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Gong H, Du X, Su A, Du Y. Pharmacological treatment of Tourette's syndrome: from the past to the future. Neurol Sci 2024; 45:941-962. [PMID: 37962703 DOI: 10.1007/s10072-023-07172-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
Tourette's syndrome (TS) is a neuropsychiatric disease featuring tics and vocal tics, with a prevalence of approximately 1%, including 75% of the total number of male patients. TS seriously disturbs the patients' career, education, and life and brings a serious and unbearable psychological burden to the patients themselves and their families. At present, there are no specific clinical medications recommended for treating TS. Therefore, it is necessary to select the appropriate medication for symptomatic treatment based on the doctor's personal experience and the patient's symptoms, with the main goal of relieving symptoms, thus improving the patient's social skills and psychological problems. Here we conducted a comprehensive search on PubMed to review and organize the history and current status of the development of drug therapy for TS through a timeline format. We also systematically evaluated the effects of each drug for TS treatment to summarize the current problems and new research directions and to provide some ideas for clinical treatment.
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Affiliation(s)
- Hao Gong
- School of Basic Medical Sciences, Henan University, Kaifeng, People's Republic of China
- Department of General Surgery, West China Hospital Sichuan University, Chengdu, 610041, People's Republic of China
| | - Xiangyu Du
- School of Basic Medical Sciences, Henan University, Kaifeng, People's Republic of China
- Department of General Surgery, West China Hospital Sichuan University, Chengdu, 610041, People's Republic of China
| | - Anping Su
- Department of General Surgery, West China Hospital Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yaowu Du
- School of Basic Medical Sciences, Henan University, Kaifeng, People's Republic of China.
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Barchel D, Stolar O, Ziv-Baran T, Gueta I, Berkovitch M, Kohn E, Bar-Lev Schleider L. Use of Medical Cannabis in Patients with Gilles de la Tourette's Syndrome in a Real-World Setting. Cannabis Cannabinoid Res 2024; 9:293-299. [PMID: 36342913 PMCID: PMC10874815 DOI: 10.1089/can.2022.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective: Tourette's syndrome (TS) is a neurodevelopmental disorder characterized by vocal and motor tics and other comorbidities. Clinical recommendations for the use of medical cannabis are established, yet further guidance is needed. The aim of this study was to describe the experience of patients with TS with medical cannabis. Materials and Methods: TS patients were recruited from a registry of patients ("Tikun Olam" company). Questionnaires were answered before and after 6 months of treatment. Patients were divided into two groups: (A) patients who responded and (B) patients who did not respond to the follow-up questionnaire. In group A, an analysis was made to evaluate the presence and frequency of motor and vocal tics. The patients' general mood, employment status, quality of life, and comorbidities were also included in the analysis. Results: Seventy patients were identified. The tetrahydrocannabinol and cannabidiol mean daily dose was 123 and 50.5 mg, respectively. In group A, a statistically significant improvement was identified in quality of life (p<0.005), employment status (p=0.027), and in the reduction of the number of medications (p<0.005). Sixty-seven percent and 89% of patients with obsessive-compulsive disorder and anxiety comorbidities, respectively, reported an improvement. No statistically significant improvement was identified in motor tics (p=0.375), vocal tics (p>0.999), tics frequency (p=0.062), or general mood (p=0.129). The most frequent adverse effects were dizziness (n=4) and increased appetite (n=3). Conclusion: Subjective reports from TS patients suggest that medical cannabis may improve their quality of life and comorbidities. More studies are needed to evaluate the efficacy and safety of medical cannabis. Registry in the MOH: https://www.moh.gov.sg/ (Trial number: 0185-19-ASF).
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Affiliation(s)
- Dana Barchel
- Clinical Pharmacology and Toxicology Unit, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel; affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Orit Stolar
- Autistic Spectrum Disorder Clinic, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel; affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Tel-Aviv University, Tel-Aviv, Israel
| | - Itai Gueta
- Internal Medicine A, Sheba Medical Center, The Institute of Clinical Pharmacology and Toxicology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
| | - Matitiahu Berkovitch
- Clinical Pharmacology and Toxicology Unit, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel; affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Elkana Kohn
- Clinical Pharmacology and Toxicology Unit, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel; affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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3
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Raz G, Davidovitch S, Halevi M, Zuckerman M, Ben-Haim Y, Koryto Y, Steinberg T, Leitner Y, Rotstein MS. Impact of movie and video game elements on tic manifestation in children. Eur J Neurol 2024; 31:e16120. [PMID: 37946628 DOI: 10.1111/ene.16120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND AND PURPOSE Children in developed countries spend a significant portion of their waking hours engaging with audiovisual content and video games. The impact of media consumption on children's health and well-being has been widely studied, including its effects on tic disorders. Previous studies have shown that tic frequency can both increase and decrease during activities like gaming and television watching, resulting in mixed findings. METHODS To better understand the impact of audiovisual media on tics, we conducted a fine-grained tic manifestation analysis. We focused on the effects of the impact of a movie scene with suspensful elements and a video game designed to heighten anticipation, thought to stimulate phasic and striatal dopamine release. We closely monitored tic frequency throuhghout these experiences based on moment-to-moment tic annotation. The study included 20 participants (19 males aged 7-16) diagnosed with tic disorders (Yale Global Tic Severity Scale≥8), and we tested the replicability of our findings with an independent group of 36 children (15 females, aged 7-15) with tic disorders. RESULTS During film viewing, we observed significant synchronization in the temporal tic patterns of various individuals despite diversity in their tic profiles. Furthermore, employing a video game developed for our study, we found that tic frequency increases during anticipation of a pending reward. This finding was replicated in a second experiment with an independent cohort. CONCLUSIONS Our results indicate that tic frequency is affected by media elements in the short-term, and call for further investigation of the long-term impacts of exposure to such tic triggers.
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Affiliation(s)
- Gal Raz
- Steve Tisch School of Film and Television, Faculty of the Arts, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shiri Davidovitch
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Mor Halevi
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Maya Zuckerman
- David and Yolanda Katz Faculty of the Arts, Tel Aviv University, Tel Aviv, Israel
| | - Yael Ben-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Koryto
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tamar Steinberg
- Matta and Harry Freund Neuropsychiatric Tourette Clinic, Department of Child and Adolescent Psychiatry, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Leitner
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Child Development Institute, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
- Pediatric Neurology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Michael S Rotstein
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Child Development Institute, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
- Pediatric Neurology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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4
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Jankovic J, Coffey B, Claassen DO, Jimenez‐Shahed J, Gertz BJ, Garofalo EA, Stamler DA, Wieman M, Savola J, Harary E, Alexander J, Barkay H, Gordon MF. Safety and Efficacy of Long-Term Deutetrabenazine Use in Children and Adolescents with Tics Associated with Tourette Syndrome: An Open-Label Extension Study. Mov Disord Clin Pract 2023; 10:1388-1398. [PMID: 37772282 PMCID: PMC10525047 DOI: 10.1002/mdc3.13849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/06/2023] [Accepted: 07/08/2023] [Indexed: 09/30/2023] Open
Abstract
Background Tourette syndrome (TS) is a neurodevelopmental disorder characterized by motor and phonic tics. Objective To assess the safety and efficacy of deutetrabenazine (Teva Neuroscience, Inc, Parsippany, NJ), a vesicular monoamine transporter 2 inhibitor, in children and adolescents with TS. Methods Alternatives for Reducing Tics in TS (ARTISTS) open-label extension (OLE) (NCT03567291) was a 54-week, global, phase 3, open-label extension study of deutetrabenazine (6-48 mg daily) conducted May 28, 2018 to April 3, 2020 with a 2-week randomized withdrawal period. Participants (6-16 years of age) had TS and active tics causing distress or impairment. Safety (primary outcome) was assessed by treatment-emergent adverse events (TEAEs) and clinical laboratory testing. Efficacy was measured by the Yale Global Tic Severity Scale-Total Tic Score (YGTSS-TTS). Results The intent-to-treat population (228 participants; mean age, 12.0 years; 79.8% male; 86.4% white) had a median (range) duration of exposure of 28.4 (0.3-52.9) weeks. Of 227 participants in the safety analysis, 161 (70.9%) reported ≥1 TEAE (exposure-adjusted incidence rate, 2.77/patient-year), of which 95 (41.9%) were treatment related. The most frequently reported TEAEs were headaches, somnolence, nasopharyngitis, weight increases, and anxiety. No additional safety signals were observed. Worsening of YGTSS-TTS after the 2-week randomized withdrawal was not statistically significant (least squares mean difference, -0.4; P = 0.78). Several exploratory measures showed sustained improvement throughout the treatment periods. Conclusions In this long-term, open-label trial, deutetrabenazine was well tolerated with low frequency of TEAEs. There was no significant difference in tics between treatment arms during the 2-week randomized withdrawal period, however, descriptive statistics and comparison with baseline showed a numeric improvement in tics, quality of life, and other measures.
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Affiliation(s)
- Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of NeurologyBaylor College of MedicineHoustonTexasUSA
| | - Barbara Coffey
- Department of Psychiatry and Behavioral Sciences, Child and Adolescent PsychiatryUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Daniel O. Claassen
- Department of Neurology, Division of Behavioral and Cognitive NeurologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Joohi Jimenez‐Shahed
- Movement Disorders Neuromodulation & Brain Circuit Therapeutics, Departments of Neurology and NeurosurgeryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | | | | | - David A. Stamler
- Teva Branded Pharmaceutical Products R&D, Inc.La JollaCaliforniaUSA
| | - Maria Wieman
- Teva Branded Pharmaceutical Products R&D, Inc.West ChesterPennsylvaniaUSA
| | | | - Eran Harary
- Innovative Medicines, Global Clinical DevelopmentTeva Pharmaceutical Industries Ltd.NetanyaIsrael
| | - Jessica Alexander
- Global Medical AffairsTeva Branded Pharmaceutical Products R&D, Inc.West ChesterPennsylvaniaUSA
| | - Hadas Barkay
- Innovative Medicines, Global Clinical DevelopmentTeva Pharmaceutical Industries Ltd.NetanyaIsrael
| | - Mark Forrest Gordon
- Innovative Medicines, Global Clinical DevelopmentTeva Branded Pharmaceutical Products R&D, Inc.West ChesterPennsylvaniaUSA
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Cadeddu R, Van Zandt M, Santovito LS, Odeh K, Anderson CJ, Flanagan D, Nordkild P, Pinna G, Pittenger C, Bortolato M. Prefrontal allopregnanolone mediates the adverse effects of acute stress in a mouse model of tic pathophysiology. Neuropsychopharmacology 2023; 48:1288-1299. [PMID: 37198434 PMCID: PMC10354086 DOI: 10.1038/s41386-023-01603-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 04/24/2023] [Accepted: 05/05/2023] [Indexed: 05/19/2023]
Abstract
Ample evidence suggests that acute stress can worsen symptom severity in Tourette syndrome (TS); however, the neurobiological underpinnings of this phenomenon remain poorly understood. We previously showed that acute stress exacerbates tic-like and other TS-associated responses via the neurosteroid allopregnanolone (AP) in an animal model of repetitive behavioral pathology. To verify the relevance of this mechanism to tic pathophysiology, here we tested the effects of AP in a mouse model recapitulating the partial depletion of dorsolateral cholinergic interneurons (CINs) seen in post-mortem studies of TS. Mice underwent targeted depletion of striatal CINs during adolescence and were tested in young adulthood. Compared with controls, partially CIN-depleted male mice exhibited several TS-relevant abnormalities, including deficient prepulse inhibition (PPI) and increased grooming stereotypies after a 30-min session of spatial confinement - a mild acute stressor that increases AP levels in the prefrontal cortex (PFC). These effects were not seen in females. Systemic and intra-PFC AP administration dose-dependently worsened grooming stereotypies and PPI deficits in partially CIN-depleted males. Conversely, both AP synthesis inhibition and pharmacological antagonism reduced the effects of stress. These results further suggest that AP in the PFC mediates the adverse effects of stress on the severity of tics and other TS-related manifestations. Future studies will be necessary to confirm these mechanisms in patients and define the circuitry responsible for the effects of AP on tics.
