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Kasuistik

Aripiprazol

Eine medikamentöse Behandlungsalternative beim Tourette-Syndrom im Kindes- und Jugendalter

Published Online:July 08, 2010https://doi.org/10.1024/1422-4917/a000049

Abstract

Fragestellung: Fallberichte von sieben Patienten mit Ticstörungen mit einer Krankheitsdauer von mindestens zwei Jahren sollen Hinweise zur Wirksamkeit des partiellen Dopamin-Agonisten, Aripiprazol, geben, welches sich in der Behandlung von Ticstörungen als wirksam und gut verträglich erwiesen hat. Methodik: Fünf Patienten mit einem Tourette-Syndrom (TS) und zwei mit chronisch motorischer Ticstörung (Alter 8;7–18;1 Jahre), bei denen zuvor eingesetzte Neuroleptika ungenügend wirksam waren oder wegen nicht tolerierbarer Nebenwirkungen abgesetzt werden mussten, wurden mindestens acht Wochen lang mit Aripiprazol behandelt. Vor und nach der Behandlung beantworteten die Eltern der Patienten das Ausmaß der vokalen und motorischen Ticsymptomstärke auf der Yale-Tourette-Syndrom-Symptomliste. Ergebnisse: Innerhalb des Beobachtungszeitraums kam es zu einem deutlichen Rückgang der motorischen Ticsymptomatik um 66 % sowie zu einem Rückgang der vokalen Ticsymptomstärke um 26 %, bei einer mittleren Tagesdosis von 14.3 mg (min. 5 mg, max. 30 mg). Symptome einer komorbiden Aufmerksamkeitsdefizit-Störung sowie einer Zwangserkrankung wurden durch die Behandlung nicht wesentlich beeinflusst. Während der Behandlung traten leichte Nebenwirkungen wie Bauchschmerzen, Müdigkeit und Weinerlichkeit auf. Behandlungsabbrüche wurden nicht beobachtet. Schlussfolgerungen: Aripiprazol stellt womöglich eine wirkungsvolle und gut verträgliche, nebenwirkungsarme Alternative zur bisher üblichen neuroleptischen Behandlung von Ticstörungen dar. Die Wirksamkeit, insbesondere im Hinblick auf Komorbiditäten, sollte in klinisch kontrollierten Studien verifiziert werden.


Aripiprazole – a medical treatment alternative for Tourette Syndrome in childhood and adolescence

Objective: We report a case-series of seven patients with a medical history of at least two years of tic disorder treated with the partial dopamine agonist aripiprazole to illustrate its efficacy as a treatment alternative for motor and vocal tics in children and adolescents. Method: A case series of five patients with Tourette Syndrome (TS) and two with chronic motor tic disorder (age range 8; 7–18; 1 year), the majority of whom had been refractory to treatment with other neuroleptics or had ceased treatment due to intolerable side effects, were treated for eight weeks with aripiprazole. Before and after treatment, parents rated the severity of motor and vocal tic symptoms on the Yale Tourette Syndrome Checklist. Results: Within eight weeks mean motor tic symptoms decreased by 66% and mean vocal tic symptoms decreased by 26%. Mean effective dosage was 14.3 mg/day (min. 5 mg, max. 30 mg). Symptoms of comorbid ADHD or Obsessive Compulsive Disorder were not significantly influenced. During medication only mild side effects were observed, e.g., abdominal pain, fatigue and increased emotional sensitivity. No patient dropped out of treatment due to side effects. Conclusions: Aripiprazole may be an effective pharmacologic treatment alternative for individuals with chronic motor tic disorder and TS. It induces quick, significant and sustained effects with few generally mild and transient side effects, if anything. Its effectiveness, especially relative to comorbidities, should be verified in double-blind, placebo-controlled studies.

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