It is now accepted that children with Tourette Syndrome, besides having vocal and phonic tics, may be also at risk for other problems such as Attention Deficit Disorder, sleep and appetite disturbances, and quite often, obsessive-compulsive symptoms. From our preliminary work, we concluded that TS patients with obsessive-compulsive symptoms had less than satisfactory response to currently available treatments. Clomipramine is a tricyclic antidepressant which has been used in the treatment of depression for many years. It is also the most effective treatment for obsessive-compulsive disorder. In this study, 20 TS patients with obsessive-compulsive symptoms and 20 without, will be treated with Clomipramine and both tics and obsessive-compulsive symptoms will be assessed periodically so that the effect of medication on both syndromes can be evaluated. Since there is some evidence that brain serotonin metabolism is disturbed in TS patients, and since the effects of Clomipramine are believed to be mediated at least in part through changes in serotonin metabolism, we will also take blood samples from all patients before and after the treatment to measure changes in serotonin activity and plasma concentration of Clomipramine and its metabolites. When completed, the study may help improve the treatment of TS patients with obsessive-compulsive symptoms. By focusing on only those patients who have obsessive-compulsive symptoms, we hope to isolate a subgroup of these patients who may have similar underlying disturbances and who are distinct from other subgroups. Studying the biochemical changes in this subgroup will also enhance our understanding of mechanisms underlying this complex disorder. Paul Sandor, M.D. Toronto Western Hospital Toronto, Ontario, Canada Award: $7,000 Tourette Association of America Inc. – Research Grant Award 1986 It is now accepted that children with Tourette Syndrome, besides having vocal and phonic tics, may be also at risk for other problems such as Attention Deficit Disorder, sleep and appetite disturbances, and quite often, obsessive-compulsive symptoms. From our preliminary work, we concluded that TS patients with obsessive-compulsive symptoms had less than satisfactory response to currently available treatments. Clomipramine is a tricyclic antidepressant which has been used in the treatment of depression for many years. It is also the most effective treatment for obsessive-compulsive disorder. In this study, 20 TS patients with obsessive-compulsive symptoms and 20 without, will be treated with Clomipramine and both tics and obsessive-compulsive symptoms will be assessed periodically so that the effect of medication on both syndromes can be evaluated. Since there is some evidence that brain serotonin metabolism is disturbed in TS patients, and since the effects of Clomipramine are believed to be mediated at least in part through changes in serotonin metabolism, we will also take blood samples from all patients before and after the treatment to measure changes in serotonin activity and plasma concentration of Clomipramine and its metabolites. When completed, the study may help improve the treatment of TS patients with obsessive-compulsive symptoms. By focusing on only those patients who have obsessive-compulsive symptoms, we hope to isolate a subgroup of these patients who may have similar underlying disturbances and who are distinct from other subgroups. Studying the biochemical changes in this subgroup will also enhance our understanding of mechanisms underlying this complex disorder. Paul Sandor, M.D. Toronto Western Hospital Toronto, Ontario, Canada Award: $7,000 Tourette Association of America Inc. – Research Grant Award 1986