多巴胺受体激动剂
虽然多巴胺 (D2) 受体激动剂的使用与抽搐多巴胺受体模型相反，且有研究证明多巴胺 (D2) 受体拮抗剂治疗有效，但小型研究发现 D2 激动剂对抽搐治疗有效。[107]Gilbert DL, Sethuraman G, Sine L, et al. Tourette’s syndrome improvement with pergolide in a randomized, double-blind, crossover trial. Neurology. 2000 Mar 28;54(6):1310-5.http://www.ncbi.nlm.nih.gov/pubmed/10746603?tool=bestpractice.com[108]Lipinski JF, Sallee FR, Jackson C, Sethuraman G. Dopamine agonist treatment of Tourette disorder in children: results of an open-label trial of pergolide. Mov Disord. 1997 May;12(3):402-7.http://www.ncbi.nlm.nih.gov/pubmed/9159736?tool=bestpractice.com[109]Cianchetti C, Frielta A, Piscino T, et al. Pergolide improvement in neuroleptic-resistant Tourette cases: various mechanisms causing tics. Neurol Sci. 2005 Jun;26(2):137-9.http://www.ncbi.nlm.nih.gov/pubmed/15995832?tool=bestpractice.com[110]Anca MH, Giladi N, Korczyn AD. Ropinirole in Gilles de la Tourette syndrome. Neurology. 2004 May 11;62(9):1626-7.http://www.ncbi.nlm.nih.gov/pubmed/15136698?tool=bestpractice.com[111]Durson SM, Burke JG, Reveley MA. Buspirone treatment of Tourette’s syndrome. Lancet. 1995 May 27;345(8961):1366-7.http://www.ncbi.nlm.nih.gov/pubmed/7752772?tool=bestpractice.com[112]Feinberg M, Carroll BJ. Effects of dopamine agonists and antagonists in Tourette's disease. Arch Gen Psychiatry. 1979 Aug;36(9):979-85.http://www.ncbi.nlm.nih.gov/pubmed/380492?tool=bestpractice.com[113]Kurlan R, Crespi G, Coffey B, et al; Pramipexole for TS Trial Investigators. A multicenter randomized placebo-controlled clinical trial of pramipexole for Tourette's syndrome. Mov Disord. 2012 May;27(6):775-8.http://www.ncbi.nlm.nih.gov/pubmed/22407510?tool=bestpractice.com 然而，普拉克索治疗儿童 Tourette 综合征的试验发现，其不能有效抑制抽动。[113]Kurlan R, Crespi G, Coffey B, et al; Pramipexole for TS Trial Investigators. A multicenter randomized placebo-controlled clinical trial of pramipexole for Tourette's syndrome. Mov Disord. 2012 May;27(6):775-8.http://www.ncbi.nlm.nih.gov/pubmed/22407510?tool=bestpractice.com 总的来说，多巴胺受体激动剂的证据似乎尚无定论。
其他药物
目前已经研发或正在研发的用于治疗 Tourette 综合征的一些其他药物，包括新的非典型抗精神病药物（例如，帕潘立酮、舍吲哚）、调节乙酰胆碱或组胺的药物[27]Rapanelli M, Pittenger C. Histamine and histamine receptors in Tourette syndrome and other neuropsychiatric conditions. Neuropharmacology. 2016 Jul;106:85-90.http://www.ncbi.nlm.nih.gov/pubmed/26282120?tool=bestpractice.com 抗惊厥药物、乙酰半胱氨酸、[114]Bloch MH, Panza KE, Yaffa A, et al. N-acetylcysteine in the treatment of pediatric Tourette syndrome: randomized, double-blind, placebo-controlled add-on trial. J Child Adolesc Psychopharmacol. 2016 May;26(4):327-34.http://www.ncbi.nlm.nih.gov/pubmed/27027204?tool=bestpractice.com 纳洛酮、类固醇 5-α 还原酶和其他神经活性剂（丁螺环酮、甲氧氯普胺、毒扁豆碱、依考匹泮、[115]Gilbert DL, Budman CL, Singer HS, et al. A D1 receptor antagonist, ecopipam, for treatment of tics in Tourette syndrome. Clin Neuropharmacol. 2014 Jan-Feb;37(1):26-30.http://www.ncbi.nlm.nih.gov/pubmed/24434529?tool=bestpractice.com 氘代丁苯那嗪 [deutetrabenazine] [116]Jankovic J, Jimenez-Shahed J, Budman C, et al. A pilot study of SD-809 (deutetrabenazine) in tics associated with Tourette syndrome. Neurology. 2016 April;86(16 Suppl):1-46. 和螺朵林）。[115]Gilbert DL, Budman CL, Singer HS, et al. A D1 receptor antagonist, ecopipam, for treatment of tics in Tourette syndrome. Clin Neuropharmacol. 2014 Jan-Feb;37(1):26-30.http://www.ncbi.nlm.nih.gov/pubmed/24434529?tool=bestpractice.com[117]Termine C, Selvini C, Rossi G, et al. Emerging treatment strategies in Tourette syndrome: what's in the pipeline? Int Rev Neurobiol. 2013;112:445-80.http://www.ncbi.nlm.nih.gov/pubmed/24295630?tool=bestpractice.com
ω-3 脂肪酸
临床观察说明 ω-3 脂肪酸对 Tourette 综合征有治疗作用。 然而，ω-3 脂肪酸的唯一可用的双盲安慰剂对照研究未显示其对 Tourette 综合征的治疗有效。[118]Gabbay V, Babb JS, Klein RG, et al. A double-blind, placebo-controlled trial of ω-3 fatty acids in Tourette's disorder. Pediatrics. 2012 Jun;129(6):e1493-500.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362909/http://www.ncbi.nlm.nih.gov/pubmed/22585765?tool=bestpractice.com
