There is much interest in the role of cholinergic systems in nervous and mental disease. Since nicotine, the psychoactive ingredient in tobacco, is the primary nicotine cholinergic agonist it is important to ascertain the possibilities of this agent for therapy of neuropsychiatric disorders. Although it is commonly felt that """"""""nicotine has no therapeutic applications,"""""""" recent work has demonstrated that it may prove beneficial as an adjunct therapy for extrapyramidal disorders such as Tourette Syndrome. Tourette Syndrome is a complex disorder with both motor and verbal tics. While the drugs of choice for the disorder are dopamine receptors blockers, such as haloperidol, some patients show only marginal response. Furthermore, these drugs can lead to sedation, exacerbation of learning difficulties, and possible tardive dyskinesia. For these reason, an agent that potentiates the effects of neuroplastics administration of 2 mg nicotine gum alone had little effect. A major problem associated with treating patients with nicotine gum were the associated side effects, such as the bitter taste of the gum, upset stomach and nausea, thus making compliance very difficult especially for younger patients. Since nicotine is beneficial to patients, there may be a tendency for non-complying patients to obtain nicotine from another source, such as smokeless tobacco products. Therefore, it may also be important to find an alternative more compliant nicotine source. With the current availability of transdermal nicotine patches, these problems can be alleviated, thus providing good compliance. Also, it is now possible to determine if continuous nicotine via the transdermal approach in combination with haloperidol can be beneficial for patients. Preliminary studies with 7 mg nicotine patches and neuroleptic in several patients have shown significant improvement of Tourette's symptoms. The present study will examine the effects of transdermal nicotine in a controlled double-blind fashion on patients wit Tourettes Syndrome to determine whether continuous nicotine potentiates the therapeutic effects of haloperidol in this disorder and is more compliant. These studies should help determine the usefulness for treating neuroleptic responsive disorders wit nicotine adjunctive therapy.
| Silver, A A; Shytle, R D; Philipp, M K et al. (2001) Transdermal nicotine and haloperidol in Tourette's disorder: a double-blind placebo-controlled study. J Clin Psychiatry 62:707-14 |
| Silver, A A; Shytle, R D; Philipp, M K et al. (1996) Case study: long-term potentiation of neuroleptics with transdermal nicotine in Tourette's syndrome. J Am Acad Child Adolesc Psychiatry 35:1631-6 |
