This week, two papers from the last couple of months on treatment of TS. Follow the links to the description of the studies, in the main repository of medical research information, known as "medline".

1) A Randomized, Double-Blind, Placebo-Controlled Study of Topiramate in the Treatment of Tourette Syndrome

This study is by a major author from Texas, Dr. Joseph Jankovic. As described below there are very many small scale studies of drug treatment, but this one is better than the majority as it is a "double blind placebo controlled study". This means that some patients received dummy pills (placebo) and neither the doctors assessing the patients nor the patients themselves knew which was which (although sometimes it is possible to guess, a factor that must be borne in mind). There are certainly cases where a drug looks promising when used in a few patients, but a proper placebo trial like this later shows that to be mere illusion.

Rather than a standard dopamine blocking drug, this was a study of an epilepsy drug called Topiramate. Only 29 patients were tested, mainly males and both children and adults and over a period of less than three months. On average, patients taking the drug improved in terms of the number and severity of their tics compared to the placebo group. This kind of study doesn't give us hard evidence about how this drug compares with other drugs and the fact that different patients react differently is always a problem in TS. However, it is an indication that this drug might be worth trying.

2) Complementary and alternative medicine use in Gilles de la Tourette syndrome

This is a study about the use of complementary (CAM) therapies. Using questionnaire of 100 patients or parents there was a high frequency of use of at least one kind of CAM (64%). These included prayer (study done in Chicago), vitamins, massage, dietary supplements, chiropractic manipulation, meditation, yoga, acupuncture, hypnosis, homeopathy etc- basically anything. Most people initiated these strategies without telling their doctor.

It would be interesting to know if a similar picture exists in the UK. Whilst there isn't evidence that any of these treatments help TS and additionally for most of them there is no scientific rationale to explain how they possibly could, it isn't possible to say that nobody has benefited from going down this route. Even placebos help patients, especially if they have faith that they might. Moreover some of these therapies may promote relaxation, which in itself is a legitimate strategy, although we do know that relaxation therapy alone is inferior to a package including Habit Retraining Therapy (HRT, see below).