重复经颅磁刺激疗法 (rTMS)
一些附属运动皮层 rTMS 的初步研究显示，该疗法对抽搐治疗效果有利。[119]Mantovani A, Lisanby SH, Pieraccini F, et al. Repetitive transcranial magnetic stimulation (rTMS) in the treatment of obsessive–compulsive disorder (OCD) and Tourette’s syndrome (TS). Int J Neuropsychopharmacol. 2006 Feb;9(1):95-100.https://academic.oup.com/ijnp/article/9/1/95/659473http://www.ncbi.nlm.nih.gov/pubmed/15982444?tool=bestpractice.com[120]Mantovani A, Leckman JF, Grantz H,et al. Repetitive transcranial stimulation of the supplementary motor area in the treatment of Tourette syndrome: report of two cases. Clin Neurophysiol. 2007 Oct;118(10):2314-5.http://www.ncbi.nlm.nih.gov/pubmed/17709291?tool=bestpractice.com 然而，其他研究发现，针对动作、运动前或辅助运动皮层时，rTMS 组和假治疗组之间无显著差异。[121]Münchau A, Bloem BR, Thilo KV, et al. Repetitive transcranial magnetic stimulation for Tourette syndrome. Neurology. 2002 Dec 10;59(11):1789-91.http://www.ncbi.nlm.nih.gov/pubmed/12473773?tool=bestpractice.com[122]Landeros-Weisenberger A, Mantovani A, Motlagh MG, et al. Randomized sham controlled double-blind trial of repetitive transcranial magnetic stimulation for adults with severe Tourette Syndrome. Brain Stimul. 2015 May-Jun;8(3):574-81.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4454615/http://www.ncbi.nlm.nih.gov/pubmed/25912296?tool=bestpractice.com
大麻
吸食大麻和口服四氢大麻酚 (THC) 的几个病例报告表明，大麻素可能对治疗 Tourette 综合征有效。[123]Kluger B, Triolo P, Jones W, et al. The therapeutic potential of cannabinoids for movement disorders. Mov Disord. 2015 Mar;30(3):313-27.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357541/http://www.ncbi.nlm.nih.gov/pubmed/25649017?tool=bestpractice.com 两项评估口服 THC 的小型安慰剂对照临床试验显示，与安慰剂相比，THC 能明显改善抽动症状，该试验为初步临床观察结果提供了数据支持。[124]Müller-Vahl KR, Schneider U, Prevedel H, et al. Delta 9-tetrahydrocannabinol (THC) is effective in the treatment of tics in Tourette syndrome: a 6-week randomized trial. J Clin Psychiatry. 2003 Apr;64(4):459-65.http://www.ncbi.nlm.nih.gov/pubmed/12716250?tool=bestpractice.com[125]Müller-Vahl KR, Schneider U, Koblenz A, et al. Treatment of Tourette's syndrome with Delta 9-tetrahydrocannabinol (THC): a randomized crossover trial. Pharmacopsychiatry. 2002 Mar;35(2):57-61.http://www.ncbi.nlm.nih.gov/pubmed/11951146?tool=bestpractice.com 尽管 Cochrane 分析认为常规推荐使用大麻素抑制抽动的证据不足，[126]Curtis A, Clarke CE, Rickards HE. Cannabinoids for Tourette's syndrome. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD006565.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006565.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/19821373?tool=bestpractice.com 但该治疗方法在治疗顽固性病例时可能发挥一定作用。[123]Kluger B, Triolo P, Jones W, et al. The therapeutic potential of cannabinoids for movement disorders. Mov Disord. 2015 Mar;30(3):313-27.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357541/http://www.ncbi.nlm.nih.gov/pubmed/25649017?tool=bestpractice.com[126]Curtis A, Clarke CE, Rickards HE. Cannabinoids for Tourette's syndrome. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD006565.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006565.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/19821373?tool=bestpractice.com[127]Hasan A, Rothenberger A, Münchau A, et al. Oral delta 9-tetrahydrocannabinol improved refractory Gilles de la Tourette syndrome in an adolescent by increasing intracortical inhibition: a case report. J Clin Psychopharmacol. 2010 Apr;30(2):190-2.http://www.ncbi.nlm.nih.gov/pubmed/20520294?tool=bestpractice.com[128]Müller-Vahl KR. Treatment of Tourette syndrome with cannabinoids. Behav Neurol. 2013;27(1):119-24.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215298/http://www.ncbi.nlm.nih.gov/pubmed/23187140?tool=bestpractice.com
