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Steuber ER, McGuire JF. A meta-analysis of transcranial magnetic stimulation in Tourette syndrome. J Psychiatr Res 2024; 173:34-40. [PMID: 38479346 PMCID: PMC11018498 DOI: 10.1016/j.jpsychires.2024.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 04/17/2024]
Abstract
There is growing enthusiasm for the treatment of neuropsychiatric disorders using neuromodulation. While some reports claim that transcranial magnetic stimulation (TMS) can be used to treat Tourette Syndrome (TS), little research exists to support this assertion. This meta-analysis examined the efficacy of TMS to reduce tic severity in patients with TS. Additionally, it explored the effect of TMS to reduce premonitory urge severity-the primary mechanism implicated in the frontline evidence-based treatment of TS. Five treatment comparisons were selected using PRISMA guidelines. All studies included were required to be (1) a randomized controlled trial, (2) compare TMS to a sham condition, and (3) have all participants meet diagnostic criteria for a persistent tic disorder and/or TS. A random effects model meta-analysis examined the efficacy of using TMS to reduce tic severity and explored the effect of TMS to reduce premonitory urge severity. TMS did not significantly reduce tic severity (g = 0.44; 95% CI = -0.17, 1.05; z = 1.40; p = 0.16), but a moderate reduction in premonitory urge severity was found (g = 0.63; 95% CI = 0.9, 1.17; z = 2.27; p < 0.02). Trials with larger sample sizes and a preponderance of women were found to have greater therapeutic effects of TMS for tic severity. There is limited support for the use of TMS to reduce tic severity, though reductions in premonitory urge severity were observed. Major limitations of the existing literature are examined, with a call for research investigating newer TMS protocols and their use as a treatment augmentation strategy.
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Affiliation(s)
- Elizabeth R Steuber
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Wu J, Yang F, Wang Z, Wang L, Tian T, Xue Z, Sun L. Pediatric massage therapy for treatment of tic disorders in children: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2024; 103:e37568. [PMID: 38518056 PMCID: PMC10957010 DOI: 10.1097/md.0000000000037568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/20/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Tic disorder is a common neurodevelopmental disorder in childhood, characterized primarily by motor or vocal tics. However, there is no systematic evaluation of pediatric massage therapy for children with Tic disorder. This study aims to evaluate the effectiveness and safety of massage therapy for children with tic disorder through a comprehensive meta-analysis and systematic review. METHODS We systematically searched relevant randomized controlled trials from various databases such as CBM, CNKI, VIP, Wanfang database, PubMed, Embase, Web of Science, Cochrane Library, and SINOMED, published up to October 2023. To collect randomized controlled trials on pediatric massage therapy or in combination with other therapies for the treatment of tic disorders in children. The risk of bias in the included articles was assessed using the Cochrane guideline. Meta-analyses were performed using Review Manager 5.4, and publication bias was evaluated by using Begg test and Egger test in Stata SE software. RESULTS This meta-analysis included 19 randomized controlled trials with 1423 patients. Pediatric massage therapy alone or in combination with conventional medication demonstrated a significant increase in clinical effectiveness rates [risk ratios = 1.15, 95% confidence interval [CI] (1.10, 1.20), Z = 6.54, P < .001], and reduced Yale Global Tie Severity Scale scores [standardized mean difference = -0.85, 95% CI (-1.50, -0.19), Z = 2.54, P = .01] and traditional Chinese medicine syndrome scores [standardized mean difference = -1.35, 95%CI (-2.08, -0.63), Z = 3.66, P = .0002]. In terms of adverse reactions, there was no statistical difference between the experimental and control groups [risk ratios = 0.26, 95% CI (0.14, 0.49), Z = 4.25, P < .001]. The Begg test and Egger test results indicated no publication bias. CONCLUSION Evidence suggests that pediatric massage therapy is effective in improving tic disorders in children.
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Affiliation(s)
- Jiaqi Wu
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Fushuang Yang
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Zhongtian Wang
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Lie Wang
- Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Tong Tian
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Zhilong Xue
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Liping Sun
- Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, China
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Ramsey KA, McGuire JF. Advancements in the phenomenology, assessment, and treatment of Tourette syndrome. Curr Opin Psychiatry 2024; 37:57-64. [PMID: 38226540 PMCID: PMC10922452 DOI: 10.1097/yco.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
PURPOSE OF REVIEW Tourette syndrome (TS) and chronic tic disorders, collectively referred to as TS, are relatively common childhood onset neuropsychiatric conditions associated with functional impairment and distress. Over the past several years, clinical research has contributed to the advancement of the field's understanding of mechanisms and clinical correlates of TS. This progress has led to the development of key assessment tools and the implementation of novel interventions for individuals with TS. RECENT FINDINGS This article provides a review of innovative TS research focusing on four key themes: investigation of clinical phenomenology of TS; validation of assessment tools for TS; dissemination of current evidence-based treatments for TS; and exploration of new intervention programs. SUMMARY Cumulatively, this growing body of work presents considerable progress and provides a path forward to improve the assessment and treatment of TS.
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Affiliation(s)
- Kesley A Ramsey
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine
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Affiliation(s)
- Steven P Trau
- Division of Child Neurology, Department of Neurology, University of North Carolina-Chapel Hill School of Medicine, Chapel Hill, NC
| | - Harvey S Singer
- Department of Neurology, Johns Hopkins Hospital and the Kennedy Krieger Institute, Baltimore, MD
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Nilles C, Szejko N, Martino D, Pringsheim T. Prospective follow-up study of youth and adults with onset of functional tic-like behaviours during the COVID-19 pandemic. Eur J Neurol 2024; 31:e16051. [PMID: 37644767 DOI: 10.1111/ene.16051] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND PURPOSE Very little is known about the long-term prognosis of patients with functional tic-like behaviours (FTLBs). We sought to characterize the trajectory of symptom severity over a 12-month period. METHODS Patients with FTLBs were included in our prospective longitudinal child and adult clinical tic disorder registries at the University of Calgary. Patients were prospectively evaluated 6 and 12 months after their first clinical visit. Tic inventories and severity were measured with the Yale Global Tic Severity Scale (YGTSS). RESULTS Eighty-three youths and adults with FTLBs were evaluated prospectively until April 2023. Mean YGTSS total tic severity scores were high at baseline, with a mean score of 29.8 points (95% confidence interval [CI] = 27.6-32.1). Fifty-eight participants were reevaluated at 6 months, and 32 participants were reevaluated at 12 months. The YGTSS total tic severity score decreased significantly from the first clinical visit to 6 months (raw mean difference = 8.9 points, 95% CI = 5.1-12.7, p < 0.0001), and from 6 to 12 months (raw mean difference = 6.4 points, 95% CI = 0.8-12.0, p = 0.01). Multivariable linear regression demonstrated that tic severity at initial presentation and the presence of other functional neurological symptoms were associated with higher YGTSS total tic scores at 6 months, whereas younger age at baseline, receiving cognitive behavioural therapy for anxiety and/or depression, and prescription of selective serotonin reuptake inhibitors were associated with lower YGTSS total tic scores at 6 months. CONCLUSIONS We observed a meaningful improvement in tic severity scores in youth and adults with FTLBs over a period of 6-12 months.
