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.
Q: I have always felt that my son is hypoglycemic. If he misses
a meal or doesn't eat enough
at lunch, his TS symptoms are terrible. These usually abate once he
has eaten. Is there any
research on this? Other parents have reported this in support group
meetings.
A: True hypoglycemia is an uncommon illness, but it is possible
that hunger directly affects
tics or other TS symptoms. Unfortunately, I cannot find any good research
on the effects of
hunger or of specific foods on the severity of TS symptoms. In the
meantime, your
observation is important for your son, and adding a snack to the schedule
may help both of
you. My real suspicion is that hunger per se is not the important factor
here. Instead, we all
know that any kind of stress generally worsens most brain diseases,
and hunger is a
biologically important kind of stress.
Q: Can you comment on the use of Zyprexa for tics?
A: Olanzapine (brand name Zyprexa®) belongs to a class of
drugs called atypical
antipsychotics because of their effects in people with schizophrenia.
Other atypicals include
clozapine (generic and Clozaril®) and quetiapine (Seroquel®).
These newer drugs differ in
important ways from older antipsychotic drugs used to treat TS, including
haloperidol
(Haldol®) or pimozide (Orap®). A major advantage is that these
drugs (especially clozapine)
are less likely to cause restlessness or abnormal movements as side
effects. Unfortunately,
preliminary studies with clozapine suggest that these drugs probably
are not as effective for
controlling tics as the older drugs. Further studies are needed because
no one really knows the
answer. However, in a given individual, one of these drugs may be effective
and if so would
likely cause fewer side effects. If someone with TS has been successfully
using haloperidol or
pimozide, an attempt to change to olanzapine or quetiapine may be reasonable;
you would
want to discuss the pros and cons, and other options, with your physician.