Treatment of Gilles de la Tourette's syndrome: eight-year, practice-based experience in a predominantly adult population.

Over 86% of 58 patients with Gilles de la Tourette's syndrome achieved effective pharmacologic control of the symptoms for 3 months or longer. Differences in response patterns were common among patients and required individualized tailoring of management. Dopamine-blocking neuroleptics were the mainstay of therapy. However, frequent mid-course alterations were required as previously successful drugs stopped working or as their side effects became intolerable. While haloperidol and now pimozide are most frequently used, trifluoperazine and thiothixene can provide superior relief in individual patients. A combination of neuroleptics or even a rotation from one to another may occasionally become necessary. No tardive dyskinesia was encountered in this population. Clonidine proved inferior to neuroleptics in the treatment of the motor and vocal tics, but may have a role in some patients with prominent obsessive-compulsive symptomatology.