Intervention Review

Pimozide for tics in Tourette's syndrome

  1. Tamara Pringsheim1,*,
  2. Connie Marras2

Editorial Group: Cochrane Movement Disorders Group

Published Online: 15 APR 2009

Assessed as up-to-date: 3 FEB 2008

DOI: 10.1002/14651858.CD006996.pub2


How to Cite

Pringsheim T, Marras C. Pimozide for tics in Tourette's syndrome. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD006996. DOI: 10.1002/14651858.CD006996.pub2.

Author Information

  1. 1

    University of Calgary, Clinical Assistant Professor, Department of Clinical Neurosciences and Pediatrics, Calgary, Alberta, Canada

  2. 2

    Toronto Western Hospital, Movement Disorders Clinic, Toronto, ON, Canada

*Tamara Pringsheim, Clinical Assistant Professor, Department of Clinical Neurosciences and Pediatrics, University of Calgary, Alberta Children's Hospital, C4-431, 2888 Shaganappi Trail NW, Calgary, Alberta, AB T3B 6A8, Canada. tmprings@ucalgary.ca.

Publication History

  1. Publication Status: New
  2. Published Online: 15 APR 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Neuroleptic drugs with potent D-2 receptor blocking properties have been the traditional treatment for tics caused by Tourette Syndrome. Pimozide is the most studied of these. Use of these medications is declining because of concerns about side effects, and new atypical neuroleptics are now available. The true benefit and risks associated with pimozide compared to other drugs is not known.

Objectives

To evaluate the efficacy and harms of pimozide in comparison to placebo or other medications in the treatment of tics in Tourette Syndrome.

Search methods

We cross-referenced pimozide and its proprietary names with Tourette Syndrome and its derivations, as MeSH headings and as text words, and searched the Cochrane Movement Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 4), MEDLINE (1950-April 2007), and EMBASE (1980-April 2007). Reference lists of relevant articles were reviewed for additional trials.

Selection criteria

All randomized, controlled, double blind studies comparing pimozide to placebo or other medications for the treatment of tics in Tourette Syndrome were considered for inclusion in this review. Both parallel group and crossover studies of children or adults, at any dose and for any duration, were included.

Data collection and analysis

Data was abstracted independently by two authors onto standardized forms and disagreements were resolved by discussion.

Main results

Six randomized controlled trials were included (total 162 participants, age range 7 to 53 years).  Pimozide was compared with: placebo and haloperidol (two trials), placebo (one trial), haloperidol (one trial), and risperidone (two trials). Methodological quality was rated ‘fair’ for all studies. Studies used different outcome measurement scales for assessing tic severity and adverse effects. Significant clinical heterogeneity made meta-analysis inappropriate. Pimozide was superior to placebo in three studies, though it caused more side effects than placebo in one of these. Pimozide was inferior to haloperidol in one of three studies (the other two showed no significant difference between the drugs), which also showed significantly fewer side effects associated with pimozide. No significant differences between pimozide and risperidone were detected.

Authors' conclusions

Pimozide is an effective treatment for tics in Tourette Syndrome, though the number of trials comparing its effect to placebo and other drugs is limited. Trials of longer duration (minimum six months) are needed to investigate the longer-term effects of pimozide compared to atypical neuroleptics.  Future trials should use the Yale Global Tic Severity Scale to assess the main outcome measure, and quantify adverse events with the Extrapyramidal Symptoms Rating Scale.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Pimozide is an effective treatment for tics in Tourette Syndrome.

Pimozide is a well-studied drug used to treat the tics (uncontrolled movements and noises) caused by Tourette Syndrome.  There are concerns about side effects associated with pimozide, so it would be helpful to know how it compares to other drugs, and newer drugs.  The review authors searched the medical literature for clinical trials that compared pimozide to other drugs, or a dummy drug (placebo), for treating tics in patients with Tourette Syndrome. The trials identified showed that pimozide was more effective at reducing tics than placebo.  It was slightly less effective than the drug haloperidol, but showed fewer side effects. There were no important differences between pimozide and risperidone for either reduction of tics or side effects. In future, if trials could be run for longer, it would help the investigation of the nature of side effects caused by these drugs.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

Pimozide用於治療妥瑞氏症的抽動(tics)症狀

習慣上我們治療妥瑞氏症會使用一些擁有D2受體拮抗劑效果的neuroleptic drug。其中Pizomide是目前研究最多的藥物。而這些藥物因為副作用和有新一代非典型抗精神病藥物出現,使用率逐漸減少。然而Pimozide和這些新一代的藥物的療效和副作用實際上孰優孰劣,還未有明確的研究證實。

目標

評估pimozide和其他藥物或安慰劑用於治療妥瑞氏症的抽動症狀時,療效和風險如何。

搜尋策略

我們用“Pimozide”和其他同樣成分的藥名以及妥瑞氏症作為搜尋的關鍵字,Mesh的標題字或內文,範圍包含the Cochrane Movement Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL)(The Cochrane Library 2007, Issue 4), MEDLINE (1950April 2007), and EMBASE(1980April 2007). 以及這些文章中所列相關的參考資料。

選擇標準

所有比較Pimozide和安慰劑或其他藥物用於治療妥瑞氏症的抽動症狀的隨機對照雙盲試驗都被收入。

資料收集與分析

由二位作者用統一的格式獨立地擷取資料,若有相去的地方再透過討論決定。

主要結論

總共有六個隨機對照試驗,162個病人,年紀範圍從7到53歲。有二篇試驗內容是將Pimozide和安慰劑及haloperidol比較,有一篇是和安慰劑比較,有一篇和haloperidol比較,有二篇和risperidone比較。研究方法的品質皆被評為′尚可'(fair)。因為各個試驗使用了不同的衡量標準評估抽動的嚴重度和後遺症,要把各個試驗綜合作薈萃分析是不適當的。Pimozide在三個試驗中優於安慰劑,其中有一個試驗顯示Pimozide造成更多的副作用。在三篇比較Pimozide和haloperidol的試驗中,有一篇haloperidol較優,另外二篇則顯示沒有有意義的差異。同一篇文章裡也提到Pimozide的副作用更少。Pimozide和risperidol的比較則沒有被證實有任何差異。

作者結論

雖然關於Pimozide和其他藥物或安慰劑效果比較的試驗並不完美,但是他仍然是妥瑞氏症的抽動症狀有效的治療方法。Pimozide和非典型抗精神病藥物對病人的影響應該需要更長時間,至少六個月的追蹤時間。未來的試驗最好能統一使用Yale global tic severity scale去評估病人的嚴重度,使用Extrapyramidal symptoms rating scale評估藥物的副作用。

翻譯人

本摘要由新光醫院王瑄翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

目前我們對Pimozide這種藥物的療效已經蠻透徹,並且臨床上被運用在妥瑞氏症病人無法控制的抽動或是發出聲音。對於這種藥物的副作用仍然是我們擔心的,更進一步應該要了解Pimozide和其他治療藥物的副作用相比如何。這篇文章回顧了醫學文獻中比較Pimozide和其他療法及安慰劑用於妥瑞氏症治療的臨床試驗。目前我們能得到的結果Pimozide是優於安慰劑的,療效比haloperidol差一些,但是副作用比較少。和risperidone比起來,不管是療效或是副作用都沒有什麼顯著差異。如果臨床試驗的時間能拉長,我們能更清楚的明白這些藥物的副作用。