1
|
Lu C, Wu LQ, Hao H, Kimberly Leow X, Xu FW, Li PP, Wang DS. Clinical efficacy and safety of acupuncture treatment of TIC disorder in children: A systematic review and meta-analysis of 22 randomized controlled trials. Complement Ther Med 2021; 59:102734. [PMID: 33989798 DOI: 10.1016/j.ctim.2021.102734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 03/19/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To systematically evaluate the clinical efficacy and safety of acupuncture in the treatment of Tic Disorders (TD) in children, and to clarify the current evidence regarding the clinical application of acupuncture in the treatment of TD. METHODS Randomized controlled trials (RCTs) comparing acupuncture treatment with pharmaceutical treatment for TD were included in this review. A comprehensive search of 6 electronic literature databases was conducted, and the retrieval date was from the establishment of the database to April 2020. The Cochrane Collaboration's bias risk assessment tool was used to evaluate the bias risk of the included literature, and adopted the Review Manager 5.3 was used for statistical analysis of the data in the included literature. RESULTS A total of 22 RCTs (1668 participants) were included in this review. Meta-analysis indicated that acupuncture showed superior effects in the following aspects, including higher overall effective rate [RR = 1.20,95 % CI(1.09,1.20),P<0.00001], significant reduction in Yale Global Tic Severity Scale (YGTSS) scores [MD=-2.79,95 %CI(-4.75,-0.82),P = 0.005], lower incidence of adverse effects [RR = 0.26,95 %CI(0.17,0.41),P<0.00001], and reduced recurrence rate [RR = 0.28,95 %CI(0.17,0.46),P<0.00001]. CONCLUSION Acupuncture treatment alone is more effective in the treatment of TD than pharmaceutical treatment, as seen in the reduction of YGTSS scores, fewer adverse effects and lower recurrence rates.
Collapse
Affiliation(s)
- Chen Lu
- Beijing University of Chinese Medicine, No. 11 Beisanhuan East Road, Chaoyang District, Beijing, 100029, China.
| | - Li-Qun Wu
- Dongfang Hospital,Beijing University of Chinese Medicine, No. 6, Fangxingyuan District 1, Fengtai District, Beijing, 100078, China.
| | - Hongwen Hao
- Dongfang Hospital,Beijing University of Chinese Medicine, No. 6, Fangxingyuan District 1, Fengtai District, Beijing, 100078, China.
| | - Xinting Kimberly Leow
- Beijing University of Chinese Medicine, No. 11 Beisanhuan East Road, Chaoyang District, Beijing, 100029, China.
| | - Fang-Wei Xu
- Beijing University of Chinese Medicine, No. 11 Beisanhuan East Road, Chaoyang District, Beijing, 100029, China.
| | - Pan-Pan Li
- Beijing University of Chinese Medicine, No. 11 Beisanhuan East Road, Chaoyang District, Beijing, 100029, China.
| | - Dong-Sheng Wang
- Beijing University of Chinese Medicine, No. 11 Beisanhuan East Road, Chaoyang District, Beijing, 100029, China.
| |
Collapse
|
2
|
You HZ, Zhou YF, Yu PB, Xie J, Chen J, Li JJ, Wang GH, Sun KX. The Efficacy of Acupuncture on Tic Disorders in Children: A Retrospective and Propensity Score-Matched Study. Front Pediatr 2021; 9:745212. [PMID: 34805042 PMCID: PMC8600324 DOI: 10.3389/fped.2021.745212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background : Acupuncture has been considered as a complementary or alternative therapy for children with tic disorders (TD), but its efficacy remains largely unknown. This study retrospectively examined the efficacy of acupuncture treatment for TD in children over the course of 12 weeks. Methods: Data were collected from Traditional Chinese Medicine clinics in a public pediatric hospital in Shanghai between June 2020 and March 2021. A total of 250 patients with TD were included in the study, with 122 patients exposed to acupuncture therapy combined with conventional treatment (observation group), and 128 patients exposed to conventional treatment alone (control group). Propensity score matching analyses were used to balance baseline characteristics, resulting in 78 matched patients for each group. Reductions in the Yale Global Tic Severity Scale (YGTSS) total score were analyzed in the two groups after 12 weeks of treatment. Results: The two groups reached equilibrium in terms of baseline demographic characteristics and YGTSS total score after the propensity score matching (P > 0.05). Compared to the control group, the reduction in the YGTSS total score after 12 weeks of treatment was greater for the observation group (OR = 2.94, 95% CI: 1.03, 8.39, P = 0.04), and this association was stronger for patients who had significant vocal tics (β = 0.29, 95% CI: 0.88, 2.68, P = 0.001). The clinical efficacy for the observation group was significantly better than the control group. Conclusions: We provided preliminary evidence supporting the therapeutic effect of acupuncture for TD in children. Hence, our findings indicate that acupuncture could be an adjuvant treatment efficacious for TD in children, especially for vocal tics.
