Use of Levetiracetam to Treat Tics in Children and Adolescents With Tourette Syndrome Yasser Awaad, MD, MSc, * Anne Marie Michon, MSN, RN, and Sarah Minarik, BSN, RN Department of Pediatrics, Oakwood Healthcare System, University of Michigan Medical School, Dearborn, Michigan, USA Abstract: Some drugs currently used to treat tics in pediatric patients have drawbacks, including the risk of side effects. New therapeutic options with better safety profiles are needed. Le- vetiracetam is an antiepileptic drug with atypical mechanisms of action that might be beneficial for this indication. We eval- uated the effects of levetiracetam on motor and vocal tics, behavior, and school performance in children and adolescents with tics and Tourette syndrome (TS). Sixty patients, 18 years of age, with tics and TS were enrolled in this prospective, open-label study. The initial starting dose of levetiracetam was 250 mg/day. The dosage was titrated over 3 weeks to 1,000 to 2,000 mg/day. Clinical outcomes were assessed with the Clin- ical Global Impression Scale, Yale Global Tic Severity Scale, and Revised Conners’ Parent Rating Scale. Behavior and school performance were also recorded. All 60 patients showed improvements based on all of the scales used, and 43 patients improved with regard to behavior and school performance. Levetiracetam was generally well tolerated. Three patients dis- continued treatment because of exaggeration of preexisting behavioral problems. Levetiracetam may be useful in treating tics in children and adolescents. Given its established safety profile, levetiracetam is a candidate for evaluation in a well- controlled trial. © 2005 Movement Disorder Society Key words: tics; Tourette syndrome; levetiracetam Tics are a common movement disorder in children and adolescents. As many as 10% of boys may experience tics at some point during childhood; tics are less common in girls. 1–3 Both motor tics (e.g., involving the facial muscles, neck, and upper limbs) and vocal tics (e.g., throat clearing, grunting, coughing, or cursing) occur in patients with Tourette syndrome (TS). In addition, pa- tients with TS often have comorbidities such as obses- sive– compulsive disorder and attention deficit hyperac- tivity disorder (ADHD). 4 Although tics may spontaneously improve or resolve over time, drug therapy should be considered for patients whose symptoms interfere with their daily life. A major goal of therapy for tics is to improve the patient’s quality of life by minimizing the potential for social embarrass- ment. Drugs used to treat TS include the neuroleptic agents haloperidol, pimozide, and fluphenazine. 5–7 How- ever, the use of these drugs is associated with troubling side effects. In one study, for example, only 12.5% (3 of 24) of patients with tics were able to continue their haloperidol without interruption. 8 Because of issues with neuroleptic drugs, other agents that are less effective but believed to be better tolerated are being evaluated for the treatment of tics. Despite the evaluation of several drugs, no single drug has emerged as an ideal therapy. Thus, there continues to be a need for effective and safe agents to treat tics. Based on the proposed role of -aminobutyric acid (GABA) in the dysfunction of the basal ganglia in pa- tients with TS, 7,9 GABAergic drugs may be a viable therapeutic option to improve tics. GABAergic drugs such as clonazepam and baclofen, for example, have been evaluated. 7,10 Levetiracetam is an antiepileptic drug that may have atypical GABAergic effects. 11 Levetirac- etam inhibits the ability of zinc and beta carbolines to interrupt chloride influx—an effect that enhances chlo- ride ion influx at the GABA type A (GABA-A) receptor complex. 12 These mechanisms of action could produce a beneficial effect in patients with TS. In addition, the safety profile of levetiracetam is well established, and there are some studies of the use of levetiracetam in *Correspondence to: Dr. Yasser Awaad, University of Michigan Medical School, 21031 Michigan Avenue, Dearborn, MI 48124. E-mail: yasser.awaad@oakwood.org Received 12 April 2004; Revised 11 August 2004; Accepted 21 September 2004 Published online 9 February 2005 in Wiley InterScience (www. interscience.wiley.com). DOI: 10.1002/mds.20385 Movement Disorders Vol. 20, No. 6, 2005, pp. 714 –718 © 2005 Movement Disorder Society 714