Introduction: Tics are sudden, recurrent, involuntary motor movements or vocalizations caused by involuntary contractions of motor or vocal muscles. Typically these disorders are characterized by early childhood onset and are more common in the male population. Genetic, neurobiological, neurochemical and environmental factors play a role in the pathogenesis, and malfunctioning of the basal ganglia is thought to be responsible for the disease. The presence of abnormalities in the EEG of some patients, worsening of the tics with administration of dopamine agonists, and improvement of tics with antidopaminergic agents are some of the known biological evidence. Amisulpride, with a pure antidopaminergic activity, and thus being used effectively in the treatment of Tourette's syndrome, makes it a candidate to treat other tic disorders, as well. In this report, an adult patient diagnosed with "Tic Disorder Not Otherwise Specified," who was previously treated with several antidepressant and antipsychotic drugs, is cured with amisulpride.
Case presentation: A 21-year-old single male patient was admitted to the hospital complaining of impairment in interpersonal relations, difficulties in social adaptation due to the involuntary repetition of certain movements. His complaints had started at the age of nine after his uncles were killed. Though the patient was tried on different treatment regimens, but he had no benefits. Because of his tics, he hardly finished his primary school education and was not able to work for a long time. In history there were no perinatal or neonatal complications and he was born by spontaneous vaginal birth. As the sixth of eleven children, his developmental history was normal. There was no family history of any mental illness, epilepsy, alcoholism, or movement disorder. On his admission to the unit, he was given amisulpride 200mg/day and the dosage was increased to 400mg/day in three days. He had a score of 15 in motor tics on admission and he had a score of 3 for motor score (80% decrease) at the third week of the treatment. No side effects were observed and he was discharged at the end of the third week. All of the signs were in remission on the follow up after two months.
Discussion: Contrary to the antipsychotics effecting both D1 and D2 receptors in the nigrostriatal pathway, antipsychotics of the benzamide group, which work as selective D2 receptor antagonists, are effective in the treatment of tic disorders. As the most preferred drug in this group, amisulpride causes less extrapyramidal side effects by selectively acting on the limbic regions rather than striatal regions. In the literature, there are case reports of amisulpride's effective use in tic disorders. Clinicians should keep in mind that, with less side effect risk compared to conventional antipsychotics and the benefits of its mechanism of action, amisulpride might be the drug of choice in tic disorders. On the other hand, larger controlled clinical trials should be planned on this issue.
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