The primary purpose of this study is to use neurophysiological measures to assess changes in attention and concentration in children and adolescents with Tourette Syndrome (TS) following treatment with a single transdermal nicotine patch given in addition to their usual neuroleptic medication. Although TS is characterized primarily by motor and vocal tics, problems with attention may also be part of the symptom profile in those both with and without co-morbid Attention Deficit/Hyperactivity Disorder (ADHD). Although neuroleptics are usually the treatment of choice for TS, insufficient reduction of symptoms often requires the use of increased doses. Higher doses may then result in undesirable side effects, including detrimental effects on attention and concentration. When nicotine is given as a supplement to neuroleptic medication, it appears to result in a greater reduction of motor and vocal tics than when the neuroleptic is given alone. Improvements in attention span have also been reported anecdotally. There is some indication that effects resulting from a single nicotine patch, given in combination with a neuroleptic, may last for up to 2 weeks on average. Nicotine alone has been shown to improve attention in both normal and neuropsychiatric populations (e.g. ADHD). This is a double-blind, placebo-controlled, crossover design study which will examine the short- and long-term effects of a single nicotine patch (given as a supplement to the usual neuroleptic regimen) on the clinical symptoms of motor and vocal tics as well as on laboratory measures (e.g. brain event-related potentials and behavioral performance measures) and clinical ratings of attention. In order to assess differentially treatment effects on attentional difficulties in TS-affected children and adolescents with and without co-morbid ADHD, the two TS groups will be compared with a third group of non-affected, age-matched controls. Besides establishing how effectively the treatment combination reduces motor and vocal tics in TS-affected children and adolescents with and without co-morbid ADHD, the study will provide objective assessments of any attentional deficits in TS thereby allowing us to determine whether nicotine â€œnormalizesâ€ such attentional deficits. Enhanced therapeutic response with nicotine supplementation may bring about a reduced need for neuroleptic doses, thereby resulting in fewer side effects, as well as improved attention. These results would be of particular interest to parents, teachers and individuals with TS, some of whom are coping with the costs of having TS in and out of classroom and work settings. Verner J. Knott, D.Phil. Royal Ottawa Hospital/University of Ottawa, Ontario, Canada Award: $28,797 Tourette Association of America Inc. – Research Grant Award 1998
Clinical and Attention Effects of Acute Nicotine Treatment in Tourette’s Disorder
Institution Organization Name
University of Ottawa Canada
Knott, Verner, D.Phil.