Collapse
Affiliation(s)
- Hai-Zhen You
- Department of Traditional Chinese Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Fang Zhou
- Department of Traditional Chinese Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ping-Bo Yu
- Department of Traditional Chinese Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Xie
- Department of Traditional Chinese Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Chen
- Department of Traditional Chinese Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ji-Jun Li
- Department of Traditional Chinese Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guang-Hai Wang
- Department of Developmental and Behavioral Pediatrics, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University of Medicine, Shanghai, China
| | - Ke-Xing Sun
- Department of Traditional Chinese Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
3
|
Chen CW, Hsueh CW, Chung CH, Wang HS, Chang HJ, Chien WC. The association between tic medication therapy and psychiatric comorbidities among patients with Tourette syndrome: A national population-based study in Taiwan. Brain Dev 2020; 42:373-382. [PMID: 32029325 DOI: 10.1016/j.braindev.2020.01.002] [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: 12/13/2018] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tourette syndrome (TS) is often comorbid with attention deficit hyperactivity disorder, obsessive-compulsive disorder, and depression. Medications are the main treatment for TS. Relationships between TS medication therapy and psychiatric comorbidities remain unclear. This study explored the impacts of TS medication on the risk of psychiatric comorbidities using a nationally representative sample of TS in Taiwan. METHODS Data from National Health Insurance Research Database in Taiwan was used to identify 997,213 children and adolescents aged 6-18 years who had received a diagnosis of TS based on ICD-9-CM codes in 2000-2010. Cox's proportional hazard regression analysis was conducted to estimate the risk of comorbidities among subjects with and without tic medication therapy. RESULTS We found that in TS patients, a lower risk of psychiatric comorbidities occurred in the tic medication therapy group (p = 0.012) and the crude hazard ratio (HR) was 0.6 (95% confidence interval (CI) = 0.4-0.8, p < 0.001). After adjusting for potential confounders of gender, age, income, level of care, department visited, brain injury, and the number of suicide attempts, the risk of comorbidities was still significantly lower in the tic medication therapy group (adjusted HR = 0.5, 95% CI = 0.3-0.6, p < 0.001). DISCUSSION One limitation was that we did not include all mediations used to treat psychiatric comorbidities among TS patients. This study found the effectiveness of TS medications on improving psychiatric comorbidities. CONCLUSIONS Compared to those without medication, medication therapy appears to have a benefit of decreasing the risk of psychiatric comorbidities. Strategies to improve medication regimens should be considered in clinical settings.
Collapse
Affiliation(s)
- Chia-Wen Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chang-Wei Hsueh
- Division of Pediatric Neurology, Landseed Hospital, Taoyuan, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taiwanese Injury, Taipei, Taiwan
| | - Huei-Shyong Wang
- Division of Pediatric Neurology, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsiu-Ju Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taiwanese Injury, Taipei, Taiwan.
