Kevin J. Black, M.D., one of the staff physicians at the Washington University Movement Disorders Clinic, is on the TSA's Physician Referral List. Since each person is different, you will want to contact your personal physician for specific medical advice.
Q: How about using Wellbutrin® with guanfacine?
A: In general I have a strong aversion to using two drugs together
for similar symptoms. Often there is no real additional benefit compared
to changing dosage or switching outright. In general, using two medicines
rather than one increases side effects, the chance of getting the instructions
confused, the chance for drug interactions, and cost. Sometimes, though,
a combination just works better.
For the two medicines you asked about, there is
no absolute reason not to combine them.
Q: Has anyone ever followed patients with Tourette syndrome through
the life span? Do the language problems faced by many of them become
even more of a problem with aging?
A: There is not much systematic information available about
this. This might be a great area for the national TSA to try to collect
some research. The 1999 book Tourette's Syndrome, edited by Leckman
and Cohen, reviews what has been published on the subject. In addition,
some doctors have been around a long time and have a gut feeling. Here
is my read on the question.
(1) Tics get worse and better at different times
in people's lives. (2) Tics can get worse or better at almost any time.
For instance, I saw a woman in her 80's who had had some tics for nearly
all of her life but they had been worse recently. (3) Many people with
tics seem to overall have fewer tics after adolescence, and many more seem
to find ways to have the tics bother their life less. (4) Studies of ADHD
in people with tics show that some people seem to get better over time.
(5) There isn't much data about how learning disorders change over time
in people with tics. The usual view is that people who find ways to get
around it can be more successful. For instance, if spelling is a real curse
for you, don't be a proofreader.
Q: Tell us about pergolide treatment for tics.
A: Last week's edition of the journal Neurology included
results of a carefully-done study using the medicine pergolide (brand name
Permax®) in 24 children (ages 7 to 17). According to doctors' ratings
of tic severity, there was a 35% improvement on average after 6 weeks of
pergolide, versus a 6% improvement with a placebo (sugar pill). Parents'
ratings showed less improvement. There were no more side effects with the
active medicine than with the placebo. This confirms earlier, less well
controlled studies that also showed some improvement in tics with pergolide.
It may be a reasonable treatment option for some people.
Pergolide is an interesting medicine. It is used
to treat Parkinson's disease and is a dopamine agonist ("fake dopamine").
The curious thing is that pergolide can be thought of as an opposite to
drugs like haloperidol.
We are just starting a study in kids and adults
to test whether LDOPA, which is in your body anyway
but is also used as a medicine in Parkinson's disease, can also improve
tics. If so, it may be better tolerated than other medicines currently
being used to treat tics. (Thanks to the national TSA for supporting this
study. See www.nil.wustl.edu/labs/kevin/studies/TS-dopa-tx.htm
if you would like more information.)