Gilles de la Tourette's disorder associated with pemoline

According to DSM-III, Tourette's disorder is characterized by 'recurrent, involuntary, repetitive rapid movements (tics) including multiple vocal tics... The tics typically involve the head and, frequently, other parts of the body such as the torso and upper and lower limbs. The vocal tics include ... clicks, yelps, barks, sniffs, coughs or words'. Age of onset ranges from 2 to 15 years. The tics are exacerbated by stress and can be voluntarily suppressed. Recent reports in the literature have begun to support an organic etiology for this syndrome. A neurophysiologic impairment of the CNS has been postulated, with varying support from data showing anatomic pathology implied by abnormalities found on psychological testing, EEGs, and neurological examinations. The neurotransmitters dopamine and norepinephrine have been suggested as mediators for this disorder. This hypothesis is supported by the observation that haloperidol, which blocks postsynaptic dopamine and norepinephrine receptors, will relieve symptoms in most affected individuals. There have also been case reports of precipitation of worsening of symptoms by methylphenidate therapy. Methylphenidate is a pharmacological antagonist of haloperidol that increases the availability of neurotransmitter at postsynaptic catecholaminergic receptor sites. The case report introduces another pharmacologic agent that may be implicated in movement disorders.