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. Some of you know him from our support group meetings. Here he answers some questions from our readers for general information. Since each person is different, you will want to contact your personal physician for specific medical advice.

1. Q: When would you consider the usage of Risperdal®? What kind of drug is it and
what are its side effects?
A: Risperidone (brand name Risperdal®) is a medication approved in the last year or
two by the FDA. Like haloperidol (Haldol®) or pimozide (Orap®), it blocks dopamine D2-
like receptors. Unlike these drugs, risperidone also strongly blocks serotonin-2 receptors. In
patients with schizophrenia risperidone has fewer acute neurologic side effects than
haloperidol. There are some suggestions that risperidone may also help treat obsessions and
compulsions even in patients without tics. Risperidone has not been around long enough to
know if it will cause less tardive dyskinesia than older antipsychotics. Two or three open
studies have shown improvement in tics in patients treated with risperidone. The main side
effects were weight gain and sedation. Risperidone does not have the blessing of the FDA for
treating tics, and further studies are needed to see if it is better than placebo or other drugs.
In people whose tics are severe enough to need medication, risperidone may be a
reasonable option. Because of the probable risk of tardive dyskinesia with this class of drugs,
I would first try alternatives, such as clonidine, in many patients. Remember not everyone
needs medication, and tics themselves are not always the worst problem.

2. Q: What research are you aware of that considers the accompanying disabilities that
often go with TS? (e.g. once, at a support group meeting, 15 out of 20 of those attending had
a near relative with lupus).
A: There are only a few things that often go with TS, primarily obsessive-compulsive
disorder, learning disabilities, and attention-deficit/hyperactivity disorder. I was not aware of
any connection with lupus, and none of the following sources knew of such a connection,
either: a MEDLINE search, some textbooks, and a colleague with a special interest in the
neuropsychiatric complications of lupus. However, there are two things that make your
support-group observation exciting: (1) lupus is known to cause other movement disorders
such as chorea and dystonia, and (2) tics have been associated in rare cases with Sydenham's
chorea, which, like lupus, is an autoimmune illness. I would be very interested in working
with MOTSA on a formal survey of support group members and of a control group so we can
find out if there really is a connection.

3. Q: Have you read Susan Hughes's book What Makes Ryan Tick? (Members of our
support group feel that it is must reading for those in the medical field working with families
with Tourette Syndrome.)
A: I have not read it but I borrowed a copy at the MOTSA meeting earlier this week.
If I have comments on it I could give them in the next newsletter.

4. P.S. I think the "ask the parent" column is a superb idea.

Kevin Black MD