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Affiliation(s)
- Christelle Nilles
- Department of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Natalia Szejko
- Department of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Tamara Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Morand-Beaulieu S, Crowley MJ, Grantz H, Leckman JF, Sukhodolsky DG. Functional connectivity during tic suppression predicts reductions in vocal tics following behavior therapy in children with Tourette syndrome. Psychol Med 2023; 53:7857-7864. [PMID: 37485677 PMCID: PMC10755221 DOI: 10.1017/s0033291723001940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/06/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Comprehensive Behavioral Intervention for Tics (CBIT) is recommended as a first-line treatment for Tourette syndrome in children and adults. While there is strong evidence proving its efficacy, the mechanisms of reduction in tic severity during CBIT are still poorly understood. In a recent study, our group identified a functional brain network involved in tic suppression in children with TS. We reasoned that voluntary tic suppression and CBIT may share some mechanisms and thus we wanted to assess whether functional connectivity during tic suppression was associated with CBIT outcome. METHODS Thirty-two children with TS, aged 8 to 13 years old, participated in a randomized controlled trial of CBIT v. a treatment-as-usual control condition. EEG was recorded during tic suppression in all participants at baseline and endpoint. We used a source-reconstructed EEG connectivity pipeline to assess functional connectivity during tic suppression. RESULTS Functional connectivity during tic suppression did not change from baseline to endpoint. However, baseline tic suppression-related functional connectivity specifically predicted the decrease in vocal tic severity from baseline to endpoint in the CBIT group. Supplementary analyses revealed that the functional connectivity between the right superior frontal gyrus and the right angular gyrus was mainly driving this effect. CONCLUSIONS This study revealed that functional connectivity during tic suppression at baseline predicted reduction in vocal tic severity. These results suggest probable overlap between the mechanisms of voluntary tic suppression and those of behavior therapy for tics.
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Affiliation(s)
- Simon Morand-Beaulieu
- Department of Psychology, McGill University, Montreal, QC, Canada
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | | | - Heidi Grantz
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - James F. Leckman
- Department of Psychology, McGill University, Montreal, QC, Canada
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Bekk M, Meland KJ, Moen E, Nøstvik LI, Gausdal AL, Hummelen B. Group-based comprehensive behavioral intervention for tics (CBIT) for adults with Tourette syndrome or chronic tic disorders: A pilot study. Scand J Psychol 2023; 64:784-793. [PMID: 37339108 DOI: 10.1111/sjop.12942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/15/2023] [Accepted: 05/29/2023] [Indexed: 06/22/2023]
Abstract
Comprehensive behavioral intervention for tics (CBIT) administered individually is an effective treatment for tics. However, the effectiveness of CBIT administered in groups for adults with Tourette syndrome and chronic tic disorders has not been investigated yet. This pilot study examined the effectiveness of group-based CBIT with respect to reduction of tic severity and tic-related impairment, as well as improvement of tic-related quality of life. Data from 26 patients were included in the intention-to-treat analyses. The Yale Global Tic Severity Scale was used to assess total tic severity and tic-related impairment. The Gilles de la Tourette - Quality of Life Scale was used to assess tic-related quality of life. These measures were administered at three points in time: at pretreatment, posttreatment, and 1-year follow-up. The results showed a significant reduction of total tic severity from pretreatment to 1-year follow-up, with larges effect sizes. Tic-related impairment and tic-related quality of life also improved significantly, although the effect sizes were smaller. Motor tics showed a stronger reduction than vocal tics. Additional analysis revealed that all change was achieved during treatment and that this effect was maintained from posttreatment to 1-year follow-up. The results of this study indicate that group-based CBIT is a promising treatment for tics.
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Affiliation(s)
- Morten Bekk
- Regional Resource Centre for Autism, ADHD and Tourette Syndrome, Health Region South-East, Oslo University Hospital, Oslo, Norway
| | - Karete J Meland
- Outpatient Unit for OCD-Spectrum Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erna Moen
- Outpatient Unit for OCD-Spectrum Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | | | - Benjamin Hummelen
- Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Jin YJ, Ge GL. Acupoint thread-embedding for children with tic disorders of spleen deficiency and liver hyperactivity and its effect on serum level of NSE. Zhongguo Zhen Jiu 2023; 43:1261-1265. [PMID: 37986249 DOI: 10.13703/j.0255-2930.20230129-k0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
OBJECTIVES To observe the clinical efficacy of acupoint thread-embedding for children with tic disorders of spleen deficiency and liver hyperactivity and its effect on serum level of neuron-specific enolase (NSE). METHODS A total of 68 children with tic disorders of spleen deficiency and liver hyperactivity were randomized into an observation group (34 cases, 1 case dropped out) and a control group (34 cases, 3 cases dropped out, 1 case was eliminated). In the observation group, acupoint thread-embedding was applied at Baihui (GV 20) and bilateral Hegu (LI 4), Taichong (LR 3), Pishu (BL 20), Ganshu (BL 18), Quchi (LI 11), Zusanli (ST 36),etc., once every 4 weeks. In the control group, tiapride hydrochloride tablet was given orally, twice a day. Both groups were treated for 12 weeks. Before and after treatment, the Yale global tic severity scale (YGTSS) score and serum level of NSE were observed in the two groups, and the clinical efficacy was evaluated. RESULTS After treatment, except for vocal tic score of YGTSS in the control group, the each-item scores and total scores of YGTSS and serum levels of NSE in the two groups were decreased compared with those before treatment (P<0.05); the each-item scores and total score of YGTSS and serum level of NSE in the observation group were lower than those in the control group (P<0.05). The total effective rate in the observation group was 87.9% (29/33), which was higher than 76.7% (23/30) in the control group (P<0.05). CONCLUSIONS Acupoint thread-embedding has a good effect in the treatment of children with tic disorders of spleen deficiency and liver hyperactivity, could reduce the YGTSS score and serum level of NSE.
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Affiliation(s)
- Yu-Jing Jin
- Department of TCM, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450046, China
| | - Guo-Lan Ge
- Department of TCM, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou 450046, China.