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Affiliation(s)
- Roberto Cadeddu
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Meghan Van Zandt
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Luca Spiro Santovito
- The Psychiatric Institute, Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Karen Odeh
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Collin J Anderson
- Department of Neurology, School of Medicine, University of Utah, Salt Lake City, UT, USA
- School of Medical Sciences, University of Sydney, Camperdown, NSW, Australia
- School of Biomedical Engineering, University of Sydney, Camperdown, NSW, Australia
| | - Deirdre Flanagan
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | | | - Graziano Pinna
- The Psychiatric Institute, Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
- UI Center on Depression and Resilience (UICDR), Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
- Center for Alcohol Research in Epigenetics (CARE), Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Christopher Pittenger
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA.
- Department of Psychology, School of Arts and Sciences, Yale University, New Haven, CT, USA.
- Child Study Center, School of Medicine, Yale University, New Haven, CT, USA.
- Center for Brain and Mind Health, School of Medicine, Yale University, New Haven, CT, USA.
| | - Marco Bortolato
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
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Soerensen CB, Lange T, Jensen SN, Grejsen J, Aaslet L, Skov L, Debes NM. Exposure and Response Prevention for Children and Adolescents with Tourette Syndrome Delivered via Web-Based Videoconference versus Face-to-Face Method. Neuropediatrics 2023; 54:99-106. [PMID: 36423651 DOI: 10.1055/a-1987-3205] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Chronic tic disorders, such as Tourette syndrome, are characterized by motor and vocal tics. Tics present a considerable burden for some patients, and therefore, effective treatment is important. One evidence-based treatment option is a behavioral therapy called exposure and response prevention (ERP). Despite its effectiveness, access to ERP remains limited due to a lack of treatment sites. Web-based videoconferences can connect patients at home with a therapist located in the hospital, allowing for treatment delivery over a wide geographic area. The primary aim of this study was to compare the development of tics during and 1 year after ERP delivery, respectively, via web-based videoconferences and traditional face-to-face methods in a naturalistic setting. In total, 116 patients treated using either the face-to-face method (n = 72) or web-based videoconferences (n = 44) were included. The primary outcome measure was tic severity. In both training modalities, tic severity decreased during ERP and the effect lasted in the follow-up period. No statistically significant differences in tic severity between the training modalities were found at baseline, last training session, or at follow-up. Our results suggest that ERP delivered via web-based videoconferences is a good alternative to the traditional face-to-face method.
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Affiliation(s)
- Camilla Birgitte Soerensen
- Department for Children and Adolescents, Danish Tourette Clinic at Herlev University Hospital, Herlev, Denmark
| | - Theis Lange
- Section of Biostatistics, Department of Public Health, Copenhagen University, København, Denmark
| | - Sidsel Normann Jensen
- Section of Biostatistics, Department of Public Health, Copenhagen University, København, Denmark
| | - Judy Grejsen
- Department for Children and Adolescents, Danish Tourette Clinic at Herlev University Hospital, Herlev, Denmark
| | - Lone Aaslet
- Department for Children and Adolescents, Danish Tourette Clinic at Herlev University Hospital, Herlev, Denmark
| | - Liselotte Skov
- Department for Children and Adolescents, Danish Tourette Clinic at Herlev University Hospital, Herlev, Denmark
| | - Nanette Mol Debes
- Department for Children and Adolescents, Danish Tourette Clinic at Herlev University Hospital, Herlev, Denmark
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Ricketts EJ, Swisher V, Greene DJ, Silverman D, Nofzinger EA, Colwell CS. Sleep Disturbance in Tourette's Disorder: Potential Underlying Mechanisms. CURRENT SLEEP MEDICINE REPORTS 2023; 9:10-22. [PMID: 37636897 PMCID: PMC10457082 DOI: 10.1007/s40675-022-00242-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 01/24/2023]
Abstract
Purpose of review Sleep disturbance is common in TD. However, our understanding of the pathophysiological mechanisms involved is preliminary. This review summarizes findings from neuroimaging, genetic, and animal studies to elucidate potential underlying mechanisms of sleep disruption in TD. Recent findings Preliminary neuroimaging research indicates increased activity in the premotor cortex, and decreased activity in the prefrontal cortex is associated with NREM sleep in TD. Striatal dopamine exhibits a circadian rhythm; and is influenced by the suprachiasmatic nucleus via multiple molecular mechanisms. Conversely, dopamine receptors regulate circadian function and striatal expression of circadian genes. The association of TD with restless legs syndrome and periodic limb movements indicates shared pathophysiology, including iron deficiency, and variants in the BTDB9 gene. A mutations in the L-Histidine Decarboxylase gene in TD, suggests the involvement of the histaminergic system, implicated in arousal, in TD. Summary These biological markers have implications for application of novel, targeted interventions, including noninvasive neuromodulation, iron supplementation, histamine receptor antagonists, and circadian-based therapies for tic symptoms and/or sleep and circadian rhythms in TD.
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Affiliation(s)
- Emily J Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Valerie Swisher
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Deanna J Greene
- Department of Cognitive Science, University of California, San Diego
| | - Daniel Silverman
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles
| | - Eric A Nofzinger
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Christopher S Colwell
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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Zamani E, Ahmadi Shad A, Fatemi H, Mahboubi S, Motavallian A, Evazalipour M. Assessment of Protective Effects of Carvacrol on Haloperidol-Induced Oxidative Stress and Genotoxicity in Human Peripheral Blood Lymphocytes. J Toxicol 2022; 2022:9565881. [PMID: 36329925 PMCID: PMC9626238 DOI: 10.1155/2022/9565881] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/14/2022] [Indexed: 08/24/2023] Open
Abstract
Haloperidol is a first-generation antipsychotic drug that has several indications in a wide range of mental conditions. The extensive prescription of haloperidol is correlated with some less-known adverse effects such as genotoxicity. Carvacrol is a monoterpenoid mainly found in oregano and thyme. It has the potential to scavenge free radicals in addition to increasing antioxidant defense enzyme activities and glutathione levels. In this study, we attempted to explore the possible potential of haloperidol in inducing genotoxicity in human peripheral lymphocytes as well as the protective role of carvacrol against this effect. The lymphocytes were divided into separate groups as follows: control group (cosolvent and NS); carvacrol group (5 μM); haloperidol group (25, 50, and 100 ng/ml); haloperidol (25, 50, and 100 ng/ml) + carvacrol (5 μM); positive control (0.8 μg/ml Cisplatin). After 24 hours of treatment, we conducted a cytokinesis-Block micronucleus test and an alkaline comet assay in order to determine genetic damage. Additionally, we measured glutathione and MDA levels as the biomarkers associated with oxidative stress. Significant increases in the levels of genotoxicity biomarkers (micronucleus frequency, DNA percentage in tail and tail moment) were observed in haloperidol-treated cells. The result of our oxidative stress tests also demonstrated that haloperidol had the potential to induce oxidative stress via reducing the levels of glutathione and increasing lipid peroxidation. Treatment with carvacrol significantly decreased the genotoxic events. It can be presumed that the induction of oxidative stress by haloperidol is the critical event associated with haloperidol-mediated genotoxicity. Therefore, using carvacrol as a natural antioxidant protected human lymphocytes against haloperidol genetic damage.
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Affiliation(s)
- Ehsan Zamani
- Department of Pharmacology and Toxicology, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran
| | - Alireza Ahmadi Shad
- Student Research Committee, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran
| | - Hediye Fatemi
- Department of Pharmacology and Toxicology, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran
- Student Research Committee, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran
| | - Saba Mahboubi
- Student Research Committee, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran
| | - Azadeh Motavallian
- Department of Pharmacology and Toxicology, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Mehdi Evazalipour
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran
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Lin X, Lin F, Chen H, Weng Y, Wen J, Ye Q, Chen C, Cai G. Comparison of efficacy of deep brain stimulation, repeat transcranial magnetic stimulation, and behavioral therapy in Tourette syndrome: A systematic review and Bayesian Network Meta-Analysis. Heliyon 2022; 8:e10952. [PMID: 36281376 PMCID: PMC9587297 DOI: 10.1016/j.heliyon.2022.e10952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/19/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Background Tourette syndrome (TS) is an incurable neuropsychiatric disorder. Deep brain stimulation (DBS), repeat transcranial magnetic stimulation (rTMS), and behavioral therapy (BT) are all effective treatments. However, the comparison of therapeutic effect of these three therapies is lacking. Methods A systematic literature search was conducted for randomized controlled studies (RCT). A network meta-analysis by R4.04 software according to Bayesian framework were performed. Results were meta-analyzed and network meta-analyzed to evaluate and compare the efficacy of DBS, rTMS and BT in TS patients. Results A total of 18 randomized controlled studies with 661 participants were included. The Yale Global Tic Severity Scale (YGTSS) and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) were utilized to evaluate the symptoms of TS. All three treatments improved the tic symptoms of TS [DBS 12.11 (95%CI 7.58-16.65); rTMS 4.96 (95%CI 1.01-10.93); andBT 11.72 (95%CI 10.42-13.01)]; and obsessive-compulsive symptom [DBS 4.9 (95%CI 1.13-8.67); rTMS 5.28 (95%CI 0.21-10.77); and BT 1.61 (95%CI 0.74-2.48)]. The cumulative probability results showed that DBS had the best effect on the improvement of tic symptoms, followed by BT; and rTMS was ranked last. However, in terms of improvement of obsessional symptoms, rTMS was ranked first, DBS was ranked second, and BT was ranked last. In addition, the meta regression analysis of YGTSS in DBS, rTMS and BT has significant difference (P = 0.05). Limitation Due to the lack of quantitative indicators, we did not perform a network meta-analysis of the side effects of the three treatments. Conclusion Our study showed that DBS, rTMS, and BT are effective in TS. DBS causes the best improvement in tic symptoms, and rTMS is the most effective in improving the obsessive-compulsive symptoms.
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Affiliation(s)
- Xiaofeng Lin
- Department of Neurology, Union Hospital, Institute of Neuroscience, Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350001, China,Endocrinology, Fujian Provincial Hospital, Fuzhou 350001, China
| | - Fabin Lin
- Department of Neurology, Union Hospital, Institute of Neuroscience, Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350001, China,Department of Clinical Medicine, Fujian Medical University, Fuzhou 350001, China,Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Huiyun Chen
- Fujian Province Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fujian 35008, China
| | - Yanhong Weng
- Department of Neurology, Union Hospital, Institute of Neuroscience, Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350001, China
| | - Junping Wen
- Endocrinology, Fujian Provincial Hospital, Fuzhou 350001, China,Corresponding author.
| | - Qinyong Ye
- Department of Neurology, Union Hospital, Institute of Neuroscience, Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350001, China
| | - Chunmei Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou 350001, China,Corresponding author.
| | - Guoen Cai
- Department of Neurology, Union Hospital, Institute of Neuroscience, Institute of Clinical Neurology, Fujian Medical University, Fuzhou 350001, China,Department of Clinical Medicine, Fujian Medical University, Fuzhou 350001, China,Corresponding author.
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10
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O’Malley JA. Diagnosing Common Movement Disorders in Children. Continuum (Minneap Minn) 2022; 28:1476-1519. [DOI: 10.1212/con.0000000000001187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bennett SM, Hindin JS, Mohatt J, Bauer C, Schild J, Falk A, Specht M, Woods D, Walkup J. Proof of Concept Study of an Oral Orthotic in Reducing Tic Severity in Tourette Syndrome. Child Psychiatry Hum Dev 2022; 53:953-963. [PMID: 33959852 DOI: 10.1007/s10578-021-01178-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 11/30/2022]
Abstract
The use of an oral orthotic, called an occlusal splint, has gained recognition for the potential to reduce the frequency of tics for individuals with Persistent Tic Disorders. The purpose of this study was to assess the feasibility of a fully blinded, randomized controlled trial (RCT) to assess the safety, tolerability and initial efficacy of the oral orthotic in youth with chronic tics. Thirteen youth were randomly assigned to wear an active or sham orthotic in a two week double-blind RCT, with a 4-6 week unblinded follow up period. A statistically significant difference was found for change in tic severity between participants wearing the active and sham orthotic. However, this difference was not replicated during the follow up period. The oral orthotic is a promising intervention for the reduction of tics in youth with Tourette's Syndrome and is worthy of continued study to establish intervention efficacy and mechanism of action.
