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: Tell us about Seroquel. Is it the answer for those of our
kids who have gained oodles of weight on
Orap or Risperdal?
A: Seroquel is the most recently approved antipsychotic drug,
and compared to older drugs such as
Haldol or Orap it causes much less parkinsonism and similar problems.
Since the most effective drugs for
tics happen to also be useful for psychosis, people have wondered if
Seroquel might help tics with fewer
side effects. To my knowledge, there is no really good information
yet on whether Seroquel helps tics or
causes fewer side effects in TS patients, but apparently some patients
have had benefit. Unfortunately
weight gain is reasonably common with Seroquel, so that may not be
the main reason to switch. Low fat
diets (in moderation) and exercise may help with the weight gain on
an otherwise helpful medication
given at its minimum helpful dose.
(Brand names and generic equivalents: Seroquel® = quetiapine; Orap®
= pimozide; Risperdal® =
risperidone; Haldol® = haloperidol)
Q: Tell us about remoral (?sp). At the last support group meeting,
a parent said her son was on it
because he was so mean. And that it helped...
A: You may mean Remeron. It is a newer medicine marketed as
an antidepressant. It is proven to help
with major depression. It is different chemically from other available
antidepressants so it may be
reasonable if other antidepressants haven't helped. However, it is
probably less likely to help with OCD
than certain other antidepressants (Prozac, Paxil, Zoloft, Luvox, Anafranil).
Side effects include
sleepiness (which may be a bonus in some people) and weight gain. Again
everyone is an individual and
not everyone has every good or bad effect. Teenagers can show depression
in different ways, and if a
medicine helped meanness that's wonderful. However, depending on the
situation, I would probably try
to stop it after 3-12 months to see if the meanness stays gone anyway.
(Brand names and generic equivalents: Remeron® = mirtazapine; Prozac®
= fluoxetine; Paxil® =
paroxetine; Zoloft® = sertraline; Luvox® = fluvoxamine; Anafranil®
= clomipramine)
Q: Have you heart anything about spinal stenosis going with Tourette?
It has to do with a book I've
been reading - a novel, in which a character has TS. The author refers
to his bent over appearance and
says it's from spinal stenosis which often accompanies this condition.
A: (Stenosis means narrowing.) I don't know of any direct connection
like the one you describe. I
wonder what the author was thinking of. There's no reason to think
that spinal problems cause tics.
Going for rare possibilities . . . A few people have injured their
upper spinal cord with severe and
frequent neck-jerking tics. They have had nerve tingling and weakness,
but I doubt bent appearance
would be the only problem. Also as you know some cases of tics have
been associated with rheumatic
fever, which can cause arthritis.