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Maiquez BM, Smith C, Dyke K, Chou C, Kasbia B, McCready C, Wright H, Jackson JK, Farr I, Badinger E, Jackson GM, Jackson SR. A double-blind, sham-controlled, trial of home-administered rhythmic 10-Hz median nerve stimulation for the reduction of tics, and suppression of the urge-to-tic, in individuals with Tourette syndrome and chronic tic disorder. J Neuropsychol 2023; 17:540-563. [PMID: 37133932 PMCID: PMC10947020 DOI: 10.1111/jnp.12313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/23/2023] [Indexed: 05/04/2023]
Abstract
Tourette syndrome (TS) and chronic tic disorder (CTD) are neurological disorders of childhood onset characterized by the occurrence of tics; repetitive, purposeless, movements or vocalizations of short duration which can occur many times throughout a day. Currently, effective treatment for tic disorders is an area of considerable unmet clinical need. We aimed to evaluate the efficacy of a home-administered neuromodulation treatment for tics involving the delivery of rhythmic pulse trains of median nerve stimulation (MNS) delivered via a wearable 'watch-like' device worn at the wrist. We conducted a UK-wide parallel double-blind sham-controlled trial for the reduction of tics in individuals with tic disorder. The device was programmed to deliver rhythmic (10 Hz) trains of low-intensity (1-19 mA) electrical stimulation to the median nerve for a pre-determined duration each day, and was intended to be used by each participant in their home once each day, 5 days each week, for a period of 4 weeks. Between 18th March 2022 and 26th September 2022, 135 participants (45 per group) were initially allocated, using stratified randomization, to one of the following groups; active stimulation; sham stimulation or to a waitlist (i.e. treatment as usual) control group. Recruited participants were individuals with confirmed or suspected TS/CTD aged 12 years of age or upward with moderate to severe tics. Researchers involved in the collection or processing of measurement outcomes and assessing the outcomes, as well as participants in the active and sham groups and their legal guardians were all blind to the group allocation. The primary outcome measure used to assess the 'offline' or treatment effect of stimulation was the Yale Global Tic Severity Scale-Total Tic Severity Score (YGTSS-TTSS) assessed at the conclusion of 4 weeks of stimulation. The primary outcome measure used to assess the 'online' effects of stimulation was tic frequency, measured as the number of tics per minute (TPM) observed, based upon blind analysis of daily video recordings obtained while stimulation was delivered. The results demonstrated that after 4-week stimulation, tic severity (YGTSS-TTSS) had reduced by 7.1 points (35 percentile reduction) for the active stimulation group compared to 2.13/2.11 points for the sham stimulation and waitlist control groups. The reduction in YGTSS-TTSS for the active stimulation group was substantially larger, clinically meaningful (effect size = .5) and statistically significant (p = .02) compared to both the sham stimulation and waitlist control groups, which did not differ from one another (effect size = -.03). Furthermore, blind analyses of video recordings demonstrated that tic frequency (tics per minute) reduced substantially (-15.6 TPM) during active stimulation compared to sham stimulation (-7.7 TPM). This difference represents a statistically significant (p < .03) and clinically meaningful reduction in tic frequency (>25 percentile reduction: effect size = .3). These findings indicate that home-administered rhythmic MNS delivered through a wearable wrist-worn device has the potential to be an effective community-based treatment for tic disorders.
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Affiliation(s)
- Barbara Morera Maiquez
- School of PsychologyUniversity of NottinghamNottinghamUK
- Neurotherapeutics Ltd, The Ingenuity CentreUniversity of Nottingham Innovation ParkTriumph RoadNottinghamNG7 2TUUK
| | - Caitlin Smith
- School of PsychologyUniversity of NottinghamNottinghamUK
- Neurotherapeutics Ltd, The Ingenuity CentreUniversity of Nottingham Innovation ParkTriumph RoadNottinghamNG7 2TUUK
| | - Katherine Dyke
- School of PsychologyUniversity of NottinghamNottinghamUK
| | - Chia‐Ping Chou
- Neurotherapeutics Ltd, The Ingenuity CentreUniversity of Nottingham Innovation ParkTriumph RoadNottinghamNG7 2TUUK
| | - Belinda Kasbia
- Neurotherapeutics Ltd, The Ingenuity CentreUniversity of Nottingham Innovation ParkTriumph RoadNottinghamNG7 2TUUK
| | - Ciara McCready
- Neurotherapeutics Ltd, The Ingenuity CentreUniversity of Nottingham Innovation ParkTriumph RoadNottinghamNG7 2TUUK
| | - Hannah Wright
- Neurotherapeutics Ltd, The Ingenuity CentreUniversity of Nottingham Innovation ParkTriumph RoadNottinghamNG7 2TUUK
| | - Jessica K. Jackson
- Neurotherapeutics Ltd, The Ingenuity CentreUniversity of Nottingham Innovation ParkTriumph RoadNottinghamNG7 2TUUK
| | - Isabel Farr
- School of PsychologyUniversity of NottinghamNottinghamUK
| | - Erika Badinger
- School of PsychologyUniversity of NottinghamNottinghamUK
| | - Georgina M. Jackson
- Neurotherapeutics Ltd, The Ingenuity CentreUniversity of Nottingham Innovation ParkTriumph RoadNottinghamNG7 2TUUK
- Institute of Mental Health, School of MedicineUniversity of NottinghamNottinghamUK
| | - Stephen R. Jackson
- School of PsychologyUniversity of NottinghamNottinghamUK
- Neurotherapeutics Ltd, The Ingenuity CentreUniversity of Nottingham Innovation ParkTriumph RoadNottinghamNG7 2TUUK
- Institute of Mental Health, School of MedicineUniversity of NottinghamNottinghamUK
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Ricketts EJ, Woods DW, Espil FM, McGuire JF, Stiede JT, Schild J, Yadegar M, Bennett SM, Specht MW, Chang S, Scahill L, Wilhelm S, Peterson AL, Walkup JT, Piacentini J. Childhood Predictors of Long-Term Tic Severity and Tic Impairment in Tourette's Disorder. Behav Ther 2022; 53:1250-1264. [PMID: 36229120 PMCID: PMC9872160 DOI: 10.1016/j.beth.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 05/29/2022] [Accepted: 07/07/2022] [Indexed: 01/26/2023]
Abstract
Tics peak in late childhood and decline during adolescence. Yet, for some with Tourette's disorder, tics persist into adulthood. We evaluated childhood predictors of adult tic severity and tic impairment, and change over time. Eighty adolescents/adults were evaluated 11 years following a randomized-controlled trial of behavior therapy. An independent evaluator rated tic severity and tic impairment at baseline, posttreatment, and long-term follow-up. At baseline, parents completed demographics/medical history, and youth tic, internalizing, and externalizing symptom ratings. Youth rated premonitory urge severity and family functioning. After controlling for prior tic treatment effects, female sex and higher tic severity predicted higher tic severity in adulthood; and female sex, no stimulant medication use, higher tic severity, and poorer family functioning predicted higher tic impairment. Higher tic severity and premonitory urge severity predicted smaller reductions in tic severity, whereas higher externalizing symptoms predicted greater reduction in tic severity. Female sex predicted smaller reduction in tic impairment, and externalizing symptoms predicted greater reduction in tic impairment. Female sex and childhood tic severity are important predictors of tic severity and tic impairment in adulthood. Family functioning, premonitory urge severity, and tic severity are important modifiable targets for early or targeted intervention to improve long-term outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - John T Walkup
- Ann and Robert H. Lurie Children's Hospital of Chicago; Northwestern University Feinberg School of Medicine
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Yu L, Li Y, Yan J, Wen F, Wang F, Liu J, Cui Y, Li Y. Transcranial Magnetic Stimulation for Obsessive-Compulsive Disorder and Tic Disorder: A Quick Review. J Integr Neurosci 2022; 21:172. [PMID: 36424736 DOI: 10.31083/j.jin2106172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 06/16/2023] Open
Abstract
Repetitive transcranial megnetic stimulation (rTMS) has been widely used in patients with psychiatric disorders. Previous studies revealed good efficacy of rTMS for patients with obsession-compulsive disorder (OCD) and Tic disorder (TD). OCD and TD are closely related and considered to etiologically overlap. Patients with the co-occurrence of OCD and TD are often identified. Therefore, we conducted a quick review of rTMS for the treatment of these two diseases to compare the similarities and differences of rTMS for OCD and TD, which might provide an indication for the treatment of the co-occurrence of OCD and TD. We searched articles published in PubMed, Wanfang, and Web of Science from January 2001 to January 2022. Both inclusion criteria and exclusion criteria were developed to identify the relevant included studies. Data on the frequency, target area, sample size, and number of males, especially the rTMS treatment procedure or parameters, were extracted in the included studies. We included 26 studies on OCD and 12 studies on TD in this quick review. A total of 996 participants were included. Based on the review of the included studies, lowfrequency rTMS might be used more than high-frequency rTMS, and the supplementary motor area (SMA) might show better efficacy than the dorsolateral prefrontal cortex (DLPFC) in OCD. For patients with TD, low-frequency rTMS located in the SMA might show good efficacy both in OCD and TD. Our quick review elaborated the treatment efficacy of rTMS for both patients with OCD and those with TD. It seems that the SMA is an important target choice for both OCD and TD patients. Low-frequency rTMS might be used more than high-frequency rTMS in both OCD and TD patients. In future studies, we should explore more about the efficacy of rTMS for patients with co-occurring OCD and TD, especially for the efficacy of targeted SMA with low frequency.
