Reactions 430 - 5 Dec 1992

★ SImipramine

First report of motor and vocal tics in children?:2 case reports

Two boys, aged 8 and 13 years, developed motor and vocaltics after 2 weeks’ treatment with imipramine 75-100 mg/dayfor attention deficit hyperactivity disorder (ADHD) andconcurrent depression. The tics observed included throatclearing, head shaking, stuttering, echolalia, palilalia, and theuse of profane language. Both children had family histories oftics. Imipramine was gradually withdrawn. As no improvementin the tics was observed, treatment with haloperidol wasinitiated Although successful, the dose of haloperidol waslowered in the first boy because of oversedation and refusal toattend school. When the tic symptoms reappeared,haloperidol was replaced with thioridazine which resulted inremission of the tics. The second boy continued to receivehaloperidol and, although the tics persisted, they improved80-90%. After 1 year’s follow-up, both boys met the DSM-IIIRtime requirement for the diagnosis of Tourette’s syndrome.

Author comment: ‘To our knowledge, there are nopreviously documented case reports about TCAs (tricyclicantidepressants) precipitating tics or TS (Tourette’ssyndrome).’ In these children, the development of Tourette’ssyndrome may have been coincidental; however, ‘... thepresence of ADHD may serve as a ‘‘warning sign’’ to alertclinicians to the risk of imipramine-induced tic symptoms indepressed children’Parraga HC, et al. Emergence of motor and vocal tics during imipramineadministration in two children. Journal of Child and AdolescentPsychopharmacology 2: 227-234, No. 3, 1992 - USA 800163235

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Reactions 5 Dec 1992 No. 4300114-9954/10/0430-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved