Tourette's Syndrome Treated with ACTH and Prednisone: Report of Two Cases

Two cases of Tourette's syndrome in young boys presented with initial symptoms that coincided with the onset of an infectious disease. Standard treatment with neuroleptics yielded weak therapeutic effects, and provoked significant adverse effects at low doses, in both cases. Based on additional clinical and laboratory findings, it was hypothesized that an allergic process was affecting immunological mechanisms of the brain, and the patients were treated with ACTH and prednisone. In one case, this treatment led to remission of the tic symptoms, which remained improved through lengthy follow up. In the other case, tics resurfaced repeatedly at times of demonstrable recurrent bacterial infections, and required multiple courses of ACTH and prednisone to obtain a complete remission of the symptoms. These findings may provide a new area for research into the etiology and treatment of Tourette's syndrome. The presence of streptococcal infections in these two cases of TS is reminiscent of the findings of antistriatal antibodies in Sydenham's chorea produced by streptococcus, and raises the speculation that some cases of Tourette's syndrome may represent an autoimmune phenomenon directed to parts of the central nervous system following infection and may respond to treatments with hormones that have an anti-allergenic action.