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Affiliation(s)
- Shannon M Bennett
- Weill Cornell Medical College, 315 East 62nd Street, 5th Floor, New York, NY, 10065, USA.
| | | | - Justin Mohatt
- Weill Cornell Medical College, 315 East 62nd Street, 5th Floor, New York, NY, 10065, USA
| | | | | | - Avital Falk
- Weill Cornell Medical College, 315 East 62nd Street, 5th Floor, New York, NY, 10065, USA
| | - Matthew Specht
- Weill Cornell Medical College, 315 East 62nd Street, 5th Floor, New York, NY, 10065, USA
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12
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Cavanna AE. Current and emerging pharmacotherapeutic strategies for Tourette syndrome. Expert Opin Pharmacother 2022; 23:1523-1533. [PMID: 35913140 DOI: 10.1080/14656566.2022.2107902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Tourette syndrome (TS) is a chronic tic disorder characterized by both motor and vocal tics. The vast majority of patients present with co-morbid behavioral problems, especially tic-related obsessive-compulsive behaviors and attention-deficit and hyperactivity disorder. Evidence-based guidelines on the pharmacotherapy of TS have become available in recent years. AREAS COVERED The main purpose of this paper is to provide an overview of the current and emerging pharmacotherapeutic strategies for TS. A comprehensive search for the literature on the pharmacotherapy of tics was conducted using multiple databases (MEDLINE, Scopus, Web of Science, and Google Scholar), without date limits. EXPERT OPINION In consideration of the heterogeneity of the TS phenotypes, pharmacotherapy should be tailored to the individual patient. The choice of the pharmacological agent should take into account both the efficacy-to-tolerability ratio and the presence of co-morbid conditions. Evidence-based pharmacotherapy should aim at improving health-related quality life within a dynamic framework that typically requires active monitoring of the clinical presentation and reevaluation of the treatment intervention over time.
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Affiliation(s)
- Andrea E Cavanna
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, UK.,School of Life and Health Sciences, Aston University, Birmingham, UK.,University College London and Institute of Neurology, London, UK
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13
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Psychotherapy Combined with Western Medicine in the Treatment of Children with Tic Disorder: Systematic Review and Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2365210. [PMID: 35419080 PMCID: PMC9001075 DOI: 10.1155/2022/2365210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
Abstract
Objective To evaluate the efficacy of psychotherapy in children with tic disorder and to provide basis for the application of psychotherapy in the treatment of children with tic disorder. Methods A detailed search was conducted based on PubMed, Cochrane library database, CNKI, Wanfang Data, and VIP database to determine the randomized controlled trial (RCT) of psychotherapy combined with drugs and oral drugs in the treatment of tic disorder. The search time was from the establishment of the database to August 20, 2021. All kinds of extracted data are meta analyzed, and the statistical software used is Review Manager 5.3 software. Results According to the inclusion and exclusion criteria, 14 clinical trials were finally included, including 513 TD children, including 267 in the psychological intervention group and 246 in the control group. All trials were conducted in China and published from 2013 to 2021. In terms of clinical efficacy, compared with the control group, the psychotherapy combined with drugs group had more advantages in improving the effective rate (RR = 3.25, 95% CI: 2.17~4.85, Z = 5.74, P < 0.00001) and improving the clinical symptoms of children with TD (WM = −5.36, 95% CI: -6.41 ~ -4.30, Z = 9.97, P < 0.00000 1). Conclusion Psychotherapy as an adjuvant therapy for clinical treatment of TD can improve the clinical efficacy, but due to the low methodological quality of the existing trials, the research may have potential bias. In the future, large sample, multicenter, and double-blind randomized controlled trials need to be carried out to provide further support.
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14
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Eapen V, Usherwood T. Assessing tics in children. BMJ 2022; 376:e069346. [PMID: 35241477 DOI: 10.1136/bmj-2021-069346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Valsamma Eapen
- University of New South Wales, Sydney, Australia
- South Western Sydney Local Health District, Liverpool, Australia
- Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Tim Usherwood
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
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15
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Rizwan M, Shahid NUA, Naguit N, Jakkoju R, Laeeq S, Reghefaoui T, Zahoor H, Yook JH, Mohammed L. Efficacy of Behavioural Intervention, Antipsychotics, and Alpha Agonists in the Treatment of Tics Disorder in Tourette’s Syndrome. Cureus 2022; 14:e22449. [PMID: 35345730 PMCID: PMC8942175 DOI: 10.7759/cureus.22449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/20/2022] [Indexed: 11/23/2022] Open
Abstract
Tourette's Syndrome (TS), in which patients have sudden, repeated, involuntary twitches and movements, called tics, is a condition of the nervous system. They can be motor, vocal, simple, or complex tics. It can be physically, emotionally, mentally, and socially distressing and challenging for those suffering from it. Usually, it is accompanied by various comorbidities like attention-deficit hyperactivity disorder, obsessive-compulsive disorder, and sleep disorders. A variety of environmental and genetic factors are also associated with tics in TS like the first-degree relatives are more at risk of developing TS.TS is heterogeneous with complicated patterns of inheritance and phenotypic manifestations. There is a strong association between common single nucleotide polymorphisms (SNP, s) in the SLITRK1 gene and TS. Environmental factors like prenatal, postnatal, and perinatal factors directly influence tics in TS. These factors are low birth weight, intrauterine growth retardation (IGR), and various infections. The treatment of TS can be broadly classified into non-pharmacological and pharmacological treatment. Non-pharmacological therapy includes various behavioural interventions that can be helpful in situations when patients are tolerant of medical treatments. Psychoeducation and counselling play an essential role in the treatment of TS. It is vital to give a proper understanding to the patient and their family about the disease. Cognitive-behavioral intervention for tics, cognitive-behavioral therapy, exposure and response prevention, relaxation techniques, deep brain stimulation, and habit reversal training are the commonly used therapies for tics. These therapies have shown good efficacy because it improves the Yale Global Tic Severity Scale score (YGTSS) significantly. And they show effectiveness in patients who are irresponsive to medical treatment. The main lines of medical treatment are antipsychotics and alpha agonists. Typical (haloperidol, pimozide) or atypical (aripiprazole, risperidone, olanzapine) Antipsychotics differ in their side effects, efficacy, and tolerance in different age groups of children. Haloperidol was the first drug approved by the Food and Drug Administration for tics, but later on, new developments and improvements were made as far as drug therapy is concerned. The alpha-agonist most commonly used is clonidine which is also available in the form of adhesive patches. Another alpha agonist which is also widely used is guanfacine. Botulinum toxin and baclofen have also shown efficacy in dealing with tics in TS with other comorbidities. We will review in this article all the main lines of treatment and their effectiveness in TS.
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Assessing the educational needs of physicians in the management of patients with Tourette syndrome: results of a United States survey on practicing clinicians and caregivers. CNS Spectr 2022; 28:343-350. [PMID: 35179458 DOI: 10.1017/s1092852921000766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Objective
To better understand current practices of U.S.-based physicians in the management of Tourette syndrome (TS) and identify gaps that may be addressed by future education.
Methods
Two survey instruments were developed to gather data on management of TS and perceptions from physicians and caregivers of children with TS. The clinician survey was developed in consultation with a TS physician expert and utilized clinical vignettes to assess and quantify practice patterns. The caregiver survey was adapted from the clinician survey and other published studies and gathered details on diagnosis, treatment, and perceptions regarding management.
Results
Data included responses from 138 neurologists (including 57 pediatric neurologists), 162 psychiatrists (including 42 pediatric psychiatrists), and 67 caregivers. Most (65%) pediatric neurologists rely solely on clinical findings to make a diagnosis, whereas the majority of other specialists utilize additional testing (eg, neuroimaging, lab testing, and genetics). Most psychiatrists (96%) utilize standardized criteria to make a diagnosis, whereas 22% of neurologists do not. Many physicians (44% of psychiatrists and 20% of neurologists) use pharmacotherapy to treat a patient with “slightly bothersome” tics and no functional impairment, whereas caregivers favored behavioral therapy. Most (76%) caregivers preferred to make the final treatment decision, whereas 80% of physicians preferred equal or physician-directed decision-making.
Conclusions
This study provides insight into practice patterns and perceptions of U.S.-based neurologists and psychiatrists in managing TS. Results highlight the potential value of physician education, including diagnostic approach, tic management and monitoring, involvement of caregivers in decision-making, and updates on TS management.
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Frey J, Malaty IA. Tourette Syndrome Treatment Updates: a Review and Discussion of the Current and Upcoming Literature. Curr Neurol Neurosci Rep 2022; 22:123-142. [PMID: 35107785 PMCID: PMC8809236 DOI: 10.1007/s11910-022-01177-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 11/30/2022]
Abstract
Purpose of Review This study aims to examine the treatments currently available for Tourette syndrome (TS) and to discuss evolving therapies, spanning behavioral, pharmacologic, complementary and alternative medicine, and neuromodulation approaches. Recent Findings Behavioral therapies have undergone several modifications to improve accessibility, including transitioning to a virtual format which is particularly important in the current pandemic. There are several recent or ongoing pharmacologic studies that have shown promise including the selective D1 receptor antagonist ecopipam and various cannabinoid compounds. Adaptive DBS may enable the physiologic markers of tics to determine stimulation parameters and improve tic outcomes related to neuromodulation. Summary In recent years, there has been a wealth of research across multiple treatment domains in the TS field. This review highlights exciting and new potential options for the future treatment of patients with TS.
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Affiliation(s)
- Jessica Frey
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Irene A Malaty
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.
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18
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Bortolato M, Coffey BJ, Gabbay V, Scheggi S. Allopregnanolone: The missing link to explain the effects of stress on tic exacerbation? J Neuroendocrinol 2022; 34:e13022. [PMID: 34423500 PMCID: PMC8800948 DOI: 10.1111/jne.13022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 12/13/2022]
Abstract
The neurosteroid allopregnanolone (3α-hydroxy-5α-pregnan-20-one; AP) elicits pleiotropic effects in the central nervous system, ranging from neuroprotective and anti-inflammatory functions to the regulation of mood and emotional responses. Several lines of research show that the brain rapidly produces AP in response to acute stress to reduce the allostatic load and enhance coping. These effects not only are likely mediated by GABAA receptor activation but also result from the contributions of other mechanisms, such as the stimulation of membrane progesterone receptors. In keeping with this evidence, AP has been shown to exert rapid, potent antidepressant properties and has been recently approved for the therapy of moderate-to-severe postpartum depression. In addition to depression, emerging evidence points to the potential of AP as a therapy for other neuropsychiatric disorders, including anxiety, seizures, post-traumatic stress disorder and cognitive problems. Although this evidence has spurred interest in further therapeutic applications of AP, some investigations suggest that this neurosteroid may also be associated with adverse events in specific disorders. For example, our group has recently documented that AP increases tic-like manifestations in several animal models of tic disorders; furthermore, our results indicate that inhibiting AP synthesis and signalling reduces the exacerbation of tic severity associated with acute stress. Although the specific mechanisms of these effects remain partially elusive, our findings point to the possibility that the GABAergic activation by AP may also lead to disinhibitory effects, which could interfere with the ability of patients to suppress their tics. Future studies will be necessary to verify whether these mechanisms may apply to other externalising manifestations, such as impulse-control problems and manic symptoms.
