April 2022

Good news, it now looks as though lisdexamfetamine/ Vyvanse will be available within months. It was previously registered though not funded by Pharmac, but it practical terms obtaining it was very difficult. It will be imported by Takeda Pharmaceuticals and Jo and I will meet with their advisor in a few weeks time. The multiple daily dosing necessary for people taking dexamphetamine has been a real disadvantage compared with methylphenidate. 

Last month, I enjoyed attending the American Neuropsychiatric Association conference virtually. There were some great presentations and one of the more interesting was by Dr Tamara Pringsheim regarding the phenomenon of “TikTok tics” which has been an issue for the past few years amongst movement disorder experts. I have seen several cases myself. These are now being labelled Functional Tic Like Behaviours to help align their treatment with functional neurological disorders in general, and diagnostic criteria have been developed. The good news is that people do recover over time. 

There was also some useful discussion around the use of stimulants for ADHD when a comorbidity of a tic disorder such as Tourettes Disorder. It’s clear from the literature and expert opinion that there is no simple correlation between commencing a stimulant and an exacerbation of the tic disorder, and none of the discussants indicated they would avoid trials of appropriate treatment. There are of course cases in which methylphenidate etc. does increase tic frequency and severity, but equally atomoxetine can and tics can improve if the individual is less stressed. Of course other treatments such as clonidine run minimal risk of exacerbating tics but are also less effective.