Good evening
Dr. D!
There
is no FH of tics just the usual mild nuerotics and OCD's.
Given
the genetic theories that fit what we know about TS so far, this isn't
surprising. You may be interested in reading a book by Dr. David E.
Comings (Tourette Syndrome & Human Behavior, 1990, Hope Press).
It is getting a little dated now but Dr. Comings had some revolutionary
ideas in this area that have taken 10 years to get in "vogue".
he
had a bad case of RSV pneumonia and received Ribavirin. Have you heard
of any association there? (medline search=0).
I have
not, however there is some intriguing research being done linking Group
Alpha Beta Hemolytic Streptococcus (GABHS) infection with TS symptoms.
I have a review of this research on my website at www.lifesatwitch.com/Research.html
(the article is entitled Sydenham's Tourettic PANDAS).
Second do Clonidine and Guanafacine really suppress ticks
These
antihypertensives are not directly indicated for tics (Drug Information
for Mental Health, 2001), however the "scuttlebutt" from those
in the field that have prescription privileges is that one tends to
see tic reduction in about 50% of cases. My understanding is that this
class of drugs works more "downstream" (at least in terms
of TS symptoms) than do the antipsychotics -- given that tics are exacerbated
by stress, it follows that a drug that DE-stresses will have beneficial
impact. Besides having side-effects that are a little easier to accept,
this class of drugs is popular because, as you note, they also treat
ADHD symptoms which more often than not co-occur with TS. It is still
a popular misconception that traditional stimulant medications (used
in the treatment of ADHD) can
"cause" or "worsen" tics, and so clonidine seems
a safer bet for many. While the clonidine may not help the tics, the
logic goes, at least it won't worsen them while addressing the ADHD
symptoms.
A (very)
recent paper may be of interest to you:
The Tourette's
Syndrome Study Group (2002). Treatment of ADHD in children with tics:
A randomized controlled trial. Neurology, 58, 527-536.
The study
found that methylphenidate and clonidine, alone or in combination, are
effective for ADHD and do not worsen comorbid tics.
Thank
you for your intriguing questions -- I hope my answers are of some help
to you.
All the
best to both you and your son sir........
Dr. Dunc.
