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The opiate system in Gilles de la Tourette syndrome: diverse effects of naltrexone treatment

Published online by Cambridge University Press:  16 April 2020

N Müller ,
A Putz  and
A Straube
N Müller
Affiliation:
Psychiatrische Klinik, Klinikum lnnenstadt, Nuβbaumstr 7, D-80336 , Munich
A Putz
Affiliation:
Psychiatrische Klinik, Klinikum lnnenstadt, Nuβbaumstr 7, D-80336 , Munich
A Straube
Affiliation:
Neurologische Klinik, Klinikum Groβhardern, Marchioninistr 15, D-81366 , Munich, Germany
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Summary

The main symptoms of Gilles de la Tourette syndrome (GTS) are motor and vocal tics, but there are also several psychiatric disturbances such as obsessive compulsive symptoms (OCD) and mutilations. The etiology and pathophysiology of this basal ganglia disorder are unknown. Though many patients benefit from therapy with dopamine antagonists, the effect is often insufficient. Therapeutic efficacy of the opiate antagonist naltrexone has been described in recent years. Ten patients (three f, seven m) with GTS were invesitgated in a seven-week, open dose-response trial, using naltrexone in doses ranging from 12.5 mg to 200 mg/day. The severity of the GTS symptoms were rated with the Yale Global Tic Severity Scale (YGTSS) and the Tourette Syndrome Global Scale (TSGS); OCD was estimated by the Maudsley Obsessive Compulsive Inventory (MOCI). The course of tics and psychopathology was assessed by three self-report scales, and two scales rated by clinicians (Clinical Global Impression, CGI; Brief Psychiatric Rating Scale, BPRS). Only two patients showed improvement of the GTS. In four patients, no effect was observed, whereas the other four patients exhibited deterioration. One patient finished the complete trial, three patients dropped out because of lack of improvement, and four because of deterioration of the symptoms. Considering the mean values, no improvement of GTS could therefore be observed, and because of the unpredictable effect, the study was stopped after ten patients. Nevertheless, the effects were quite controversial. The opiate system seems to be affected only in some of the GTS patients in a clinically relevant manner, and opiate antogonists can either improve or provoke GTS symptoms. Pathophysiologically different subgroups of GTS may contribute to the controversal results.

Keywords

Tourette's syndromeopiate systemdopamine systemnaltrexone
Type
Original article
Information
European Psychiatry , Volume 9 , Issue 1 , 1994 , pp. 39 - 44
Copyright
Copyright © Elsevier, Paris 1994

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