[101]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
Dois pequenos ensaios clínicos controlados por placebo que avaliam o THC por via oral identificaram melhoras significativas nos sintomas de tique em comparação com placebo, corroborando essas observações clínicas iniciais.[102]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
[103]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
Embora a análise Cochrane tenha sugerido que não há evidências suficientes para recomendação de rotina do uso de canabinoides na supressão de tiques, eles podem ter uma função no tratamento de casos refratários.[52]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
[101]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
[104]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