| |
Collapse
|
4
|
Liu ZS, Cui YH, Sun D, Lu Q, Jiang YW, Jiang L, Wang JQ, Luo R, Fang F, Zhou SZ, Wang Y, Cai FC, Lin Q, Xiong L, Zheng Y, Qin J. Current Status, Diagnosis, and Treatment Recommendation for Tic Disorders in China. Front Psychiatry 2020; 11:774. [PMID: 32903695 PMCID: PMC7438753 DOI: 10.3389/fpsyt.2020.00774] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 07/21/2020] [Indexed: 12/19/2022] Open
Abstract
Tic disorders (TD) are a group neuropsychiatric disorders with childhood onset characterized by tics, i.e. repetitive, sudden, and involuntary movements or vocalizations; and Tourette syndrome (TS) is the most severe form of TD. Their clinical manifestations are diverse; and are often associated with various psychopathological and/or behavioral comorbidities, including attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, depression, and sleep disorders. Individual severity and response to treatment are highly variable, and there are some refractory cases, which are less responsive to conventional TD treatment. TD/TS are also common in the Chinese pediatric population. To help improve the understanding of TD for pediatricians and other health professionals, and to improve its diagnosis and treatment in China, the Chinese Child Neurology Society (CCNS) has developed an Expert Consensus on Diagnosis and Treatment of TD in China, which is based on our clinical experience and the availability therapeutic avenues. It is focused on clinical diagnosis and evaluation of TD and its comorbidities, psychological and educational intervention, nonpharmacological therapy, pharmacological treatment, including traditional Chinese medicine and acupuncture, as well as prognosis in children with TD in China. A summary of the current status of TD and up-to-date diagnosis and treatment recommendations for TD in China is presented here.
Collapse
Affiliation(s)
- Zhi-Sheng Liu
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong-Hua Cui
- Department of Neurology and Psychiatry, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Dan Sun
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Lu
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu-Wu Jiang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jia-Qin Wang
- Department of Pediatrics, Third Affiliated Hospital of Xinxiang Medical College, Xinxiang, China
| | - Rong Luo
- Department of Pediatrics, Huaxi Second Hospital of Sichuan University, Chengdu, China
| | - Fang Fang
- Department of Neurology and Psychiatry, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Shui-Zhen Zhou
- Department of Neurology, Pediatric Hospital Affiliated to Fudan University, Shanghai, China
| | - Yi Wang
- Department of Neurology, Pediatric Hospital Affiliated to Fudan University, Shanghai, China
| | - Fang-Cheng Cai
- Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Lin
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Lan Xiong
- Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Yi Zheng
- Department of Pediatrics, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jiong Qin
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| |
Collapse
|
5
|
Lin L, Yu L, Xiang H, Hu X, Yuan X, Zhu H, Li H, Zhang H, Hou T, Cao J, Wu S, Su W, Li M. Effects of Acupuncture on Behavioral Stereotypies and Brain Dopamine System in Mice as a Model of Tourette Syndrome. Front Behav Neurosci 2019; 13:239. [PMID: 31680895 PMCID: PMC6803462 DOI: 10.3389/fnbeh.2019.00239] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/23/2019] [Indexed: 12/23/2022] Open
Abstract
Tourette syndrome (TS), a developmental neurobehavioral disorder, is characterized by involuntary behavioral stereotypies. Clinical studies have confirmed the positive effect of acupuncture on treating TS, but the underlying mechanisms are not fully understood. In the present study, we used behavioral tests, Western blotting, double-immunofluorescence labeling, and fluorescence spectrophotometry to investigate whether acupuncture performed at acupoints "Baihui" (GV20) and "Yintang" (GV29) affected behavioral stereotypies and regulated the dopamine (DA) system in three different brain regions in Balb/c mice injected with 3,3'-iminodipropionitrile (IDPN) as a model for TS. We found that acupuncture alleviated behavioral stereotypies, down-regulated the expression of D1R and D2R in the striatum (STR) and substantia nigra pars compacta (SNpc), and decreased the concentration of DA in the STR, SNpc, and prefrontal cortex (PFC) as well. Moreover, acupuncture reduced the expression of tyrosine hydroxylase (TH) in the SNpc. Conclusively, acupuncture ameliorated behavioral stereotypies by regulating the DA system in the STR, SNpc, and PFC. Our findings provide novel evidence for the therapeutic effect of acupuncture on TS.
Collapse
Affiliation(s)
- Lixue Lin
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lingling Yu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongchun Xiang
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuefei Hu
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaocui Yuan
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - He Zhu
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongping Li
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Zhang
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tengfei Hou
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Cao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuang Wu
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen Su
- Department of Pediatrics, Wuhan No. 1 Hospital, Wuhan, China
| | - Man Li
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
6
|
Cothros N, Martino D, McMorris C, Stewart D, Tehrani A, Pringsheim T. Prescriptions for Alpha Agonists and Antipsychotics in Children and Youth with Tic Disorders: A Pharmacoepidemiologic Study. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2019; 9:645. [PMID: 31413891 PMCID: PMC6691607 DOI: 10.7916/tohm.v0.645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/14/2019] [Indexed: 12/12/2022]
Abstract
Background Trends in the use of antipsychotics and alpha agonists for the treatment of tic disorders in Canadian children, and how closely these trends align with evidence-based guidelines on the pharmacotherapy of tic disorders, have not been explored. Methods IQVIA's Canadian Disease and Therapeutic Index, a survey-based data set, was used to identify prescription patterns by physicians. Respondents recorded all patient visits during a 48-hour period in each quarter of the year, including patient age, gender, drug recommendation and therapeutic indication. Recommendations for alpha agonists and antipsychotics from 2012 to 2016 were analysed for children and adolescents with tic disorders. Results Risperidone and clonidine were the most commonly recommended medications for tic disorders over the study period, with 36,868 and 35,500 recommendations in 2016, respectively. Recommendations for clonidine increased over the study period, whereas those for risperidone decreased. Guanfacine (approved in Canada in 2013) was used less frequently than clonidine. Clonidine was more frequently recommended than antipsychotics in children younger than 6, in whom antipsychotic recommendations were uncommon. Aripiprazole was the second most commonly recommended antipsychotic for tic disorders, with 22,892 recommendations in 2016. Of the first-generation antipsychotics, pimozide was most commonly recommended (11,334 recommendations in 2016); haloperidol was infrequently recommended. Discussion The trends observed are in line with guideline recommendations reflected in the decreasing use of risperidone, and the growing use of clonidine and guanfacine. The growing use of aripiprazole is likely due to emerging evidence from clinical trials supporting its efficacy for tics. Recommendations for pimozide and haloperidol were limited, likely due to the greater adverse effects associated with these medications.
Collapse
Affiliation(s)
- Nicholas Cothros
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Hotchkiss Brain Institute, Foothills Hospital, Calgary, AB, CA
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Hotchkiss Brain Institute, Foothills Hospital, Calgary, AB, CA
| | - Carly McMorris
- Werklund School of Education, Alberta Children's Hospital Research Institute (ACHRI), University of Calgary, Calgary, AB, CA.,The Owerko Centre, Child Development Centre (CDC), Calgary, AB, CA
| | | | | | - Tamara Pringsheim
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary and Hotchkiss Brain Institute, Foothills Hospital, Calgary, AB, CA.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Foothills Hospital, Calgary, AB, CA.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, CA
| |
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW This article was written in order to bring the reader up to date with developments that have occurred in the treatment of Tourette disorder (TD) over the last 5 years. RECENT FINDINGS Despite the fact that TD has been recognized for over a century, the understanding of the underlying mechanisms remains poor. There has been limited development in the last 5 years for new therapeutic options. Aripipazole is the only newly approved pharmaceutical therapy for TD in the last 5 years, although several medications are under active study. For the most severely affected individuals, there is increasing experience with surgical interventions. One of the most promising areas of research is the work of genetic consortiums currently looking into identifying the underlying pathogenetic basis which in turn will hopefully lead to the development of safer and more effective therapies.
Collapse
|
8
|
Striatal dopaminergic alterations in Tourette's syndrome: a meta-analysis based on 16 PET and SPECT neuroimaging studies. Transl Psychiatry 2018; 8:143. [PMID: 30072700 PMCID: PMC6072751 DOI: 10.1038/s41398-018-0202-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/17/2018] [Accepted: 06/05/2018] [Indexed: 01/07/2023] Open
Abstract
Despite intense research, the underlying mechanisms and the etiology of Tourette's syndrome (TS) remain unknown. Data from molecular imaging studies targeting the dopamine system in Tourette patients are inconclusive. For a better understanding of the striatal dopamine function in adult dopamine-antagonist-free patients we performed a systematic review in August 2017 identifying 49 PET and SPECT studies on the topic of TS. A total of 8 studies appraised the dopamine transporter (DAT) with 111 Tourette patients and 93 healthy controls, and could be included in a meta-analytic approach. We found a significantly increased striatal DAT binding in Tourette patients (Hedges' g = 0.49; 95% CI: (0.01-0.98)), although this effect did not remain significant after correcting for age differences between cohorts. A second meta-analysis was performed for the striatal dopamine receptor including 8 studies with a total of 72 Tourette patients and 71 controls. This analysis revealed a nonsignificant trend toward lower dopamine 2/3 receptor binding in striatum of Tourette patients. Other analyses regarding study population characteristics in both the DAT and receptor meta-analysis did not show any meaningful results. Our results indicate that dopaminergic alterations in TS are likely and thereby this data would be in line with the current pathophysiological hypotheses of a dysfunction in the dopamine system, e.g., the hypothesis of tonic-phasic dysfunction. However, these analyses suffer from low effect sizes probably due to the heterogeneity of TS and highlight the need for further large-scaled neuroimaging studies.
Collapse
|
9
|
Bloch Y, Arad S, Levkovitz Y. Deep TMS add-on treatment for intractable Tourette syndrome: A feasibility study. World J Biol Psychiatry 2016; 17:557-61. [PMID: 25342253 DOI: 10.3109/15622975.2014.964767] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES In a considerable minority of patients who suffer from Tourette syndrome (TS) the disorder persists into adulthood and is associated with severe symptoms and limited therapeutic options. Repetitive transcranial magnetic stimulation (rTMS) to the supplementary motor area (SMA) has shown promising therapeutic results. Deep rTMS is a novel technology that enables deeper non-invasive cortical stimulation. This open-label pilot study is the first to examine the possible role of deep rTMS as add-on treatment for intractable TS. METHODS Twelve patients were recruited in order to examine bilateral SMA inhibition via deep TMS using the HBDL coil, as a possible treatment for adult TS treatment-resistant patients. Two patients did not complete the 20-day study protocol. RESULTS There were no significant side effects. While tics did not improve among the group as a whole, the subgroup of six patients with combined TS and OCD (obsessive compulsive syndrome) showed significant improvement in tic severity (P = 0.037). CONCLUSIONS These findings support the safety of deep rTMS for treating TS. The results also highlight the importance of studying the different TS syndromes separately (e.g., with or without OCD comorbidity) when evaluating deep rTMS protocols for TS patients.
Collapse
Affiliation(s)
- Yuval Bloch
- a The Emotion-Cognition Research Center, Shalvata Mental Health Care Center , Hod-Hasharon , Israel.,b Child and Adolescent Outpatient Clinic, Shalvata Mental Health Care Center , Hod-Hasharon , Israel.,c Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel
| | - Shira Arad
- a The Emotion-Cognition Research Center, Shalvata Mental Health Care Center , Hod-Hasharon , Israel.,c Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel
| | - Yechiel Levkovitz
- a The Emotion-Cognition Research Center, Shalvata Mental Health Care Center , Hod-Hasharon , Israel.,c Sackler Faculty of Medicine, Tel-Aviv University , Tel-Aviv , Israel
| |
Collapse
|
10
|
Karakaya I, Şişmanlar ŞG. Tic disorders in the differential diagnosis of chronic cough in children in relation to four cases. Turk Arch Pediatr 2015; 50:176-9. [PMID: 26568694 DOI: 10.5152/turkpediatriars.2015.1215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 10/04/2013] [Indexed: 11/22/2022]
Abstract
Chronic cough is a frequent reason for medical referrals in childhood. In patients who do not have signs or symptoms of an underlying respiratory system disease and who do not respond to experimental treatment, psychogenic cough should be considered. In this paper, four patients who were referred to our department with a prediagnosis of psychogenic cough, found to have tic disorder as a result of the assessments performed and improved with antipsychotic medication are presented. The differantial diagnosis of chronic cough in children should include tic disorders as well as psychogenic cough. Tic disorders can be diagnosed easily with detailed history and their response to medical treatment is rather satisfactory. Recognition of these disorders by pediatricians will minimize erroneous diagnoses and inappropriate therapies in children with a complaint of chronic cough.