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Affiliation(s)
- Liping Yu
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, 100101 Beijing, China
| | - Yanlin Li
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, 100101 Beijing, China
| | - Junjuan Yan
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, 100101 Beijing, China
| | - Fang Wen
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, 100101 Beijing, China
| | - Fang Wang
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, 100101 Beijing, China
| | - Jingran Liu
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, 100101 Beijing, China
| | - Yonghua Cui
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, 100101 Beijing, China
| | - Ying Li
- Department of Psychiatry, Beijing Children's Hospital, Capital Medical University, National Center for Children Healthy, 100101 Beijing, China
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Lin LX, Lv HJ, Wu QQ, Shao LR, Shen K, Fan LJ, Hu HT, Gao H. [ GAO Hong's clinical experience in treatment of tic disorder with acupuncture technique of cultivating the primary and regulating the mind]. Zhongguo Zhen Jiu 2022; 42:815-818. [PMID: 35793895 DOI: 10.13703/j.0255-2930.20210625-k0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The paper introduces the clinical experience of GAO Hong in treatment of tic disorder. GAO Hong believes that tic disorder results from the primary qi deficiency and mind disturbance. Acupuncture for cultivating the primary and regulating the mind is proposed specially for tic disorder. This acupuncture technique focuses on harmonizing and regulating governor vessel and conception vessel. In clinical practice, the conception vessel acupoints on the abdomen and the governor vessel acupoints on the head are selected particularly, e.g. Zhongwan (CV 12), Xiawan (CV 10), Qihai (CV 6) and Guanyuan (CV 4) on the abdomen; Baihui (GV 20), Shenting (GV 24), Benshen (GB 13) and Yintang (GV 24+) on the head. The needling sequence and the insertion depth are emphasized, which affect the curative effect and GV 20 is generally punctured first. Besides, considering to the type of disorder and the affected site, tic disorder is treated in view of both syndrome/pattern differentiation and symptom differentiation.
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Affiliation(s)
- Lu-Xue Lin
- Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Hui-Juan Lv
- Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Qi-Qi Wu
- Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Lin-Ruo Shao
- Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Ke Shen
- Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Li-Juan Fan
- Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Han-Tong Hu
- Acupuncture and Moxibustion Department, Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005
| | - Hong Gao
- Acupuncture and Moxibustion Department, Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005
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Heijerman-Holtgrefe A, Huyser C, Verdellen C, van de Griendt J, Beljaars L, Kan KJ, Lindauer R, Cath D, Hoekstra P, Utens L. Effectiveness of 'Tackle Your Tics', a brief, intensive group-based exposure therapy programme for children with tic disorders: study protocol of a randomised controlled trial. BMJ Open 2022; 12:e058534. [PMID: 35768093 PMCID: PMC9240895 DOI: 10.1136/bmjopen-2021-058534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION This paper outlines the study protocol for the Dutch Tackle Your Tics study in youth with tic disorders. Tourette syndrome and chronic tic disorders are prevalent neurodevelopmental disorders, placing considerable burden on youth and their families. Behavioural treatment is the first-line, evidence-based intervention for tic disorders, but tic reduction and availability remain relatively low. Patient associations stress the need for more accessible high-quality treatments, also focusing on improving quality of life. Therefore, the brief, intensive group-based treatment Tackle Your Tics was developed. METHODS AND ANALYSIS Tackle Your Tics is a 4-day intensive and comprehensive group-based intervention for children and adolescents (9-17 years) with Tourette syndrome or a chronic tic disorder. The programme encompasses exposure and response prevention treatment and additional supporting components (coping strategies, relaxation exercises and parent support). To study the effectiveness of Tackle Your Tics and identify predictors/moderators at baseline, a single-blinded randomised controlled trial (n=104) is conducted, comparing Tackle Your Tics (n=52) with a waiting list condition lasting 3 months (n=52). Assessments are performed at similar time points for both groups: at baseline, after 4 weeks, and at 3 and 6 months of follow-up, on tic severity, quality of life and other psychosocial variables. ETHICS AND DISSEMINATION Ethics approval has been obtained from the medical ethical committee of the Amsterdam Medical Centre (METC nr NL66340.018.18, v3 June 2020). Findings will be presented on national and international conferences, peer-reviewed scientific journals, patient organisation meetings and public media. Patient representatives are fully integrated as part of the research team. If Tackle Your Tics proves to be effective, it can expand evidence-based treatment possibilities for children and adolescents with tic disorders. Identifying the psychosocial predictors/moderators for the effectiveness of this intervention can provide personalised treatment advice in the future. TRIAL REGISTRATION NUMBER NL8052.
