A 9 year old child with a history of ADHD diagnosed at 5 years of age has presented to you with multiple tics in different pas of the body. The child had also developed vocal tics including barking sounds and coprolalic. There is history of similar illness in the family. Note that the child has never had any pharmacotherapeutic agents for ADHD. Which of the following drugs will you consider in the treatment of the child initially?

This is a case of Gilles de la Tourette syndrome that has an onset at 2 - 21 years of age. Obsessive compulsive disorders and ADHD are also frequently associated with it. It is inherited in most cases as an autosomal dominant disease and the gene responsible has been mapped to chromosome 18. In this case it is also impoant to know that Methylphenidate given for ADHD may unmask Tourette syndrome. Here initially Haloperidol or Risperidone may be given at a dose of 0.25mg/24 hours and later increased to a dose of 2 - 6 mg/24 hours. It is effective in 50% of children. Ref: Nelson, 17th Edition, Page 2023