TOURETTE SYNDROME & ADHD TREATMENT CONUNDRUM EVALUATED IN FEDERAL STUDY

Treatment is especially challenging in the large percentage of children with Tourette Syndrome (TS) who also have attention deficit hyperactivity disorder (ADHD) because Ritalin (methylphenidate), the stimulant most often prescribed for ADHD, can increase the involuntary movements and sounds known as tics that are a hallmark of Tourette.

In 1996, the National Institute of Neurological Diseases and Stroke awarded a grant to seven medical centers, including Emory University, to evaluate this catch-22.

The study is entitled "Treatment of ADHD in Children with Tourette Syndrome (TACT)" and principal investigator at the Emory site is Jorge L. Juncos, M.D., associate professor of Neurology at the Emory University School of Medicine. The Emory team hopes to enroll in the study about 10 more children between now and the February 1999 enrollment deadline.

Tourette Syndrome (TS) is a neurologic disorder usually diagnosed in children under age 21. The characteristic motor and vocal tics associated with the disorder are mild in the majority of patients and often diminish with age. Very few affected persons actually have coprolalia, the involuntary swearing that the public often associates with TS. However, many children with TS also exhibit symptoms of ADHD such as short attention spans, poor concentration, impulsivity and hyperactivity, according to Dr. Juncos.

"This study has been driven by the investigators' concern that children with TS are being undertreated, or 'shortchanged,' when it comes to their ADHD symptoms," Dr. Juncos says.

"Investigators propose that fears that methylphenidate may aggravate tics is grossly exaggerated and based on poorly controlled studies in which the dose escalation of methylphenidate was not appropriately modified to meet the needs of TS children. Our goal is to examine the possibility that, by introducing clonidine (Catapres, a high blood pressure medication often used to relieve tic symptoms in Tourette) before adding methylphenidate, the potential effects of methylphenidate on tics can be mitigated."

Children enrolled in the study should be between 7-14 years of age. They will be randomized to receive either clonidine, methylphenidate, a combination of both drugs, or an inactive placebo pill.

The study requires participation from each child's family and school.

Study medications and treatments are provided free of charge.

The study takes place during the regular school semester and consists of five visits over 16 weeks. Accordingly, recruitment is now beginning for the fall semester.

Visits take place at the Wesley Woods Health Center, located near the Emory campus at 1841 Clifton Rd., N.E., Atlanta.

For information call the investigator, Dr. J. L. Juncos, at 404/ 728-4952.