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Affiliation(s)
- Annet Heijerman-Holtgrefe
- Department of Child and Adolescent Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, The Netherlands
- Dutch Tourette Association, Haarlem, The Netherlands
| | - Chaim Huyser
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, The Netherlands
| | - Cara Verdellen
- PsyQ Nijmegen/Parnassia Group, Nijmegen, The Netherlands
- TicXperts, Heteren, The Netherlands
| | | | - Laura Beljaars
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, The Netherlands
- Dutch Tourette Association, Haarlem, The Netherlands
- Parnassia Group, The Hague, The Netherlands
| | - Kees-Jan Kan
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Ramón Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, The Netherlands
| | - Daniëlle Cath
- Department of Specialized Training, GGZ Drenthe, Assen, The Netherlands
- University Medical Center Groningen, Department of Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Pieter Hoekstra
- University Medical Center Groningen, Department of Child and Adolescent Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Lisbeth Utens
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, The Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
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Peterson AL, Blount TH, Villarreal R, Raj JJ, McGuire JF. Relaxation training with and without Comprehensive Behavioral Intervention for Tics for Tourette's disorder: A multiple baseline across participants consecutive case series. J Behav Ther Exp Psychiatry 2022; 74:101692. [PMID: 34543803 DOI: 10.1016/j.jbtep.2021.101692] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/29/2021] [Accepted: 09/14/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Behavioral therapies such as the Comprehensive Behavioral Intervention for Tics (CBIT) are recommended as the first-line treatment for Tourette's Disorder. This treatment approach is comprised of three central components: habit reversal training, functional assessment/intervention, and relaxation training. Despite its combined efficacy, the contribution of each therapeutic component in CBIT for reducing tic severity remains undetermined. The study evaluated the efficacy of relaxation training alone or alongside other CBIT components for reducing tic severity. METHODS In this multiple-baseline study, participants completed a baseline assessment (A), 4 weekly sessions of relaxation training followed by a posttreatment assessment (B), 8 weekly sessions of CBIT followed by a posttreatment assessment (C), and a 1 month posttreatment follow up assessment (D). Six participants (83% male) aged 10-18 with Tourette's Disorder completed study procedures. Primary outcomes of tic severity was the Yale Global Tic Severity Scale (YGTSS). RESULTS A repeated measures ANOVA revealed a significance reduction in tic severity over time (p = .010). While post-hoc tests revealed a moderate non-significant reduction in tic severity after relaxation training (d =.23), large significant reductions in tic severity were observed after the combined treatment of relaxation training and CBIT (d = 1.17) that were maintained at a 1-month follow-up visit (d = 1.53). LIMITATIONS Findings are limited by the small sample size. CONCLUSIONS While relaxation training is effective when included in conjunction with CBIT, relaxation training alone is not effective in reducing tic severity in patients with Tourette's Disorder.
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Affiliation(s)
- Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA; Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA; Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA.
| | - Tabatha H Blount
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Robert Villarreal
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Jeslina J Raj
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Szejko N, Worbe Y, Hartmann A, Visser-Vandewalle V, Ackermans L, Ganos C, Porta M, Leentjens AFG, Mehrkens JH, Huys D, Baldermann JC, Kuhn J, Karachi C, Delorme C, Foltynie T, Cavanna AE, Cath D, Müller-Vahl K. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part IV: deep brain stimulation. Eur Child Adolesc Psychiatry 2022; 31:443-461. [PMID: 34605960 PMCID: PMC8940783 DOI: 10.1007/s00787-021-01881-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 09/15/2021] [Indexed: 12/13/2022]
Abstract
In 2011 the European Society for the Study of Tourette Syndrome (ESSTS) published its first European clinical guidelines for the treatment of Tourette Syndrome (TS) with part IV on deep brain stimulation (DBS). Here, we present a revised version of these guidelines with updated recommendations based on the current literature covering the last decade as well as a survey among ESSTS experts. Currently, data from the International Tourette DBS Registry and Database, two meta-analyses, and eight randomized controlled trials (RCTs) are available. Interpretation of outcomes is limited by small sample sizes and short follow-up periods. Compared to open uncontrolled case studies, RCTs report less favorable outcomes with conflicting results. This could be related to several different aspects including methodological issues, but also substantial placebo effects. These guidelines, therefore, not only present currently available data from open and controlled studies, but also include expert knowledge. Although the overall database has increased in size since 2011, definite conclusions regarding the efficacy and tolerability of DBS in TS are still open to debate. Therefore, we continue to consider DBS for TS as an experimental treatment that should be used only in carefully selected, severely affected and otherwise treatment-resistant patients.
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Affiliation(s)
- Natalia Szejko
- Department of Neurology, Medical University of Warsaw, Banacha 1a, 02-091, Warsaw, Poland.
- Department of Bioethics, Medical University of Warsaw, Banacha 1a, 02-091, Warsaw, Poland.
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, USA.
| | - Yulia Worbe
- Department on Neurophysiology, Saint Antoine Hospital, Sorbonne Université, Paris, France
- National Reference Center for Tourette Disorder, Pitié Salpetiere Hospital, Paris, France
| | - Andreas Hartmann
- Department of Neurosurgery, Pitié-Salpetriere Hospital, Sorbonne Université, Paris, France
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Linda Ackermans
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Christos Ganos
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Mauro Porta
- Department of Neurosurgery and Neurology, IRCCS Instituto Ortopedico Galeazzi, Milan, Italy
| | - Albert F G Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan-Hinnerk Mehrkens
- Department of Neurosurgery, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Daniel Huys
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | | | - Jens Kuhn
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Johanniter Hospital Oberhausen, Oberhausen, Germany
| | - Carine Karachi
- National Reference Center for Tourette Disorder, Pitié Salpetiere Hospital, Paris, France
- Department of Neurosurgery, Pitié-Salpetriere Hospital, Sorbonne Université, Paris, France
- Department of Neurology, Pitié-Salpetriere Hospital, Sorbonne Université, Paris, France
| | - Cécile Delorme
- Department of Neurosurgery, Pitié-Salpetriere Hospital, Sorbonne Université, Paris, France
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Andrea E Cavanna
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Danielle Cath
- Department of Specialist Trainings, GGZ Drenthe Mental Health Institution, Assen, The Netherlands
- Department of Psychiatry, University Medical Center Groningen, Rijks University Groningen, Groningen, The Netherlands
| | - Kirsten Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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16
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Soós MJ, Coulson NS, Davies EB. Exploring Social Support in an Online Support Community for Tourette Syndrome and Tic Disorders: An Analysis of Postings (Preprint). J Med Internet Res 2021; 24:e34403. [PMID: 36194454 PMCID: PMC9579925 DOI: 10.2196/34403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/15/2022] [Accepted: 03/13/2022] [Indexed: 12/03/2022] Open
Abstract
Background Online support communities have become an accessible way of gaining social, emotional, and informational support from peers and may be particularly useful for individuals with chronic conditions. To date, there have been few studies exploring the online support available for tic disorders, such as Tourette syndrome. An exploratory study looking at users’ experiences with using online support communities for tic disorders suggested that members used such communities to share experiences, information, and strategies for tic management. Objective To build on these preliminary findings, this study examined the provision of social support in an online community for Tourette syndrome. Methods Data were collected from one publicly available online support community for Tourette syndrome and tics, from its inception to December 2019, by randomly selecting 10% of posts and their corresponding comments from each year for analysis. This resulted in 510 unique posts and 3802 comments posted from 1270 unique usernames. The data were analyzed using inductive thematic analysis. Results The findings of this study suggest that users utilized the online community as a multifaceted virtual place where they could share and ask for information about tics, unload and share their feelings arising from living with Tourette syndrome, find people facing similar situations and experiences, and freely share the realities of living with Tourette syndrome. Conclusions The results complement the findings from a preliminary study and suggest that online support communities have a potentially valuable role as a mechanism for sharing and gaining information on illness experiences from similar peers experiencing tics and can promote self-management of tics. Limitations and recommendations for future research are discussed.