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Affiliation(s)
- Marco Bortolato
- Department of Pharmacology and ToxicologyCollege of PharmacyUniversity of UtahSalt Lake CityUTUSA
- Research Consortium on NeuroEndocrine Causes of Tics (ReConNECT)
| | - Barbara J. Coffey
- Research Consortium on NeuroEndocrine Causes of Tics (ReConNECT)
- Department of Psychiatry and Behavioral ScienceMiller School of MedicineUniversity of MiamiMiamiFLUSA
| | - Vilma Gabbay
- Research Consortium on NeuroEndocrine Causes of Tics (ReConNECT)
- Department of Psychiatry and Behavioral SciencesAlbert Einstein College of MedicineBronxNYUSA
| | - Simona Scheggi
- Department of Molecular and Developmental MedicineSchool of MedicineUniversity of SienaSienaItaly
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19
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Current Understanding of the Genetics of Tourette Syndrome. Biomed J 2022; 45:271-279. [PMID: 35042017 PMCID: PMC9250083 DOI: 10.1016/j.bj.2022.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 12/13/2022] Open
Abstract
Gilles de la Tourette syndrome (TS) is a common, childhood-onset psychiatric disorder characterized by persistent motor and vocal tics. It is a heterogeneous disorder in which the phenotypic expression may be affected by environmental factors, such as immune responses. Furthermore, several studies have shown that genetic factors play a vital role in the etiology of TS, as well as its comorbidity with other disorders, including attention deficit hyperactivity disorder, obsessive-compulsive disorder, and autism spectrum disorder. TS has a complex inheritance pattern and, according to various genetic studies, several genes and loci have been correlated with TS. Genome-wide linkage studies have identified Slit and Trk-like 1 (SLITRK1) and histidine decarboxylase (HDC) genes, and candidate gene association studies have extensively investigated the dopamine and serotonin system genes, but there have been no consistent results. Moreover, genome-wide association studies have implicated several genetic loci; however, larger study cohorts are needed to confirm this. Copy number variations, which are polymorphisms in the number of gene copies due to chromosomal deletions or duplications, are considered another significant source of mutations in TS. In the last decade, whole genome/exome sequencing has identified several novel genetic mutations in patients with TS. In conclusion, more studies are needed to reveal the exact mechanisms of underlying TS, which may help to provide more information on the prognosis and therapeutic plans for TS.
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20
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Taylor E, Anderson S, Davies EB. "I'm in pain and I want help": An online survey investigating the experiences of tic-related pain and use of pain management techniques in people with tics and tic disorders. Front Psychiatry 2022; 13:914044. [PMID: 35990066 PMCID: PMC9388784 DOI: 10.3389/fpsyt.2022.914044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/13/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Tic disorders (TDs) are complex neurological conditions characterized by involuntary, persistent vocalizations and motor movements called tics. Tics involve brief muscle movements and can impair many aspects of daily functioning and quality of life in patients - and their physical nature can cause pain. Understanding individuals' experiences of tic-related pain and pain management could help explore this under-researched area and identify additional support needs for this population. The aim of this study was to investigate experiences of pain and use of pain management techniques in people with tic disorders. METHODS An online survey consisting of multiple choice and open-ended questions exploring experiences of tic-related pain, help-seeking behavior for tic-related pain, and use of pain relief techniques for tic-related pain, was circulated online via international Tourette syndrome patient associations, and one online support group for Tourette syndrome. The online survey was open to adults (≥16 years) with self-reported tics. Open-ended questions were analyzed using thematic analysis. RESULTS One hundred eighty-one participants (16-71 years; 58.0% female) from 18 countries completed the online survey. Several aspects of tics were associated with pain, including the physical effort of motor tics (n = 177, 97.8%), repetitive tics (n = 141, 77.9%) and the consequences of tics (n = 131, 72.4%). Nearly two-thirds (n = 118, 64.6%) had sought professional help for tic-related pain. Distraction techniques (n = 126, 69.6%), taking pain relief medication (n = 125, 69.1%) and altering tics (n = 111, 61.3%) were the most commonly-reported methods used to relieve and cope with tic-related pain. Thematic analysis found an interrelated complex relationship between participants' tics, pain, and pain management techniques, reflected in four themes: the "tic-pain" cycle, the impact of pain, the importance of support, and the perceived successfulness of pain management techniques. CONCLUSIONS Tic-related pain was reported to have a significant physical and psychological impact which impacted aspects of daily living in people with tic disorders. The findings add to limited research suggesting tic-related pain is a dominant issue for individuals with tic disorders, potentially impacting upon their quality of life. Increased understanding of tic-related pain and its influence may be helpful in the long-term management of tic disorders, both in terms of clinical management and patients' self-management.
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Affiliation(s)
- Evangeline Taylor
- Population and Lifespan Sciences, Queen's Medical Centre, School of Medicine, The University of Nottingham, Nottingham, United Kingdom
| | | | - E Bethan Davies
- NIHR MindTech MedTech Co-operative, School of Medicine, Institute of Mental Health, The University of Nottingham, Nottingham, United Kingdom.,Clinical Neurosciences and Mental Health, School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
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21
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Roessner V, Eichele H, Stern JS, Skov L, Rizzo R, Debes NM, Nagy P, Cavanna AE, Termine C, Ganos C, Münchau A, Szejko N, Cath D, Müller-Vahl KR, Verdellen C, Hartmann A, Rothenberger A, Hoekstra PJ, Plessen KJ. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part III: pharmacological treatment. Eur Child Adolesc Psychiatry 2022; 31:425-441. [PMID: 34757514 PMCID: PMC8940878 DOI: 10.1007/s00787-021-01899-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 10/24/2021] [Indexed: 12/18/2022]
Abstract
In 2011, the European Society for the Study of Tourette Syndrome (ESSTS) published the first European guidelines for Tourette Syndrome (TS). We now present an update of the part on pharmacological treatment, based on a review of new literature with special attention to other evidence-based guidelines, meta-analyses, and randomized double-blinded studies. Moreover, our revision took into consideration results of a recent survey on treatment preferences conducted among ESSTS experts. The first preference should be given to psychoeducation and to behavioral approaches, as it strengthens the patients' self-regulatory control and thus his/her autonomy. Because behavioral approaches are not effective, available, or feasible in all patients, in a substantial number of patients pharmacological treatment is indicated, alone or in combination with behavioral therapy. The largest amount of evidence supports the use of dopamine blocking agents, preferably aripiprazole because of a more favorable profile of adverse events than first- and second-generation antipsychotics. Other agents that can be considered include tiapride, risperidone, and especially in case of co-existing attention deficit hyperactivity disorder (ADHD), clonidine and guanfacine. This view is supported by the results of our survey on medication preference among members of ESSTS, in which aripiprazole was indicated as the drug of first choice both in children and adults. In treatment resistant cases, treatment with agents with either a limited evidence base or risk of extrapyramidal adverse effects might be considered, including pimozide, haloperidol, topiramate, cannabis-based agents, and botulinum toxin injections. Overall, treatment of TS should be individualized, and decisions based on the patient's needs and preferences, presence of co-existing conditions, latest scientific findings as well as on the physician's preferences, experience, and local regulatory requirements.
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Affiliation(s)
- Veit Roessner
- Department of Child and Adolescent Psychiatry, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Heike Eichele
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway , Regional Resource Center for Autism, ADHD, Tourette Syndrome and Narcolepsy Western Norway, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jeremy S. Stern
- Department of Neurology, St George’s Hospital, St George’s University of London, London, UK
| | - Liselotte Skov
- Paediatric Department, Herlev University Hospital, Herlev, Denmark
| | - Renata Rizzo
- Child and Adolescent Neurology and Psychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Péter Nagy
- Vadaskert Child Psychiatric Hospital and Outpatient Clinic, Budapest, Hungary
| | - Andrea E. Cavanna
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Cristiano Termine
- Child Neuropsychiatry Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Christos Ganos
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Natalia Szejko
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland ,Department of Bioethics, Medical University of Warsaw, Warsaw, Poland ,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT USA
| | - Danielle Cath
- Department of Psychiatry, University Medical Center Groningen, Rijks Universiteit Groningen, GGZ Drenthe Mental Health Institution, Assen, The Netherlands
| | - Kirsten R. Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Cara Verdellen
- PsyQ Nijmegen, Parnassia Group, Nijmegen, The Netherlands ,TicXperts, Heteren, The Netherlands
| | - Andreas Hartmann
- Department of Neurology, Sorbonne Université, Pitié-Salpetriere Hospital, Paris, France ,National Reference Center for Tourette Disorder, Pitié Salpetiere Hospital, Paris, France
| | - Aribert Rothenberger
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Gottingen, Gottingen, Germany
| | - Pieter J. Hoekstra
- Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Kerstin J. Plessen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland ,Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
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22
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Coache D, Friciu M, Roullin VG, Boulé M, Forest JM, Leclair G. Stability evaluation of compounded clonidine hydrochloride oral liquids based on a solid-phase extraction HPLC-UV method. PLoS One 2021; 16:e0260279. [PMID: 34847160 PMCID: PMC8631633 DOI: 10.1371/journal.pone.0260279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022] Open
Abstract
The present study aimed to assess the stability of clonidine hydrochloride oral liquids (20-μg/mL) prepared from two different generic tablets in Ora-Blend and stored in amber plastic bottles. Physical and chemical stabilities were evaluated over a period of 90 days at 25°C. Analytical challenges were overcome with the development of a new extraction procedure based on solid phase extraction to ensure efficient clonidine hydrochloride quantification. The absence of physical instabilities, evaluated by qualitative and quantitative measurements (static multiple light scattering), as well as the absence of chemical instabilities, evidenced by a stability-indicating HPLC-UV method, confirmed that a beyond-use date of 90 days was appropriate for these compounded oral liquids.
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Affiliation(s)
- Daphné Coache
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada
| | - Mihaela Friciu
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada
| | - V. Gaëlle Roullin
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada
| | - Marianne Boulé
- Sainte-Justine University Hospital Center, Montréal, Québec, Canada
| | - Jean-Marc Forest
- Sainte-Justine University Hospital Center, Montréal, Québec, Canada
| | - Grégoire Leclair
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada
- * E-mail:
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23
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Müller-Vahl KR, Fremer C, Beals C, Ivkovic J, Loft H, Schindler C. Endocannabinoid Modulation Using Monoacylglycerol Lipase Inhibition in Tourette Syndrome: A Phase 1 Randomized, Placebo-Controlled Study. PHARMACOPSYCHIATRY 2021; 55:148-156. [PMID: 34847610 PMCID: PMC9110099 DOI: 10.1055/a-1675-3494] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction
Tourette syndrome (TS) is a complex neurodevelopmental
disorder characterized by chronic motor and vocal tics. While consistently
effective treatment is lacking, evidence indicates that the modulation of
endocannabinoid system is potentially beneficial. Lu AG06466 (previously
ABX-1431) is a highly selective inhibitor of monoacylglycerol lipase, the
primary enzyme responsible for the degradation of the endocannabinoid ligand
2-arachidonoylglycerol. This exploratory study aimed to determine the effect of
Lu AG06466 versus placebo on tics and other symptoms in patients with TS.
Methods
In this phase 1b cross-over study, 20 adult patients with TS on
standard-of-care medications were randomized to a single fasted dose of Lu
AG06466 (40 mg) or placebo in period 1, followed by the other treatment
in period 2. The effects on tics, premonitory urges, and psychiatric
comorbidities were evaluated using a variety of scaled approaches at different
time points before and after treatment.
Results
All scales showed an overall trend of tic reduction, with two out
of three tic scales (including the Total Tic Score of the Yale Global Tic
Severity Score) showing a significant effect of a single dose of Lu AG06466
versus placebo at various timepoints. Treatment with Lu AG06466 resulted in a
significant reduction in premonitory urges versus placebo. Single doses of Lu
AG06466 were generally well-tolerated, and the most common adverse events were
headache, somnolence, and fatigue.
Conclusion
In this exploratory trial, a single dose of Lu AG06466 showed
statistically significant positive effects on key measures of TS symptoms.