Collapse
Affiliation(s)
- Işık Karakaya
- Department of Child and Adolescent Psychiatry, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Şahika Gülen Şişmanlar
- Department of Child and Adolescent Psychiatry, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| |
Collapse
|
11
|
Hartmann A, Worbe Y. Pharmacological treatment of Gilles de la Tourette syndrome. Neurosci Biobehav Rev 2012; 37:1157-61. [PMID: 23137552 DOI: 10.1016/j.neubiorev.2012.10.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 10/10/2012] [Accepted: 10/28/2012] [Indexed: 11/25/2022]
Abstract
Pharmacological treatment is usually indicated in moderate to severe tics in psychosocial and/or functional impairment. Neuroleptics with D2 antagonistic activity remain the cornerstone of anti-tic therapy. Lack of randomized controlled clinical trials base therapeutic decisions mainly on clinical expertise and common sense. Recently, aripiprazole has emerged as the neuroleptic with the most advantageous efficacy/side effect ratio for treating tics. Yet, in non-responders to aripiprazole, many neuroleptic and non-neuroleptic drugs, including botulinum toxin injections, are available and often successful. Apart from conducting methodologically sound trials (which includes sufficiently long observation periods), future efforts in the field should test the combination of cognitive-behavioral therapy with drugs or of multi-drug therapy as well as the development of biomarkers (endophenotypes) to monitor and even predict treatment response.
Collapse
Affiliation(s)
- Andreas Hartmann
- Centre de Référence National Maladie Rare: Syndrome Gilles de la Tourette, Département de Neurologie, Pôle des Maladies du Système Nerveux, France.
| | | |
Collapse
|
12
|
Huys D, Hardenacke K, Poppe P, Bartsch C, Baskin B, Kuhn J. Update on the role of antipsychotics in the treatment of Tourette syndrome. Neuropsychiatr Dis Treat 2012; 8:95-104. [PMID: 22442630 PMCID: PMC3307661 DOI: 10.2147/ndt.s12990] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Tourette syndrome (TS) is a neuropsychiatric disorder with typical onset in childhood and characterized by chronic occurrence of motor and vocal tics. The disorder can lead to serious impairments of both quality of life and psychosocial functioning, particularly for those individuals displaying complex tics. In such patients, drug treatment is recommended. The pathophysiology of TS is thought to involve a dysfunction of basal ganglia-related circuits and hyperactive dopaminergic innervations. Congruently, dopamine receptor antagonism of neuroleptics appears to be the most efficacious approach for pharmacological intervention. To assess the efficacy of the different neuroleptics available, a systematic, keyword-related search in PubMed (National Library of Medicine, Washington, DC) was undertaken. Much information on the use of antipsychotics in the treatment of TS is based on older data. Our objective was to give an update and therefore we focused on papers published in the last decade (between 2001 and 2011). Accordingly, the present review aims to summarize the current and evidence-based knowledge on the risk-benefit ratio of both first and second generation neuroleptics in TS.
Collapse
Affiliation(s)
- Daniel Huys
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany Head: Prof. Dr. Joachim Klosterkötter
| | | | | | | | | | | |
Collapse
|
13
|
Genetic animal models of Tourette syndrome: The long and winding road from lab to clinic. Transl Neurosci 2012. [DOI: 10.2478/s13380-012-0020-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AbstractTourette syndrome (TS) is a disabling neuropsychiatric disorder characterised by persistent motor and vocal tics. TS is a highly comorbid state, hence, patients might experience anxiety, obsessions, compulsions, sleep abnormalities, depression, emotional liability, learning problems, and attention deficits in addition to tics. In spite of its complex heterogeneous genetic aetiology, recent studies highlighted a strong link between TS and genetic lesions in the HDC (L-histidine decarboxylase) gene, which encodes the enzyme that synthetises histamine, and the SLITRK1 (SLIT and TRK-like family member 1) gene, which encodes a transmembrane protein that was found to regulate neurite outgrowth. In addition to validating the contribution of a specific genetic aberration to the development of a particular pathology, animal models are crucial to dissect the function of disease-linked proteins, expose disease pathways through examination of genetic modifiers and discover as well as assess therapeutic strategies. Mice with a knockout of either Hdc or Slitrk1 exhibit anxiety and those lacking Hdc, display dopamine agonist-triggered stereotypic movements. However, the mouse knockouts do not spontaneously display tics, which are recognised as the hallmark of TS. In this review, we explore the features of the present genetic animal models of TS and identify reasons for their poor resemblance to the human condition. Importantly, we highlight ways forward aimed at developing a valuable genetic model of TS or a model that has good predictive validity in developing therapeutic drugs for the treatment of tics, hence potentially accelerating the arduous journey from lab to clinic.