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Affiliation(s)
- Mercédesz Judit Soós
- Population and Lifespan Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | - Neil S Coulson
- Population and Lifespan Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, United Kingdom
| | - E Bethan Davies
- National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Clinical Neurosciences and Mental Health, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Suh HW, Kwon CY, Hong S, Lee HW, Lee M, Kim JW, Chung SY. Nonpharmacological treatments for Tourette syndrome and tic disorders: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2021; 100:e25741. [PMID: 34106602 PMCID: PMC8133132 DOI: 10.1097/md.0000000000025741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A tic is a sudden, rapid, recurrent, nonrhythmic motor movement, or vocalization. Tic disorders are diagnosed based on the presence of motor or vocal tics, duration of tic symptoms, and age at onset. Current clinical practice guidelines strongly recommend behavioral therapies because they are more effective and safer than medications. To determine the most effective nonpharmacological intervention for tic disorders and Tourette syndrome, we will conduct a systematic review and network meta-analysis. METHODS We will search the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycARTICLES, AMED, 3 Chinese databases (China National Knowledge Infrastructure, Chongqing VIP, and Wanfang Data), 3 Korean databases (Korean Medical Database, Korean studies Information Service System, and ScienceON), and a Japanese database (CiNii). There will be no language or date restrictions. The primary outcome will be the tic severity scale, the Yale Global Tic Severity Scale. The secondary outcomes will include the effective rate defined by the trial authors, dropout rate, and adverse events. Methodological quality will be assessed using the Cochrane risk of bias tool. RESULTS Results of this review and network meta-analysis will be published in a peer-reviewed journal. CONCLUSIONS This systematic review will assess the effectiveness of nonpharmacological interventions for treating tic disorders. A systematic review or meta-analysis will provide an unbiased overview of the existing evidence.
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Affiliation(s)
- Hyo-Weon Suh
- College of Korean Medicine, Kyung Hee University, Dongdaemoon-gu, Seoul
| | - Chan-Young Kwon
- Department of Oriental Neuropsychiatry, College of Korean Medicine, Dong-eui University, Busanjin-gu, Busan
| | - Sunggyu Hong
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University
| | - Hyun Woo Lee
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University
| | - Misun Lee
- Kyung Hee University Industry Academic Cooperation Foundation, Dongdaemoon-gu
| | - Jong Woo Kim
- College of Korean Medicine, Kyung Hee University, Dongdaemoon-gu, Seoul
- Department of Neuropsychiatry, Kyung Hee University Korean Medicine Hospital at Gangdong, Gangdong-gu, Seoul, Republic of Korea
| | - Sun-Yong Chung
- College of Korean Medicine, Kyung Hee University, Dongdaemoon-gu, Seoul
- Department of Neuropsychiatry, Kyung Hee University Korean Medicine Hospital at Gangdong, Gangdong-gu, Seoul, Republic of Korea
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18
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Fu Q, Zhang X, Yan H, Xu J, Liu H, Yang L, Zhao S, Rong P, Ma R. Acupuncture for treating tic disorders in children: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24860. [PMID: 33761644 PMCID: PMC9282123 DOI: 10.1097/md.0000000000024860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Tic disorders (TDs) are a group of neurodevelopmental disorders in children, while pharmacotherapy is often associated with various side effects and has limited clinical effects for some patients, thus significantly affecting patients' quality of life. Studies have found acupuncture shows certain advantages in the treatment of TDs. However, there is no high level of evidence evaluating the effectiveness and safety of acupuncture for children with TDs. METHODS Each data of acupuncture for treating TDs will be searched. We will search for related English and Chinese databases. The time is limited from inception until November 2020. The primary outcome is the reduction rate (amount) of tic severity using related scales or methods, and the secondary outcomes include recurrence rate and adverse events. The risk of bias will be assessed, and the RevMan5.3 and Stata14.0 will be performed for meta-analysis. Finally, we will assess the level of the resulting evidence. RESULTS The results of the study will synthesize the current evidence and be published in peer-reviewed journals. CONCLUSIONS This research aims to provide convincing evidence of the effectiveness and safety of acupuncture for treating TDs in children. INPLASY REGISTRATION NUMBER INPLASY2020110050.
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Affiliation(s)
- Qianfang Fu
- Department of Pediatrics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing
| | - Xilian Zhang
- Department of Pediatrics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing
| | - Haihong Yan
- Department of Pediatrics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing
| | - Jiabao Xu
- Department of Pediatrics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing
| | - Hui Liu
- Department of Pediatrics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing
| | - Libin Yang
- School of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Jinghai, Tianjin, China
| | - Shuyi Zhao
- School of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Jinghai, Tianjin, China
| | - Ping Rong
- Department of Pediatrics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing
| | - Rong Ma
- Department of Pediatrics, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xiqing
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Xiqing
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McGuire JF, Ricketts EJ, Scahill L, Wilhelm S, Woods DW, Piacentini J, Walkup JT, Peterson AL. Effect of behavior therapy for Tourette's disorder on psychiatric symptoms and functioning in adults. Psychol Med 2020; 50:2046-2056. [PMID: 31451122 PMCID: PMC7190082 DOI: 10.1017/s0033291719002150] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although behavior therapy reduces tic severity, it is unknown whether it improves co-occurring psychiatric symptoms and functional outcomes for adults with Tourette's disorder (TD). This information is essential for effective treatment planning. This study examined the effects of behavior therapy on psychiatric symptoms and functional outcomes in older adolescents and adults with TD. METHOD A total of 122 individuals with TD or a chronic tic disorder participated in a clinical trial comparing behavior therapy to psychoeducation and supportive therapy. At baseline, posttreatment, and follow-up visits, participants completed assessments of tic severity, co-occurring symptoms (inattention, impulsiveness, hyperactivity, anger, anxiety, depression, obsessions, and compulsions), and psychosocial functioning. We compared changes in tic severity, psychiatric symptoms, and functional outcomes using repeated measure and one-way analysis of variance. RESULTS At posttreatment, participants receiving behavior therapy reported greater reductions in obsessions compared to participants in supportive therapy ($\eta _p^2 $ = 0.04, p = 0.04). Across treatments, a positive treatment response on the Clinical Global Impression of Improvement scale was associated with a reduced disruption in family life ($\eta _p^2 $ = 0.05, p = 0.02) and improved functioning in a parental role ($\eta _p^2 $ = 0.37, p = 0.02). Participants who responded positively to eight sessions of behavior therapy had an improvement in tic severity ($\eta _p^2 $ = 0.75, p < 0.001), inattention ($\eta _p^2 $ = 0.48, p < 0.02), and functioning ($\eta _p^2 $ = 0.39-0.42, p < 0.03-0.04) at the 6-month follow-up. CONCLUSION Behavior therapy has a therapeutic benefit for co-occurring obsessive symptoms in the short-term, and reduces tic severity and disability in adults with TD over time. Additional treatments may be necessary to address co-occurring symptoms and improve functional outcomes.