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Affiliation(s)
- Kirsten R Müller-Vahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Carolin Fremer
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | | | | | | | - Christoph Schindler
- Clinical Research Center Core Facility, Hannover Medical School, Hannover, Germany
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Liang JH, Zhang SX, Chen YC, Tan KY, Zhang JS, Zhao Y, Kakaer A, Chen YJ. Role of psychotherapy strategy for the management of patients with Tourette syndrome - A Bayesian network meta-analysis. J Psychiatr Res 2021; 143:451-461. [PMID: 34482986 DOI: 10.1016/j.jpsychires.2021.07.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 07/16/2021] [Accepted: 07/31/2021] [Indexed: 11/19/2022]
Abstract
Tourette's syndrome (TS) is a complex neurodevelopmental disorder characterized by high comorbidity. Treatment with psychotherapy is highly recommended, however, there exists limited available evidence on the use and the optimal psychotherapeutic outcome is debatable. We performed a systematic search on several bibliographic databases for randomized controlled trials (RCTs) reporting the use of psychotherapy treatment in TS patients, from inception to August 1st, 2020, and without language restrictions. Outcome measures were measured by the Yale global tic severity scale (YGTSS) to determine the efficacy of psychotherapy. Data were pooled as Standard mean difference (SMD) in the Bayesian analysis of the random effect model. A total of 17 RCTs with 9 treatments and 1042 participants were included from an initial 4901 records. The primary outcome including, Comprehensive behavioral intervention (CBIT) [SMD = -1.43, 95%Credible interval (CrI): -2.39, -0.44], Exposure with response prevention (ERP) [SMD = -1.37, 95%CrI: -2.62, -0.13], Habit reversal therapy (HRT) [SMD = -0.93, 95%CrI: 1.83, -0.05], and Behavior therapy (BT) [SMD = -0.85, 95%CrI: 1.51, -0.18], were found to be significantly lower in the TS group compared with the control group (including wait-list, treatment-as-usual or other named control group). Based on the Surface under the cumulative ranking curve (SUCRA), CBIT (SUCRA value = 86.97%, 95%CrI: 44%, 100%) was found to be a suitable psychotherapeutic treatment for TS patients. High-quality RCTs on psychotherapy are needed to perform for establishing the foundation of the generation of evidence-based guidelines.
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Affiliation(s)
- Jing-Hong Liang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, PR China.
| | - Shu-Xin Zhang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, PR China.
| | - Yi-Can Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, PR China.
| | - Kai-Yun Tan
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, PR China.
| | - Jing-Shu Zhang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, PR China.
| | - Yu Zhao
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, PR China.
| | - Aerziguli Kakaer
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, PR China.
| | - Ya-Jun Chen
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, PR China.
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Jankovic J, Coffey B, Claassen DO, Jimenez-Shahed J, Gertz BJ, Garofalo EA, Stamler DA, Wieman M, Savola JM, Gordon MF, Alexander J, Barkay H, Harary E. Safety and Efficacy of Flexible-Dose Deutetrabenazine in Children and Adolescents With Tourette Syndrome: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2128204. [PMID: 34609495 PMCID: PMC8493441 DOI: 10.1001/jamanetworkopen.2021.28204] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
IMPORTANCE Tourette syndrome is a neurodevelopmental disorder characterized by childhood onset of motor and phonic tics; treatments for tics are associated with safety concerns. Deutetrabenazine is a selective vesicular monoamine transporter 2 inhibitor approved for the treatment of chorea associated with Huntington disease and tardive dyskinesia in adults. OBJECTIVE To examine whether deutetrabenazine is effective and safe for the treatment of Tourette syndrome in children and adolescents. DESIGN, SETTING, AND PARTICIPANTS This phase 2/3, randomized, double-masked, placebo-controlled, parallel-group, dose-titration study included children and adolescents (aged 6-16 years) with Tourette syndrome with active tics causing distress or impairment (ie, Yale Global Tic Severity Scale-Total Tic Score [YGTSS-TTS] ≥20). The trial was conducted over 12 weeks, with 1 week of follow-up from February 2018 to November 2019 at 36 centers in the United States, Canada, Denmark, Russia, Serbia, and Spain. Data analysis was conducted from January 31 to April 22, 2020. INTERVENTION Patients were randomized (1:1) to receive deutetrabenazine or placebo, titrated during 7 weeks to an optimal level, followed by a 5-week maintenance period. The maximum total daily deutetrabenazine dose was 48 mg/d. MAIN OUTCOMES AND MEASURES The primary efficacy end point was change from baseline to week 12 in YGTSS-TTS. Key secondary end points included changes in Tourette Syndrome-Clinical Global Impression, Tourette Syndrome-Patient Global Impression of Impact, and Child and Adolescent Gilles de la Tourette Syndrome-Quality of Life Activities of Daily Living subscale score. Safety was assessed based on treatment-emergent adverse events, vital signs, questionnaires, and laboratory parameters. RESULTS A total of 119 participants were randomized to deutetrabenazine (59 participants; mean [SD] age, 11.5 [2.5] years; 53 [90%] boys; 49 [83%] White; 3 [5%] Black) and placebo (60 participants; mean [SD] age, 11.5 [2.6] years; 51 [85%] boys; 53 [88%] White; 3 [5%] Black). At week 12, the difference in YGTSS-TTS score was not significant between deutetrabenazine and placebo (least squares mean difference, -0.7; 95% CI, -4.1 to 2.8; P = .69; Cohen d, -0.07). There were no nominally significant differences between groups for key secondary end points. Treatment-emergent adverse events were reported for 38 patients (66%) and 33 patients (56%) receiving deutetrabenazine and placebo, respectively, and were generally mild or moderate. CONCLUSIONS AND RELEVANCE In this study of deutetrabenazine in children and adolescents with Tourette syndrome, the primary efficacy end point was not met. No new safety signals were identified. These results may be informative for future studies of treatments for tics in Tourette syndrome. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03452943.
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Affiliation(s)
| | - Barbara Coffey
- University of Miami Miller School of Medicine, Miami, Florida
| | | | | | | | | | | | - Maria Wieman
- Teva Pharmaceuticals, West Chester, Pennsylvania
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Coffey B, Jankovic J, Claassen DO, Jimenez-Shahed J, Gertz BJ, Garofalo EA, Stamler DA, Wieman M, Savola JM, Gordon MF, Alexander JK, Barkay H, Harary E. Efficacy and Safety of Fixed-Dose Deutetrabenazine in Children and Adolescents for Tics Associated With Tourette Syndrome: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2129397. [PMID: 34661664 PMCID: PMC8524312 DOI: 10.1001/jamanetworkopen.2021.29397] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IMPORTANCE Tourette syndrome is a neurodevelopmental disorder characterized by childhood onset of motor and phonic tics, often accompanied by behavioral and psychiatric comorbidities. Deutetrabenazine is a vesicular monoamine transporter 2 inhibitor approved in the US for the treatment of chorea associated with Huntington disease and tardive dyskinesia. OBJECTIVE To report results of the ARTISTS 2 (Alternatives for Reducing Tics in Tourette Syndrome 2) study examining deutetrabenazine for treatment of Tourette syndrome. DESIGN, SETTING, AND PARTICIPANTS This phase 3, randomized, double-blind, placebo-controlled, parallel-group, fixed-dose study was conducted over 8 weeks with a 1-week follow-up (June 21, 2018, to December 9, 2019). Children and adolescents aged 6 to 16 years with a diagnosis of Tourette syndrome and active tics causing distress or impairment were enrolled in the study. Children were recruited from 52 sites in 10 countries. Data were analyzed from February 4 to April 22, 2020. INTERVENTIONS Participants were randomized (1:1:1) to low-dose deutetrabenazine (up to 36 mg/d), high-dose deutetrabenazine (up to 48 mg/d), or a matching placebo, which were titrated over 4 weeks to the target dose followed by a 4-week maintenance period. MAIN OUTCOMES AND MEASURES The primary efficacy end point was change from baseline to week 8 in the Yale Global Tic Severity Scale-Total Tic Score (YGTSS-TTS) for high-dose deutetrabenazine. Key secondary end points included changes in YGTSS-TTS for low-dose deutetrabenazine, Tourette Syndrome Clinical Global Impression score, Tourette Syndrome Patient Global Impression of Impact score, and Child and Adolescent Gilles de la Tourette Syndrome-Quality of Life Activities of Daily Living subscale score. Safety assessments included incidence of treatment-emergent adverse events, laboratory parameters, vital signs, and questionnaires. RESULTS The study included 158 children and adolescents (mean [SD] age, 11.7 [2.6] years). A total of 119 participants (75%) were boys; 7 (4%), Asian; 1 (1%), Black; 32 (20%), Hispanic; 4 (3%), Native American; 135 (85%), White; 2 (1%), multiracial; 9 (6%), other race; and 1 (0.6%), of unknown ethnic origin. Fifty-two participants were randomized to the high-dose deutetrabenazine group, 54 to the low-dose deutetrabenazine group, and 52 to the placebo group. Baseline characteristics for participants were similar between groups. Of the total 158 participants, 64 (41%) were aged 6 to 11 years, and 94 (59%) were aged 12 to 16 years at baseline. Mean time since Tourette syndrome diagnosis was 3.3 (2.8) years, and mean baseline YGTSS-TTS was 33.8 (6.6) points. At week 8, the difference in YGTSS-TTS was not significant between the high-dose deutetrabenazine and placebo groups (least-squares mean difference, -0.8 points; 95% CI, -3.9 to 2.3 points; P = .60; Cohen d, -0.11). There were no nominally significant differences between groups for key secondary end points. Treatment-emergent adverse events were reported for 34 participants (65%) treated with high-dose deutetrabenazine, 24 (44%) treated with low-dose deutetrabenazine, and 25 (49%) treated with placebo and were generally mild or moderate. CONCLUSIONS AND RELEVANCE In this fixed-dose randomized clinical trial of deutetrabenazine in children and adolescents with Tourette syndrome, the primary efficacy end point was not met. No new safety signals were identified. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03571256.
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Affiliation(s)
- Barbara Coffey
- University of Miami Miller School of Medicine, Miami, Florida
| | | | | | | | | | | | | | - Maria Wieman
- Teva Pharmaceuticals, West Chester, Pennsylvania
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Besag FM, Vasey MJ, Lao KS, Chowdhury U, Stern JS. Pharmacological treatment for Tourette syndrome in children and adults: What is the quality of the evidence? A systematic review. J Psychopharmacol 2021; 35:1037-1061. [PMID: 34286606 DOI: 10.1177/02698811211032445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tourette syndrome (TS) is a neurodevelopmental disorder characterised by involuntary muscle movements manifesting as motor and vocal tics. In the majority, tics are manageable without medication. Where tics cause discomfort or impair function, behavioural or pharmaceutical treatments may be considered. AIMS To provide a meticulous examination of the quality of evidence for the current pharmacological treatments for TS. METHODS PubMed and Google Scholar were searched to identify randomised, placebo-controlled trials (RCTs) of aripiprazole, risperidone, clonidine, guanfacine, haloperidol, pimozide, tiapride and sulpiride for the treatment of tics in children and adults with TS. Quality of reporting and risk of bias were assessed against the CONSORT checklist and Cochrane risk of bias criteria, respectively. RESULTS Seventeen RCTs were identified. Response rates reached 88.6% for aripiprazole, 68.9% for clonidine, 62.5% for risperidone and 19% for guanfacine. Statistically significant improvements were reported for all medications compared to placebo in at least one study and for at least one measure of tic severity. Most studies predated the CONSORT and Cochrane criteria and did not score highly when assessed on these measures. CONCLUSIONS There are relatively few placebo-controlled trials of commonly prescribed medications. Studies are often of poor quality and short duration. There is evidence for the efficacy of each medication, but no drug is clearly superior. Clonidine and guanfacine are better tolerated than antipsychotics, but less effective. There is too little evidence to determine whether adults respond differently from children.
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Affiliation(s)
- Frank Mc Besag
- East London NHS Foundation Trust, Bedford, UK.,University College London, London, UK.,King's College London, UK
| | | | - Kim Sj Lao
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Uttom Chowdhury
- Child and Adolescent Mental Health Services, East London NHS Foundation Trust, Dunstable, Bedfordshire, UK
| | - Jeremy S Stern
- St George's Hospital Neurology, London, UK.,Tourettes Action, Farnborough, Hampshire, UK
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Abstract
Tourette syndrome (TS) causes academic, social, emotional, physical, and functional problems. Most TS patients also have comorbid neuropsychological conditions. The purpose of this review is to provide updated information to the clinician about phenomenology, epidemiology, comorbidities, pathophysiology and management strategies for tics (a hallmark of TS) and TS. Recent findings suggest that TS is likely due to a combination of several different genes and environmental factors, with possible involvement of the cortical-basal ganglia-thalamocortical circuit and related multiple neurotransmitters. First-line management includes psychoeducation for families, patients, and school personnel, as well as behavioral therapy. Non-medicine treatment for tics is advancing to include younger children and increase access via remote service applications. Pharmacotherapy is used if appropriate and several new medicines are under investigation (e.g., Tetrabenazine, valbenazine, deutetrabenazine, ecopipam, cannabinoids). Deep brain stimulation and Mouthguard therapy can be used for children with intractable illness.
