Control of Tourette’s Syndrome With Topiramate

Ms. A had no family history of Tourette’s syndrome, but she had exhibited facial tics, later accompanied by humming, coprolalia, and palilalia, since age 6. She had tried haloperidol between ages 10 and 19 but developed a stiff tongue and difficulty sleeping. The introduction of risperidone, 1.5 mg/day, had controlled her tics but had caused a weight gain of 37 lb and galactorrhea. Treatment with topiramate, 50–200 mg/day, brought her tics under control within 1 week, but she developed a slight lack of concentration, loss of appetite, and greater thirst. Her weight dropped from 183 to 145 lb in 8 months.

After recovering from pneumonia at age 9, Mr. B had experienced facial tics. The only family history of facial tics was found in his son and maternal uncle. For 15 years he had been treated with clonazepam, 0.5–2.0 mg/day. Risperidone had been prescribed instead, and in 13 months Mr. B had reached his highest weight—228.5 lb. Topiramate was substituted, 200 mg at bedtime, but he felt lethargic. When he took 100 mg at bedtime, his tics were under control, and he experienced few side effects. In a month, Mr. B had a weight loss of 12.5 lb.