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Affiliation(s)
- Joseph F. McGuire
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emily J. Ricketts
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, University of California Los Angeles, Los Angeles, California
| | - Lawrence Scahill
- Marcus Autism Center, Emory University School of Medicine, Atlanta, Georgia
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Douglas W. Woods
- Department of Psychology, Marquette University, Milwaukee, Wisconsin
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, University of California Los Angeles, Los Angeles, California
| | | | - Alan L. Peterson
- Department of Psychiatry, University of Texas Health Science at Center, San Antonio, Texas
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas
- South Texas Veterans Health Care System, San Antonio, Texas
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20
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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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Kim S, Greene DJ, Robichaux-Viehoever A, Bihun EC, Koller JM, Acevedo H, Schlaggar BL, Black KJ. Tic Suppression in Children With Recent-Onset Tics Predicts 1-Year Tic Outcome. J Child Neurol 2019; 34:757-764. [PMID: 31241402 PMCID: PMC6733613 DOI: 10.1177/0883073819855531] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Successful voluntary tic suppression is a key component of the behavioral interventions that are used to treat tic disorders. This study aimed to examine tic suppression in children with recent-onset tics and determine whether the capacity to suppress tics predicts future tic severity. We tested 45 children (30 male, mean age 7.74 years) with recent-onset tics (mean 3.47 months prior to the first study visit; baseline) and re-examined each child at the 12-month anniversary of the first recognized tic (follow-up). At the baseline visit, children performed a tic suppression task with several conditions: tic freely, inhibit tics given a verbal request, and inhibit tics in the presence of a reward. At the baseline visit, children with tics for only a few months could suppress their tics, and tic suppression was especially successful when they received an immediate and contingent reward. Additionally, the ability to suppress tics in the presence of a reward predicted tic severity at follow-up. These findings suggest that better inhibitory control of tics within months of tic onset may be an important predictor of future tic symptom outcome.
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Affiliation(s)
- Soyoung Kim
- Department of Psychiatry, Washington University School of Medicine, United States
| | - Deanna J. Greene
- Department of Psychiatry, Washington University School of Medicine, United States
- Department of Radiology, Washington University School of Medicine, United States
| | | | - Emily C. Bihun
- Department of Psychiatry, Washington University School of Medicine, United States
| | - Jonathan M. Koller
- Department of Psychiatry, Washington University School of Medicine, United States
| | - Haley Acevedo
- Department of Psychiatry, Washington University School of Medicine, United States
| | - Bradley L. Schlaggar
- Kennedy Krieger Institute, Baltimore, MD, United States
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kevin J. Black
- Department of Psychiatry, Washington University School of Medicine, United States
- Department of Radiology, Washington University School of Medicine, United States
- Department of Neurology, Washington University School of Medicine, United States
- Department of Neuroscience, Washington University School of Medicine, United States
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Abstract
This review and commentary is the product of an invited lecture called "Autoimmunity: PANS/PANDAS" presented at the 2018 Neurobiology of Diseases in Children Symposium in Chicago, IL. The talk addressed clinical and scientific questions and recently published data. At this time, among highly experienced and respected clinicians and researchers spanning relevant disciplines, there is substantial controversy regarding a role for inflammation in producing tics and obsessive-compulsive disorder. This commentary summarizes these controversies, discusses reasons for opposing views on best clinical practices, and concludes with suggestions for pathways forward.
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Affiliation(s)
- Donald L. Gilbert
- Division of Neurology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
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23
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Pailler E. [Hypnosis and orthodontic treatments]. Orthod Fr 2019; 90:29-36. [PMID: 30994447 DOI: 10.1051/orthodfr/2019005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/12/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION After being discarded from hospitals due to its lack of scientific evidence, medical hypnosis is once more in the spotlight thanks to neuroscience and medical imaging, which have proven its specificity. Medical hypnosis is currently enjoying real enthusiasm, and now the doors are opening not only to medical and surgical units but also to our orthodontic clinics. MATERIALS AND METHODS This article defines hypnosis and its different levels of application and the required techniques. It also explores all the different fields in which it can be used in orthodontic treatment. DISCUSSION Hypnosis can be applied from the very first contact with the patient and can be useful and therapeutic at every step of the process. It is useful to think of it in our discipline as a treatment in its own right contributing to heal parafunctions and tongue disorders more efficiently.
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24
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Hall CL, Davies EB, Andrén P, Murphy T, Bennett S, Brown BJ, Brown S, Chamberlain L, Craven MP, Evans A, Glazebrook C, Heyman I, Hunter R, Jones R, Kilgariff J, Marston L, Mataix-Cols D, Murray E, Sanderson C, Serlachius E, Hollis C. Investigating a therapist-guided, parent-assisted remote digital behavioural intervention for tics in children and adolescents-'Online Remote Behavioural Intervention for Tics' (ORBIT) trial: protocol of an internal pilot study and single-blind randomised controlled trial. BMJ Open 2019; 9:e027583. [PMID: 30610027 PMCID: PMC6326281 DOI: 10.1136/bmjopen-2018-027583] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Tourette syndrome and chronic tic disorder are common, disabling childhood-onset conditions. Guidelines recommend that behavioural therapy should be offered as first-line treatment for children with tics. However, there are very few trained behaviour therapists for tics and many patients cannot access appropriate care. This trial investigates whether an internet-delivered intervention for tics can reduce severity of symptoms. METHODS AND ANALYSIS This parallel-group, single-blind, randomised controlled superiority trial with an internal pilot will recruit children and young people (aged 9-17 years) with tic disorders. Participants will be randomised to receive 10 weeks of either online, remotely delivered, therapist-supported exposure response prevention behavioural therapy for tics, or online, remotely delivered, therapist-supported education about tics and co-occurring conditions. Participants will be followed up mid-treatment, and 3, 6, 12 and 18 months post randomisation.The primary outcome is reduction in tic severity as measured on the Yale Global Tic Severity Scale total tic severity score. Secondary outcomes include a cost-effectiveness analysis and estimate of the longer-term impact on patient outcomes and healthcare services. An integrated process evaluation will analyse quantitative and qualitative data in order to fully explore the implementation of the intervention and identify barriers and facilitators to implementation. The trial is funded by the National Institute of Health Research (NIHR), Health Technology Assessment (16/19/02). ETHICS AND DISSEMINATION The findings from the study will inform clinicians, healthcare providers and policy makers about the clinical and cost-effectiveness of an internet delivered treatment for children and young people with tics. The results will be submitted for publication in peer-reviewed journals. The study has received ethical approval from North West Greater Manchester Research Ethics Committee (ref.: 18/NW/0079). TRIAL REGISTRATION NUMBERS ISRCTN70758207 and NCT03483493; Pre-results.