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Affiliation(s)
- Kallol K Set
- Pediatric Neurologist, Dayton Children's Hospital, Clinical Assistant Professor, Pediatrics, Boonshoft School of Medicine, Wright State University, One Children's Plaza, Dayton, Ohio, 45404-1815, USA.
| | - Jacqueline N Warner
- Pediatric Psychologist, Clinical Assistant Professor, Pediatrics. Boonshoft School of Medicine, Wright State University, Dayton Children's Hospital, One Children's Plaza, Dayton, Ohio, 45404-1815, USA.
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Ueda K, Black KJ. A Comprehensive Review of Tic Disorders in Children. J Clin Med 2021; 10:2479. [PMID: 34204991 PMCID: PMC8199885 DOI: 10.3390/jcm10112479] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 01/13/2023] Open
Abstract
Tics are characterized by sudden, rapid, recurrent, nonrhythmic movement or vocalization, and are the most common movement disorders in children. Their onset is usually in childhood and tics often will diminish within one year. However, some of the tics can persist and cause various problems such as social embarrassment, physical discomfort, or emotional impairments, which could interfere with daily activities and school performance. Furthermore, tic disorders are frequently associated with comorbid neuropsychiatric symptoms, which can become more problematic than tic symptoms. Unfortunately, misunderstanding and misconceptions of tic disorders still exist among the general population. Understanding tic disorders and their comorbidities is important to deliver appropriate care to patients with tics. Several studies have been conducted to elucidate the clinical course, epidemiology, and pathophysiology of tics, but they are still not well understood. This article aims to provide an overview about tics and tic disorders, and recent findings on tic disorders including history, definition, diagnosis, epidemiology, etiology, diagnostic approach, comorbidities, treatment and management, and differential diagnosis.
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Affiliation(s)
- Keisuke Ueda
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | - Kevin J. Black
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA;
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO 63110, USA
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30
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Jain R, Pandey S, Raghav S. Movement Disorders in Children. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2310-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Farber RH, Angelov A, Kim K, Carmack T, Thai-Cuarto D, Roberts E. Clinical development of valbenazine for tics associated with Tourette syndrome. Expert Rev Neurother 2021; 21:393-404. [PMID: 33682568 DOI: 10.1080/14737175.2021.1898948] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction: Significant need exists for effective, well-tolerated pharmacologic treatments for Tourette syndrome (TS). Medications that inhibit vesicular monoamine transporters (i.e. VMAT2 inhibitors) downregulate presynaptic packaging and release of dopamine into the neuronal synapse and are effective in treating hyperkinetic movement disorders such as Huntington's chorea and tardive dyskinesia (TD); thus, they may be useful in treating TS.Areas covered: This review describes the clinical program evaluating the safety and efficacy of valbenazine in the treatment of involuntary tics associated with TS in adult and pediatric subjects. While there was a trend in the 6 completed trials toward greater improvement in valbenazine-treated versus placebo subjects on the primary efficacy endpoint (Yale Global Tic Severity Scale Total Tic Score), this difference did not reach statistical significance. Valbenazine was generally well-tolerated in the studies, and treatment-emergent adverse events were consistent with valbenazine studies in TD.Expert opinion: Due to the failure to meet the primary endpoint in these trials, further investigation of valbenazine for TS is unlikely. Given the need for safe and effective TS therapies and the key role of VMAT2 in modulating dopaminergic activity, it is reasonable for future studies to investigate other VMAT2 inhibitors as potential treatments for TS.
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Affiliation(s)
- Robert H Farber
- Medical Affairs, Neurocrine Biosciences, Inc., San Diego, CA, USA
| | - Angel Angelov
- Medical Affairs, Neurocrine Biosciences, Inc., San Diego, CA, USA
| | - Kristine Kim
- Medical Affairs, Neurocrine Biosciences, Inc., San Diego, CA, USA
| | - Tara Carmack
- Medical Affairs, Neurocrine Biosciences, Inc., San Diego, CA, USA
| | - Dao Thai-Cuarto
- Medical Affairs, Neurocrine Biosciences, Inc., San Diego, CA, USA
| | - Eiry Roberts
- Medical Affairs, Neurocrine Biosciences, Inc., San Diego, CA, USA
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32
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Joung YS, Lee MS. The therapeutic approaches in children and adolescent with Tourette’s disorder. PRECISION AND FUTURE MEDICINE 2021. [DOI: 10.23838/pfm.2020.00191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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33
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Wang N, Qin DD, Xie YH, Wu XC, Wang DY, Hang-Yang, Li XX, Xiong L, Liang JH. Traditional Chinese Medicine Strategy for Patients with Tourette Syndrome Based on Clinical Efficacy and Safety: A Meta-Analysis of 47 Randomized Controlled Trials. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6630598. [PMID: 33778073 PMCID: PMC7977981 DOI: 10.1155/2021/6630598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/23/2021] [Accepted: 02/08/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Although increasing evidence reveals the efficacy of traditional Chinese medicine (TCM) and its safety on Tourette Syndrome (TS) patients, whether TCM is indeed improving TS remains unclear. The purpose of the current study is to perform a meta-analysis to evaluate the efficacy and safety of TCM on treating TS patients. METHOD An elaborate search strategy was conducted based on several databases including Medline, Embase, Cochrane, Web of Science, CINAHL, CBM, VIP, CNKI, and Wanfang Data in order to identify the relevant randomized controlled trials (RCTs) from their inception to as late as May 1st, 2020. General information and data needing analysis were extracted simultaneously for the necessity of various analyses such as descriptive analysis and metaquantitative analysis. RESULTS Forty-seven trials with 5437 TS patients in total were eventually included according to our criteria. All trials were conducted in China, and the publication years ranged from 2004 to 2017. In terms of clinical efficacy, clinical symptoms of patients with TCM were more likely to be improved compared with the control group (odds ratio, OR = -1.29, 95% confidence interval, CI: -2.54 to -0.06, I 2 = 0.00%). As to the outcome of recurrence rate, the pooled results revealed that the TCM group was more inclined to stabilize the recurrence (OR = 0.44, 95% CI: 0.24 to 0.78, I 2 = 0.00%). Similar results were observed in adverse reaction (OR = 0.32, 95% CI: 0.24 to 0.43, I 2 = 32.90%). CONCLUSION The results of our study recommend applying TCM to treat TS patients for better efficacy and safety. Results need to be interpreted cautiously due to certain limitations in our study.
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Affiliation(s)
- Na Wang
- School of Basic Medical Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Dong-dong Qin
- School of Basic Medical Science, Yunnan University of Chinese Medicine, Yunnan Kunming 650500, China
| | - Yu-huan Xie
- School of Basic Medical Science, Yunnan University of Chinese Medicine, Yunnan Kunming 650500, China
| | - Xin-chen Wu
- First Affiliated Hospital, Yunnan University of Chinese Medicine, Yunnan Kunming 650500, China
| | - Ding-yue Wang
- First Affiliated Hospital, Yunnan University of Chinese Medicine, Yunnan Kunming 650500, China
| | - Hang-Yang
- First Affiliated Hospital, Yunnan University of Chinese Medicine, Yunnan Kunming 650500, China
| | - Xiao-xuan Li
- First Affiliated Hospital, Yunnan University of Chinese Medicine, Yunnan Kunming 650500, China
| | - Lei Xiong
- School of Basic Medical Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- School of Basic Medical Science, Yunnan University of Chinese Medicine, Yunnan Kunming 650500, China
| | - Jing-hong Liang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
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Abstract
Introduction: Tourette syndrome (TS) is a neurodevelopmental disorder characterized by multiple tics which often persisting in forms of different severity throughout adult life. The prevalence of neuropsychiatric co-morbidity in patients with TS is high. Treatment of TS can involve pharmacological, behavioral, or, in rare cases, surgical therapies. Over the last two decades there has been growing interest in the use of aripiprazole, a novel partial dopamine receptor agonist, as a promising anti-tic agent.Areas covered: The authors reviewed the available literature evaluating the role of aripiprazole in the treatment of TS and other tic disorders in both children and adults. This includes data from five randomized controlled trials (RCTs) and eleven open-label studies.Expert opinion: There is moderate quality evidence supporting the use of aripiprazole in reducing tic severity in children and adolescents, however there is a lack of robust evidence evaluating its use in adults, despite expert consensus. Overall, it appears that aripiprazole is a safe and effective treatment for tics. Further large scale RCTs assessing the long-term efficacy and safety of aripiprazole in the treatment of tics are warranted, especially in adult populations with TS.
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Affiliation(s)
- Joanna H Cox
- Sandwell and West Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andrea E Cavanna
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, UK.,School of Life and Health Sciences, Aston University, Birmingham, UK.,University College London and Institute of Neurology, London, UK
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35
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Yuan A, Tao R, Yu S, Jing N, Sun J. Generation of human induced pluripotent stem cell line FDCHDPi001-A from a Chinese Han Tourette's syndrome patient. Stem Cell Res 2021; 52:102227. [PMID: 33607468 DOI: 10.1016/j.scr.2021.102227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/21/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022] Open
Abstract
Tourette's syndrome (TS) is a childhood onset neuropsychiatric disorder. The underlying pathogenesis of TS remains unclear. A human induced pluripotent stem cell (hiPSC) line, derived from the peripheral blood mononuclear cells (PBMCs) from a TS patient, was generated by the reprogramming with episomal vectors expressing OCT4, SOX2, KLF4 and c-MYC. The generated hiPSC line is free of episomal vectors, with normal karyotype, expressing pluripotency markers and can differentiate into three germ layers in vivo. This hiPSC line from TS patient can offer a useful resource for studying the pathological mechanism of TS and screening effective drugs for therapeutic purpose.
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Affiliation(s)
- Aihua Yuan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China.
| | - Ran Tao
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou 510005, PR China; CAS Key Laboratory of Regenerative Biology, Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou 510530, PR China
| | - Shunying Yu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, PR China
| | - Naihe Jing
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou 510005, PR China; CAS Key Laboratory of Regenerative Biology, Guangdong Provincial Key Laboratory of Stem Cell and Regenerative Medicine, Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou 510530, PR China
| | - Jinhua Sun
- Department of Psychological Medicine, Children's Hospital of Fudan University, Shanghai 201102 , PR China.
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36
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Affiliation(s)
- Andrea E Cavanna
- From the Department of Neuropsychiatry (A.E.C.), BSMHFT and University of Birmingham; School of Life and Health Sciences (A.E.C.), Aston University, Birmingham; University College London and Institute of Neurology (A.E.C.), London, UK; and Children's Mercy Hospital (K.A.C.), Kansas City, MO.
| | - Keith A Coffman
- From the Department of Neuropsychiatry (A.E.C.), BSMHFT and University of Birmingham; School of Life and Health Sciences (A.E.C.), Aston University, Birmingham; University College London and Institute of Neurology (A.E.C.), London, UK; and Children's Mercy Hospital (K.A.C.), Kansas City, MO
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37
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Niu M, Kasai A, Seiriki K, Hayashida M, Tanuma M, Yokoyama R, Hirato Y, Hashimoto H. Altered Functional Connectivity of the Orbital Cortex and Striatum Associated with Catalepsy Induced by Dopamine D1 and D2 Antagonists. Biol Pharm Bull 2021; 44:442-447. [PMID: 33642553 DOI: 10.1248/bpb.b20-01006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The dopamine system plays an important role in regulating many brain functions, including the motor function. The blockade of dopamine receptors results in a serious motor dysfunction, such as catalepsy and Parkinsonism. However, the neuronal mechanism underlying the drug-induced motor dysfunction is not well understood. Here, we examine brain-wide activation patterns in Fos-enhanced green fluorescent protein reporter mice that exhibit cataleptic behavior induced by SCH39166, a dopamine D1-like receptor antagonist, and raclopride, a dopamine D2-like receptor antagonist. Support vector classifications showed that the orbital cortex (ORB) and striatum including the caudoputamen (CP) and nucleus accumbens (ACB), prominently contribute to the discrimination between brains of the vehicle-treated and both SCH39166- and raclopride-treated mice. Interregional correlations indicated that the increased functional connectivity of functional networks, including the ORB, CP, and ACB, is the common mechanism underlying SCH39166- and raclopride-induced cataleptic behavior. Moreover, the distinct mechanisms in the SCH39166- and raclopride-induced cataleptic behaviors are the decreased functional connectivity between three areas above and the cortical amygdala, and between three areas above and the anterior cingulate cortex, respectively. Thus, the alterations of functional connectivity in diverse brain regions, including the ORB, provide new insights on the mechanism underlying drug-induced movement disorders.
