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Tourette’s syndrome improvement with pergolide in a randomized, double-blind, crossover trial

From the Children’s Hospital Medical Center and Departments of Neurology (Dr. Gilbert) and Psychiatry (Drs. Sethuraman and Sallee and S. Peters), University of Cincinnati, OH; and the Department of Psychiatry (L. Sine), the Medical University of South Carolina, Charleston, SC.

Address correspondence and reprint requests to Dr. Donald L. Gilbert, Department of Neurology, OSB5 Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039; e-mail: d.gilbert{at}chmcc.org

OBJECTIVE: To determine whether pergolide, a mixed D₁-D₂-D₃ dopamine agonist, is efficacious and safe in the treatment of children with Tourette’s syndrome.

BACKGROUND: Neuroleptics, which block dopamine transmission, are currently used for treatment of children with severe tics, but major side effects and limited efficacy reduce clinical utility. Prior open-label reports of pergolide suggest potential benefit.

METHODS: The authors enrolled 24 children age 7 to 17 years with Tourette’s disorder, chronic motor tic disorder, or chronic vocal tic disorder by Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria, plus severity criteria on the Yale Global Tic Severity Scale (YGTSS) of 20, in a double-blind, placebo-controlled, crossover study. Children were randomized to receive either placebo or up to 300 µg/day pergolide for the first 6-week treatment period, with a 2-week placebo washout, followed by crossover to the alternate treatment. The primary outcome measure was tic severity assessed by YGTSS.

RESULTS: Compared with placebo treatment, pergolide treatment was associated with significantly lower YGTSS scores (42.0 ± 20.4 versus 23.5 ± 18.7; F = 12.0, df = 1, 17, p = 0.0011). No patient had a serious adverse event and pergolide was well tolerated.

CONCLUSIONS: In this randomized, placebo-controlled, crossover trial, pergolide appeared to be a safe and efficacious treatment for Tourette’s syndrome in children.

Key words: Pergolide—Tourette’s syndrome—Children—Pharmacotherapy—Dopamine agonist—D₁ receptor—D₂ receptor—D₃ receptor.

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