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Nicotine Patch Eases Tourette's Tics

Study finds it helps other drugs block dopamine

MONDAY, Sept. 17, 2001 (HealthDayNews) -- The same nicotine patch that smokers wear to wean themselves off cigarettes can help soothe the motor tics and the acting out that are associated with Tourette Syndrome, a new study says.

Scientists say nicotine in the patch seems to enhance the ability of other Tourette's medications to block dopamine. A glut of that messenger molecule, which is linked to motor control, emotion and other functions, is believed to be at the root of Tourette's.

A report on the study appears in this month's issue of the Journal of Clinical Psychiatry. Similar results have been reported previously, the researchers say, but the latest study is the most rigorous one to date looking at the effectiveness of nicotine in treating Tourette's.

As many as 200,000 Americans have Tourette Syndrome, though many are never diagnosed with the disorder. Doctors prescribe many drugs to help control the trademark motor and verbal tics that make life difficult for Tourette's patients. But only two medications so far have been approved specifically for the symptoms.

One of the compounds is the schizophrenia drug haloperidol, or Haldol. But the drug, which blocks dopamine, is a potent tranquilizer that can retard motor movements and dull thinking.

In earlier work, neuroscientist Paul Sanberg and his colleagues at the University of South Florida in Tampa showed that nicotine gum could help suppress Tourette's tics in children who have the disorder. But they also found that kids didn't like to chew the bitter-tasting gum, and often resorted to blowing bubbles with it or swallowing it rather than using it as intended. People who use the gum to quit smoking are expected to leave it in a corner of their mouths, something that requires the patience many kids can't muster.

Hoping to skirt that problem, Sanberg's group treated 35 Tourette's children and teens between the ages of 8 to about 18 with a combination of Haldol and a 7-milligram nicotine patch, which was applied daily. They also treated another 35 children using the drug and a dummy patch.

The addition of the slow-release nicotine patch significantly reduced the severity and frequency of motor tics, the researchers say, even when the dose of Haldol was halved. And the effects of the nicotine patch lasted for at least 30 days after it was discontinued.

"The effects can be long-lasting. That's why we think there's something that's being reset in the brain," says Sanberg, whose study was funded by the National Institutes of Health and the Tourette Syndrome Association of America.

"What we think is happening is that the continuous administration of nicotine with the patch is flooding the nicotine receptors in the brain, and it's actually turning off the receptors," he adds.

None of the children seemed to develop an addiction to nicotine. The patches did cause some nausea and dizziness as well as local irritation. But they also helped control aggressive behavior and uncontrolled outbursts that are another common feature of Tourette's, Sanberg says.

In a related study, published this month in the Journal of the American Academy of Child and Adolescent Psychiatry, Sanberg and his colleagues show that a blood pressure drug that also blocks nicotine receptors is safe for children with Tourette's. They did not test the compound, mecamylamine (brand name Inversine), along with Haldol, but Sanberg says additional work suggests that the combination can also ease tics.

Sanberg says mecamylamine may prove more useful than the nicotine patch, which kids often balk at wearing. "It's easier to take a pill," he says.

Colleen Wang, medical liaison at the Tourette Spectrum Disorder Association in South Redlands, Calif., says many doctors are now using nicotine patches as part of their treatment of children and adults with the disorder.

Most physicians prescribe patches in concert with anti-psychotic drugs such as Haldol, Wang says, although some treat patients with nicotine alone. "But usually the [adolescents] they do that with end up going and finding cigarettes," she says. "They know how to get that nicotine."

Not all neurologists are sold on nicotine therapy for tic disorders, however.

Dr. David Comings, who runs a Tourette's clinic at the City of Hope National Medical Center in Duarte, Calif., says he's been "less impressed" with the patch's performance.

"It simply hasn't worked as often as I expected it to, so I don't really use it as much anymore," says Comings.

In his practice, only about one patient in 10 reported significant improvement with nicotine, so he sticks to more accepted drugs instead.

What To Do

Nicotine may be useful in treating patients with other neurological conditions, including Parkinson's disease. Scientists have reported that patients with the brain ailment showed significant improvement in both memory and verbal learning when treated with the drug.

To find out more about Tourette Syndrome, visit We Move, a Web site devoted to movement disorders.

The University of Iowa also has information about the disorder, as do the National Institutes of Health and the Tourette Spectrum Disorder Association.

SOURCES: Interviews with Paul R. Sanberg, Ph.D., D.Sc., chief of neuroscience, University of South Florida College of Medicine, Tampa, David Comings, M.D., City of Hope National Medical Center, Duarte, Calif., and Colleen Wang, medical liaison, Tourette Spectrum Disorder Association, South Redlands, Calif.; September 2001 Journal of Clinical Psychiatry
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