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Affiliation(s)
- Misaki Niu
- Laboratory of Molecular Neuropharmacology, Graduate School of Pharmaceutical Sciences, Osaka University
| | - Atsushi Kasai
- Laboratory of Molecular Neuropharmacology, Graduate School of Pharmaceutical Sciences, Osaka University
| | - Kaoru Seiriki
- Laboratory of Molecular Neuropharmacology, Graduate School of Pharmaceutical Sciences, Osaka University
- Institute for Transdisciplinary Graduate Degree Programs, Osaka University
| | - Misuzu Hayashida
- Laboratory of Molecular Neuropharmacology, Graduate School of Pharmaceutical Sciences, Osaka University
| | - Masato Tanuma
- Laboratory of Molecular Neuropharmacology, Graduate School of Pharmaceutical Sciences, Osaka University
| | - Rei Yokoyama
- Laboratory of Molecular Neuropharmacology, Graduate School of Pharmaceutical Sciences, Osaka University
| | - Yumi Hirato
- Laboratory of Molecular Neuropharmacology, Graduate School of Pharmaceutical Sciences, Osaka University
| | - Hitoshi Hashimoto
- Laboratory of Molecular Neuropharmacology, Graduate School of Pharmaceutical Sciences, Osaka University
- Open and Transdisciplinary Research Initiatives, Osaka University
- Department of Molecular Pharmaceutical Sciences, Graduate School of Medicine, Osaka University
- Molecular Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui
- Division of Bioscience, Institute for Datability Science, Osaka University
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Liu Y, Xu J, Fang K, Xu Y, Gao J, Zhou C, Tang X, Fang X, Chen J, Xie C, Zhang F, Zhang X, Wang C. Current antipsychotic agent use and risk of venous thromboembolism and pulmonary embolism: a systematic review and meta-analysis of observational studies. Ther Adv Psychopharmacol 2021; 11:2045125320982720. [PMID: 33505665 PMCID: PMC7812411 DOI: 10.1177/2045125320982720] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/19/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Antipsychotic agents (APS) are widely used drugs to treat psychotic symptoms and can effectively reduce both positive and negative symptoms of schizophrenia. For decades, some studies suggested that there is a relationship between using APS and the risk of venous thromboembolism (VTE) and pulmonary embolism (PE). However, results remain inconclusive. METHOD This review has been registered in International Prospective Register of Systematic Reviews (PROSPERO, ID: CDR42020155620). Relevant studies were identified among observational studies published up to 1 October 2019 in the databases MEDLINE, EMBASE, and Cochrane Library. Random or fixed-effects models were used to calculate the pooled odds ratio (OR). RESULTS In total, 28 observational studies were included. The results showed that compared with non-users, current APS users have significantly increased risks of VTE [OR 1.55 95% confidence interval (CI) 1.36, 1.76] and PE (OR 3.68, 95% CI 1.23, 11.05). Subgroup analyses suggested that new users were associated with a higher risk of VTE (OR 2.06, 95% CI 1.81, 2.35). For individual drugs, increased risk of VTE and PE was observed in taking haloperidol, risperidone, olanzapine, prochlorperazine but not in chlorpromazine, quetiapine or aripiprazole. However, careful interpretation is needed because of high heterogeneity among studies and scarce data. CONCLUSION The present comprehensive meta-analysis further indicates a significantly increased risk of VTE and PE in current APS users compared with non-users. Subgroup analyses suggest that new users are more likely to develop VTE. However, due to significant heterogeneity among studies, conclusions should be considered with caution.
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Affiliation(s)
- Yinzhao Liu
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jun Xu
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | - Kacey Fang
- Department of Cognitive Science, Yale University, New Haven, CT, USA
| | - Yue Xu
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ju Gao
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chao Zhou
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaowei Tang
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinyu Fang
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiu Chen
- Institute of Neuropsychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chunming Xie
- Department of Neurology, Affiliated ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Fuquan Zhang
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiangrong Zhang
- Department of Geriatric Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Congjie Wang
- Department of Psychiatry, Huai'an No. 3 People's Hospital, Huai'an 223001, Jiangsu, China
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Abstract
The prevalence of autism spectrum disorder is increasing. It usually presents in childhood with abnormal behaviour and development
The diagnosis can be difficult. There are often comorbidities which can cause confusion
Non-drug treatments are first line. Drug treatment is not effective for the core symptoms of autism spectrum disorder. However, drugs may have a role in managing comorbidities and related symptoms, such as irritability and aggression
Anxiety is a common comorbidity. Cognitive behaviour therapy can be effective, but in some cases selective serotonin reuptake inhibitors may have a role
Most patients have problems sleeping, but drugs are not usually used to treat sleep disorders in children
Antipsychotics, such as risperidone, may be considered for irritability and aggression. Clonidine is first line for children with Tourette syndrome. Patients need regular monitoring because of the adverse effects of these drugs
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Affiliation(s)
- Melanie Turner
- Child and adolescent psychiatrist, and Director, MyChild Psychiatry and Psychology, Norwood, South Australia.,Senior clinical lecturer, University of Adelaide
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40
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Treatment use among children with Tourette syndrome living in the United States, 2014. Psychiatry Res 2020; 293:113400. [PMID: 32841891 PMCID: PMC7669536 DOI: 10.1016/j.psychres.2020.113400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 01/06/2023]
Abstract
Treatment of Tourette syndrome (TS) can be complicated by changes over time in tic expression, severity, and co-occurring disorders. Using the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome, this study provides descriptive estimates of the use of behavioral interventions and medication among children living with TS. Parent-reported data on 115 children aged 5-17 years ever diagnosed with TS were analyzed to provide descriptive, unweighted results. Overall, 77.4% of children had current or past use of any TS treatment; 59.1% ever used behavioral interventions and 56.1% had ever taken TS medication. Children with "moderate" or "severe" versus "mild" TS, ≥1 co-occurring disorders, and tics that interfered with functioning were significantly more likely to have used one or more TS treatments. Side effects were reported for 84.4% of children who took TS medication. Most parents of children with current TS (87.2%) were satisfied with the management of their child's TS. However, parents of children with "moderate" or "severe" current TS were significantly more dissatisfied compared to parents of children with "mild" TS. Findings from this study could be used to inform efforts to support children living with TS and their families.
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Yan J, Yu L, Wen F, Wang F, Liu J, Cui Y, Li Y. The severity of obsessive-compulsive symptoms in Tourette syndrome and its relationship with premonitory urges: a meta-analysis. Expert Rev Neurother 2020; 20:1197-1205. [PMID: 32954857 DOI: 10.1080/14737175.2020.1826932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Nearly half of the patients with Tourette Syndrome (TS) present with comorbid Obsessive-Compulsive Symptoms (OCS) and premonitory urges (PUs). However, inconsistent results have been found in the correlation between PUs and OCS in patients with TS. METHODS A meta-analysis was applied to identify the severity of OCS and its correlation with PUs in TS patients. Subgroup and meta-regression analyses were used to identify potential heterogeneity. RESULTS A total of 13 studies, including 576 patients, were enrolled in this study. The pooled correlation coefficient (r) was 0.29 (95% confidence interval: 0.18, 0.38) and heterogeneity (I2) of pooled r was 40% based on a fixed-effect model. The mean level of OCS based on the assessment of Children's Yale-Brown Obsessive-Compulsive Symptom Scale/Yale-Brown Obsessive-Compulsive Symptom Scale was 14.99 (95% CI: 11.41, 18.57) by a random effect model. Results of meta-regression analysis demonstrated that the severity of tic symptoms based on the assessment of the Yale Global Tic Severity Scale was the predictor of severity of OCS (p = 0.018). CONCLUSION There was a mild positive correlation between the PUs and OCS in patients with TS. The severity of OCS in TS patients was mild to moderate and positively predicted by the severity of tic symptoms.
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Affiliation(s)
- Junjuan Yan
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
| | - Liping Yu
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
| | - Fang Wen
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
| | - Fang Wang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
| | - Jingran Liu
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
| | - Yonghua Cui
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
| | - Ying Li
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing, China
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42
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Ningdong Granule Upregulates the Striatal DA Transporter and Attenuates Stereotyped Behavior of Tourette Syndrome in Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:2980705. [PMID: 33005197 PMCID: PMC7509575 DOI: 10.1155/2020/2980705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 08/15/2020] [Accepted: 08/28/2020] [Indexed: 12/01/2022]
Abstract
This study aimed to evaluate the possible mechanism of Ningdong granule (NDG) for the treatment of Tourette syndrome (TS). The rats with stereotyped behavior were established by microinjection with TS patients' sera; then, the model rats were divided into NDG and haloperidol (Hal) group, and the nonmedication model rats were regarded as treatment control (TS group). The stereotyped behavior of the rats was recorded, the level of dopamine (DA) in striatum, and the content of homovanillic acid (HVA) in sera were tested, and dopamine transporter (DAT) expression was measured in the study. The experimental results showed that NDG effectively inhibited the stereotyped behavior (P < 0.01), decreased the levels of DA in the striatum (P < 0.05), increased the content of sera HVA (P < 0.01), and enhanced the protein and mRNA expression of DAT in the striatum (P < 0.01). Additionally, the results also revealed Hal could improve the stereotyped behavior as well but had no remarkable influence on DAT expression and DA metabolism. In conclusion, NDG attenuates stereotyped behavior, and its mechanism of action might be associated with the upregulation of DAT expression to regulate DA metabolism in the brain.
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Wang D, Tian HL, Cui X, Wang Q, Guo F, Zhang W, Tang QS. Effects of Jian-Pi-Zhi-Dong Decoction on the Expression of 5-HT and Its Receptor in a Rat Model of Tourette Syndrome and Comorbid Anxiety. Med Sci Monit 2020; 26:e924658. [PMID: 32738135 PMCID: PMC7416613 DOI: 10.12659/msm.924658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 05/13/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Anxiety is one of the common comorbidities of Tourette syndrome (TS). The serotonin (5-HT) system is involved in both TS and anxiety. Jian-pi-zhi-dong decoction (JPZDD) is widely used. However, the mechanism remains unknown. In this study, a rat model of TS and comorbid anxiety was used to evaluate the effect of JPZDD on 5-HT and its receptor. MATERIAL AND METHODS 48 rats were divided into 4 groups randomly (n=12). The model was established by empty water bottle stimulation plus iminodipropionitrile injection for 3 weeks. Then the control and model groups were gavaged with saline, while the treatment groups were gavaged with fluoxetine hydrochloride (Flx) or JPZDD. Body weights were measured, and behavioral tests were evaluated with stereotypy and elevated plus maze. The morphologic characters were observed by hematoxylin and eosin staining. The content of 5-HT was detected by enzyme-linked immunosorbent assay and high-performance liquid chromatography. The expression of 5-HT2C receptor was detected by western blot and quantitative polymerase chain reaction. RESULTS The stereotypy score was lower and the time spent in the open arm was longer in the JPZDD group compared with the model group. After the treatment of Flx or JPZDD, the structure of neurons became gradually normal and the cells were arranged neatly. The contents of 5-HT in the treatment groups were higher compared with the model group in the striatum. The expression of 5-HT2C mRNA in the striatum of JPZDD and Flx groups decreased compared with the model group, and the JPZDD group was lower than the Flx group. CONCLUSIONS JPZDD alleviated both tic and anxiety symptoms and the mechanism may be via reducing the expression of 5-HT2C mRNA in the striatum, increasing the concentration of 5-HT, and enhancing the activity of the 5-HT system, which in turn exerts neuro-inhibition.