Collapse
|
14
|
Greene DJ, Schlaggar BL. Insights for treatment in Tourette syndrome from fMRI. Trends Cogn Sci 2011; 16:15-6. [PMID: 22133579 DOI: 10.1016/j.tics.2011.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 11/16/2011] [Indexed: 11/26/2022]
Abstract
In a recent American Journal of Psychiatry article, Wang and colleagues used functional MRI (fMRI) to examine cortico-striatal-thalamo-cortical circuitry in Tourette syndrome (TS), advancing the field's investigation of circuit level dysfunction in vivo in individuals with TS. Their results provide insight for interrogating neural mechanisms underlying different treatment methods.
Collapse
Affiliation(s)
- Deanna J Greene
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | | |
Collapse
|
15
|
Abstract
Tourette syndrome is a hereditary, childhood-onset neurodevelopmental disorder that was first clearly described in France in 1885. This disorder is characterized by sudden, rapid, recurrent, nonrhythmic movements (motor tics) or sounds (vocal or phonic tics), often preceded by premonitory sensations or urges. Some individuals also have psychiatric comorbidities, notably attention-deficit hyperactivity disorder or obsessive-compulsive disorder. Tourette syndrome occurs worldwide, in all races and ethnicities, in both sexes and in children as well as in adults. Estimates of its prevalence in children vary, with rates of up to 1% being reported, but rates of 0.3-0.8% are thought to accurately reflect the occurrence of the disorder. Research has led to progress in many aspects of Tourette syndrome, although many questions and unmet needs remain. For example, except for rare cases, the genetic basis remains elusive. The anatomical and neuronal changes in the brain that underlie Tourette syndrome are also unclear, although the evidence increasingly implicates alterations in basal ganglia function. Treatment is often unnecessary for individuals with mild tics, but for those with moderate to severe forms of the syndrome, some drugs are available, albeit frequently ineffective. Behavioral and surgical therapies, in particular deep brain stimulation, are currently undergoing development and show promising results. This Review examines the history of Tourette syndrome and describes its clinical presentation. The article also provides an overview of the epidemiology and pathophysiology of this disorder. Current treatment strategies and potential future therapies are also discussed.
Collapse
Affiliation(s)
- Kevin St P McNaught
- Medical and Scientific Programs, National Tourette Syndrome Association, 42-40 Bell Boulevard, Suite 205, Bayside, NY 11361, USA.
| | | |
Collapse
|
16
|
Roessner V, Rothenberger A, Rickards H, Hoekstra PJ. European clinical guidelines for Tourette syndrome and other tic disorders. Eur Child Adolesc Psychiatry 2011; 20:153-4. [PMID: 21445722 PMCID: PMC3065648 DOI: 10.1007/s00787-011-0165-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Veit Roessner
- Department of Child and Adolescent Psychiatry, University of Dresden Medical School, Fetscherstrasse 74, 01307 Dresden, Germany
| | - Aribert Rothenberger
- Department of Child and Adolescent Psychiatry, University of Goettingen, Goettingen, Germany
| | - Hugh Rickards
- Department of Neuropsychiatry, Birmingham and Solihull Mental Health Foundation Trust, Edgbaston, Birmingham UK
| | - Pieter J. Hoekstra
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|