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: Has anyone done muscle studies on anyone with TS that you
know of? I know it's considered an upper motor neuron problem but I was
just wondering. I'd also like to know if strengthening exercises improve
or decrease tics or make them worse.
A: I don't know of any. It is pretty clear that TS symptoms
come from the head, not the muscles. Overall I doubt exercise would make
the tics worse and I doubt it has more than a generic health benefit on
tics. However, some people have reportedly gotten partial benefit from
voluntarily exercising the muscles affected by the tics. I imagine there
is an interesting story here waiting to be discovered.
Q: Has anyone studied the anxiety of those with severe TS and
does it improve with BuSpar® or Xanax®?
A: You're right, we could use some research here. My approach
is to first try to figure out the cause or pattern of the anxiety. (1)
If there are obsessions or compulsions then I would not use these drugs
but would use other treatments. (2) If the anxiety started as a side effect
of medication (especially haloperidol, pimozide, or risperidone) and if
it sounds like akathisia (a fancy word meaning an uncomfortable, can't-sit-still,
have-to-get-up-and-pace feeling), then again there are different treatments
for this. (3) If there are panic attacks in the doctor sense of the word,
then Xanax can clearly help if prescribed appropriately, but overall the
symptoms may respond better to an antidepressant plus behavior therapy.
(4) There are other specific causes of anxiety such as social phobia, major
depression, or alcoholism, and each may respond to different treatments.
If I can't find something specific to treat, then trying BuSpar or drugs
like Xanax may be reasonable depending on the situation and the comparison
of potential risks versus benefits.
Q: Do you know of anyone who has broken bones with severe tics?
A: I have heard of this and would believe it but haven't seen
it myself.
Q: When comparing Risperdal® (risperidone) to Zyprexa®
(olanzapine), do you see any advantages of one over the other? I know you
have already discussed these drugs.
A: There are no studies directly comparing the two in tic patients.
Risperidone may be more effective in suppressing tics and may also be more
likely to cause movement side effects (such as muscle stiffness or spasms,
akathisia, or tardive dyskinesia). Olanzapine may be more likely to cause
sedation and weight gain. If tic severity is a major problem, then risperidone
or one of the older drugs (haloperidol, pimozide) may be the answer. If
tics are well-controlled with an older drug but there are uncomfortable
movement side effects or concern about tardive dyskinesia, olanzapine or
quetiapine (Seroquel®) may be the answer.