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Affiliation(s)
- Dan Wang
- Department of Encephalopathy, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Hui-ling Tian
- Acupuncture-Moxibustion and Tuina Institute, Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Xia Cui
- Department of Pediatrics, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Qian Wang
- Department of Pediatrics, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Fan Guo
- Department of Pediatrics, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Wen Zhang
- Department of Pediatrics, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, P.R. China
| | - Qi-sheng Tang
- Department of Encephalopathy, The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, P.R. China
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44
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Patel H, Nguyen K, Lehman E, Mainali G, Duda L, Byler D, Kumar A. Use of Complementary and Alternative Medicine in Children With Tourette Syndrome. J Child Neurol 2020; 35:512-516. [PMID: 32233737 DOI: 10.1177/0883073820913670] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Tourette syndrome is a neuropsychiatric condition defined by motor and phonic tics with onset in childhood. Many families have concerns regarding potential side effects of pharmacologic treatments, and often have difficulty accessing comprehensive behavioral intervention for tics. Patients and caregivers may turn to complementary and alternative medicine (CAM) as they perceive these as "natural" and therefore "safe." Although there are anecdotal reports of an increased use of CAM in Tourette syndrome patients, the exact prevalence is unknown. OBJECTIVE The purpose of this study was to identify commonly used CAM therapies for children with Tourette syndrome at Penn State Hershey Medical Center. METHODS A questionnaire was administered to the caregivers of children (<18 years old) via telephone. The data pertaining to demographics, type of CAM use, duration of use, adverse effects, and caregiver's perception of the effectiveness were collected. RESULTS A total of 110 patients participated in this survey. When inquired about the different CAM methods, 69.1% of the participants reported using 1 or more CAM therapies, and 58% of those who used CAM informed the doctor about their use. Ninety-three percent of those who used CAM therapy reported a decrease in tic frequency. The most commonly used CAM therapies were stress management (44.6%), herbal medicine (18.2%), homeopathy (12.7%), and meditation (9.1%). In total, 46% of the participants said that CAM helped more than medication. CONCLUSION The majority of patients interviewed were using CAM therapies, and a significant portion reported benefit greater than medication. More than half of all participants discussed CAM therapies with their physicians, and 63% of participants felt that their physicians would support their use of CAM therapies.
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Affiliation(s)
- Himadri Patel
- Penn State College of Medicine, Hershey Medical Center, Hershey, PA, USA
| | - KieuHanh Nguyen
- Penn State College of Medicine, Hershey Medical Center, Hershey, PA, USA
| | - Erik Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Gayatra Mainali
- Department of Pediatrics, Division of Neurology, Penn State College of Medicine/Penn State Children's Hospital, Hershey, PA, USA
| | - Laura Duda
- Department of Pediatrics, Division of Academic General Pediatrics, Penn State College of Medicine/Penn State Children's Hospital, Hershey, PA, USA
| | - Debra Byler
- Department of Pediatrics, Division of Neurology, Penn State College of Medicine/Penn State Children's Hospital, Hershey, PA, USA
| | - Ashutosh Kumar
- Department of Pediatrics, Division of Neurology, Penn State College of Medicine/Penn State Children's Hospital, Hershey, PA, USA
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Stiede JT, Woods DW. Pediatric Prevention: Tic Disorders. Pediatr Clin North Am 2020; 67:547-557. [PMID: 32443993 DOI: 10.1016/j.pcl.2020.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
It is not clear whether the development of tics can be prevented. Contextual variables can impact tic expression; therefore, shifting attention to behaviors that reduce tics is an important part of decreasing tic severity. Several medications are effective in reducing tic severity, but side effects restrict their use. Behavioral treatment is the gold standard psychotherapy intervention for tic disorders, with Comprehensive Behavioral Intervention for Tics being the most well-supported nonpharmacological treatment. Although children may be unable to prevent the development of tics, they can still use several strategies to reduce tic severity and impairment.
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Affiliation(s)
- Jordan T Stiede
- Psychology Department, Marquette University, Cramer Hall, 307, PO Box 1881, Milwaukee, WI 53201-1881, USA
| | - Douglas W Woods
- Marquette University, Holthusen Hall, 305, PO Box 1881, Milwaukee, WI 5320-1881, USA.
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Yu L, Yan J, Wen F, Wang F, Liu J, Cui Y, Li Y. Revisiting the Efficacy and Tolerability of Topiramate for Tic Disorders: A Meta-Analysis. J Child Adolesc Psychopharmacol 2020; 30:316-325. [PMID: 32191124 DOI: 10.1089/cap.2019.0161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Tic disorders (TDs) are chronic neuropsychiatric disorders that usually begin in childhood. Currently, antipsychotic drugs, such as aripiprazole and risperidone, are frequently used to treat TD. However, adverse reactions limit their further usage. The efficacy of topiramate has been reported in recent studies. This study aimed to investigate the efficacy and tolerability of topiramate in the treatment of children with TDs. Methods: In this study, we performed a meta-analysis to assess the efficacy and tolerability of topiramate for TDs and identified the randomized controlled trials to evaluate topiramate for children with TDs from PubMed, the China National Knowledge Infrastructure database, Web of Science, and relevant reference lists. Quality assessment followed the Cochrane Handbook for Systematic Reviews of Interventions. A modified Jadad scale was used to assess the quality of included studies. Risk ratio (RR) was calculated as the effect size of efficacy and tolerability of topiramate for TDs. Results: A total of 15 studies involving 1070 participants aged 2-17 were included in the present meta-analysis, and 693 (64.71%) participants were male cases, with 14 studies evaluating the efficacy of topiramate for the treatment of TD. The results suggested that topiramate was more effective than control drugs (RR: 1.13, 95% confidence interval: [1.06-1.20], I2 = 36%, Q = 20.31, p = 0.09). For the adverse events, there were 15 trials included in the meta-analysis, and the results showed that topiramate had fewer adverse events than control drugs (RR: 0.54, 95% confidence interval: [0.46-0.65], I2 = 45%, Q = 25.49, p = 0.03). Conclusion: Compared with haloperidol and tiapride, topiramate appears to be a promising medication with good efficacy and tolerability for children with TDs. In future studies, large-sample, double-blind, placebo-controlled trials are needed to confirm its efficacy and tolerability compared with atypical antipsychotic agents (such as risperidone or aripiprazole).
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Affiliation(s)
- Liping Yu
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Junjuan Yan
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Fang Wen
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Fang Wang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Jingran Liu
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yonghua Cui
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Ying Li
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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47
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Yadegar M, Guo S, Ricketts EJ, Zinner SH. Assessment and Management of Tic Disorders in Pediatric Primary Care Settings. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2020; 6:159-172. [PMID: 32467820 DOI: 10.1007/s40474-019-00168-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose of Review Pediatricians and other primary care providers are often the first and sole healthcare clinicians of patients who present with tics. However, limited primary care pediatric training in neuropsychiatric concerns, as well as perceived lack of comfort and preparation, make it challenging for these clinicians to confidently identify and manage tic disorders. Recent Findings Current empirical findings of tic disorder management relevant to pediatric physicians, including assessment, psychoeducation, behavioral interventions, psychotropic medications, and alternative treatments are reviewed. Summary This article discusses neuropsychiatric and medical complexities of tic disorder assessment, with particular emphasis on differential and comorbid diagnoses. Tiered referral recommendations, based on symptom severity, impairment, and consideration of comorbid conditions, are provided. Future directions for tic management, including dissemination of evidence-based treatments of tic disorders and multidisciplinary teams within pediatric primary care settings, are included.
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Affiliation(s)
- Mina Yadegar
- Univeristy of California, Los Angeles.,Boston Child Study Center - Los Angeles.,Behavioral Associates Los Angeles
| | - Sisi Guo
- Univeristy of California, Los Angeles
| | | | - Samuel H Zinner
- University of Washington School of Medicine.,Seattle Children's Hospital
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Xia X, Lin Y, Lang B, Yuan J, Sheng L, Yang D, Shen J. Characteristics of diffusion tensor imaging of central nervous system in children with tourette's disease. Medicine (Baltimore) 2020; 99:e20492. [PMID: 32481462 DOI: 10.1097/md.0000000000020492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To investigate the characteristics of diffusion tensor imaging (DTI) of the central nervous system in children with Tourette syndrome (TS).Fifteen children with TS (TS group) and 15 normal children (control group) were studied, and all of them underwent DTI. The apparent diffusion coefficient (ADC) and fractional anisotropy (FA) parameters were calculated using the DTIStudio software. The region of interest was delineated manually. The ADC and FA values of the bilateral caudate nucleus, bilateral globus pallidus, bilateral putamen, bilateral thalamus, and bilateral frontal lobe white matter were measured using the region of interest editor software. The differences of FA values and ADC values between the same brain areas were compared. The associations between ADC, FA values and Yale Global Tic Severity Scale (YGTSS) scores were evaluated by Pearson correlation analyses.The FA values of left globus pallidus and left thalamus were significantly lower in the TS group than in the control group (P < .05), while the ADC values of the right caudate nucleus and bilateral thalamus were significantly higher in the TS group than in the control group (P < .05). The decrease in FA in the left thalamus significantly correlated with the YGTSS score (r = 0.692; P < .05). No correlation was found between FA and ADC values in other brain regions and the YGTSS score (P > .05).After the DTI analyses, abnormalities were found in the left globus pallidus, right caudate nucleus, and bilateral thalamus in children with TS. Especially the changes in the left thalamus structure was crucial in the pathophysiological clock of TS.
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Affiliation(s)
| | | | - Boxu Lang
- Department of Acupuncture and Massage Rehabilitation, Municipal Hospital Affiliated to Medical School of Taizhou University, Taizhou, China
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49
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Mahajan UV, Purger DA, Mantovani A, Williams NR, Espil FM, Han SS, Stein SC, Halpern CH. Deep Brain Stimulation Results in Greater Symptomatic Improvement in Tourette Syndrome than Conservative Measures: A Meta-Analysis. Stereotact Funct Neurosurg 2020; 98:270-277. [PMID: 32434201 DOI: 10.1159/000507059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/06/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Deep brain stimulation (DBS) has emerged as a safe and effective therapy for refractory Tourette syndrome (TS). Recent studies have identified several neural targets as effective in reducing TS symptoms with DBS, but, to our knowledge, none has compared the effectiveness of DBS with conservative therapy. METHODS A literature review was performed to identify studies investigating adult patient outcomes reported as Yale Global Tic Severity Scale (YGTSS) scores after DBS surgery, pharmacotherapy, and psychotherapy. Data were pooled using a random-effects model of inverse variance-weighted meta-analysis (n = 168 for DBS, n = 131 for medications, and n = 154 for behavioral therapy). RESULTS DBS resulted in a significantly greater reduction in YGTSS total score (49.9 ± 17.5%) than pharmacotherapy (22.5 ± 15.2%, p = 0.001) or psychotherapy (20.0 ± 11.3%, p < 0.001), with a complication (adverse effect) rate of 0.15/case, 1.13/case, and 0.60/case, respectively. CONCLUSION Our data suggest that adult patients with refractory TS undergoing DBS experience greater symptomatic improvement with surprisingly low morbidity than can be obtained with pharmacotherapy or psychotherapy.
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Affiliation(s)
- Uma V Mahajan
- Case Western Reserve University, Cleveland, Ohio, USA
| | - David A Purger
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Alessandra Mantovani
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Nolan R Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Summer S Han
- Neurosurgery and Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California, USA
| | - Sherman C Stein
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Casey H Halpern
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA,
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Abstract
Introduction: Though many unanswered questions about the pathophysiology of Tourette Syndrome remain, several pharmacotherapies for tics have been studied, with varying results in terms of efficacy and the strength of evidence.Areas covered: This literature review encompasses pharmacotherapies for tics. The pharmacotherapies discussed in this review include: alpha agonists, antipsychotics, topiramate, botulinum toxin, and dopamine depleters.Expert opinion: Once the presence of tics is confirmed and psychoeducation and support are provided to patients and caregivers, one must examine the degree of tic-related impairment and the presence of psychiatric comorbidities. These factors influence treatment decisions as the presence of comorbidity and related impairment may shift the treatment target. When selecting a medication for tics, the presence of ADHD (the most frequent comorbidity) strengthens the case for choosing an alpha agonist. The case for antipsychotic medications is strongest when tic-related impairment is severe and/or the tics are refractory to more conservative measures. All medications require drug safety monitoring procedures and reevaluation over time.
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Affiliation(s)
- Nicholas Cothros
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Alex Medina
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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