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Affiliation(s)
- Charlotte Lucy Hall
- Trial Manager, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - E Bethan Davies
- Research Fellow and Trial Therapist, NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Per Andrén
- Clinical Psychologist, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden
| | - Tara Murphy
- Consultant Psychologist, University College London, Hospital for Children NHS Foundation Trust, London, UK
| | - Sophie Bennett
- Senior Research Fellow, University College London, Hospital for Children NHS Foundation Trust, London, UK
| | - Beverley J Brown
- Research Fellow and Trial Therapist, NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Susan Brown
- Research Fellow and Trial Therapist, NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Liam Chamberlain
- Trial Therapist, Division of Psychiatry and Applied Psychology, University of Nottingham, Queen’s Medical Centre, Nottingham, UK
| | - Michael P Craven
- Research Fellow and Trial Therapist, NIHR MindTech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Amber Evans
- Trial Therapist, University College London, Hospital for Children NHS Foundation Trust, Nottingham, UK
| | - Cristine Glazebrook
- Professor of Health Psychology, Division of Psychiatry and Applied Psychology, Institute of Mental Health, Nottingham, UK
| | - Isobel Heyman
- Consultant Psychiatrist, Hospital for Children NHS Foundation Trust, London, UK
| | - Rachael Hunter
- Health Economist, Research Department of Primary care and Population health and Priment CTU, University College London, London, UK
| | - Rebecca Jones
- Senior Research Associate, Research Department of Primary care and Population health and Priment CTU, University College London, London, UK
| | - Joseph Kilgariff
- Advanced Nurse, Division of Psychiatry and Applied Psychology, University of Nottingham, Queen’s Medical Centre, Nottingham, UK
| | - Louise Marston
- Principal Research Associate, Research Department of Primary care and Population Health and Priment CTU, University College London, London, UK
| | - David Mataix-Cols
- Professor of Child and Adolescent Psychiatric Science, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Stockholm Health Care Services, London, UK
| | - Elizabeth Murray
- Professor of eHealth and Primary Care, eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, Sweden
| | | | - Eva Serlachius
- Assistant Professor in Child and Adolescent Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Chris Hollis
- Queens Medical Centre, Professor of Child and Adolescent Psychiatry, Developmental Psychiatry, University of Nottingham, Nottingham, UK
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Hottel TL, Jack RL, Taynor E, Wells M, Hollis W. Improved Yale Total Tic Severity Score Due to Craniofacial Manipulation With an Oral Appliance. Compend Contin Educ Dent 2019; 40:e6-e15. [PMID: 30601024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND This study evaluated a novel treatment approach using the concept of cranial facial manipulation with an oral appliance, the TicTocStop Tic Guard (TTSTG), also known as the Tic Guard, to determine its safety and efficacy in the treatment of Tourette syndrome (TS) and chronic tic disorders (CTDs). METHODS A two-center study was undertaken at the University of Tennessee Health Science Center and a facility on Long Island, New York. A total of 77 subjects enrolled between the centers upon referral from local neurologists and via Internet enrollment; 67 subjects started the study, and 58 completed the study. A licensed Cognitive Behavioral Intervention for Tics (CBIT) determined the subjects' Yale Total Tic Severity Score (YTTSS) for tics at enrollment, after 1-week sham appliance, after 1-week Tic Guard, and after 10-weeks Tic Guard. RESULTS The results showed statistically significant improvement in the YTTSS with both the sham appliance and the Tic Guard with more robust improvement with the Tic Guard. The sham appliance resulted in a 25% overall reduction in tic severity, while the Tic Guard resulted in a 39% overall reduction in tic severity. There were no serious adverse events reported with either device. CONCLUSIONS This study demonstrated significant reduction in YTTSS using the Tic Guard with no reported serious adverse events. As a result, this device could be considered for inclusion in treatment modalities offered to patients with TS/CTD.
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Affiliation(s)
- Timothy L Hottel
- Professor, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Robin L Jack
- Associate Professor, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Elliott Taynor
- Adjunct Assistant Professor, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Martha Wells
- Associate Professor and Director of PG Pediatrics, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Wainscott Hollis
- Associate Professor, College of Dentistry, University of Tennessee Health Science Center, Memphis, Tennessee
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26
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Zhang H, Liu M, Wang Y, Li Y. [Experience of professor LI Yingkun treating tic disorder with acupuncture]. Zhongguo Zhen Jiu 2018; 38:1209-1211. [PMID: 30672203 DOI: 10.13703/j.0255-2930.2018.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Professor LI Yingkun establishes "scalp acupuncture line" guided by the scalp acupuncture points of international standardization and traditional meridian theory, which can be used to treat tic disorder. With a case, professor LI Yingkun's needling experience for tic disorder is introduced in detail and summarized in order to provide reference for the treatment of the disease.
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Affiliation(s)
- Hanrui Zhang
- School of Acupuncture and Massage, Chengdu University of TCM, Chengdu 610075, Sichuan Province, China
| | - Mao Liu
- Department of TCM, Fuling Central Hospital of Chongqing City, Chongqing 408000
| | - Yu Wang
- School of Nursing, Chengdu University of TCM
| | - Yingkun Li
- Department of Acupuncture and Rehabilitation, the Affiliated Hospital of Chengdu University of TCM
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27
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Martin-Rodríguez JF, Mir P. Automatic and voluntary motor inhibition: Intact processes for tic suppression? Mov Disord 2018; 33:1667-1669. [PMID: 30306617 DOI: 10.1002/mds.27500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/20/2018] [Accepted: 08/23/2018] [Indexed: 11/07/2022] Open
Affiliation(s)
- Juan Francisco Martin-Rodríguez
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
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28
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Weingarden H, Scahill L, Hoeppner S, Peterson AL, Woods DW, Walkup JT, Piacentini J, Wilhelm S. Self-esteem in adults with Tourette syndrome and chronic tic disorders: The roles of tic severity, treatment, and comorbidity. Compr Psychiatry 2018; 84:95-100. [PMID: 29729555 PMCID: PMC6002935 DOI: 10.1016/j.comppsych.2018.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/27/2018] [Accepted: 04/20/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Tourette syndrome (TS) and chronic tic disorders (CTD) are stigmatizing disorders that may significantly impact self-esteem. Alternatively, comorbid psychiatric illnesses may affect self-esteem more than tics themselves. Extant research on self-esteem in TS/CTD is limited, has inconsistently examined the effect of comorbidities on self-esteem, and yields mixed findings. METHOD This study aimed to clarify the roles of tics versus comorbid diagnoses on self-esteem in a large, carefully diagnosed sample of adults with TS/CTD (N = 122) receiving 10 weeks of Comprehensive Behavioral Intervention for Tics (CBIT) or Psychoeducation and Supportive Therapy (PST). RESULTS Baseline self-esteem did not differ between adults with TS/CTD only and normative means, whereas self-esteem was significantly lower among adults with TS/CTD with a comorbid psychiatric illness. In a multiple regression testing the baseline association between tic severity, presence of comorbid psychiatric illness, and depression severity with self-esteem, comorbidity and depression severity were significantly associated with self-esteem, whereas tic severity was not. Finally, using a generalized linear model, we tested the effects of treatment assignment, comorbidity, and their interaction on changes in self-esteem across treatment, controlling for baseline depression severity. Results showed that for those with a comorbid illness, self-esteem improved significantly more with CBIT than with PST. CONCLUSIONS Comorbid illnesses appear to affect self-esteem more so than tics among adults with TS/CTD. Therapeutic attention should be paid to treating comorbid diagnoses alongside tics when treating TS/CTD.
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Affiliation(s)
- Hilary Weingarden
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114, USA.
| | - Lawrence Scahill
- Department of Pediatrics, Emory University School of Medicine, Marcus Autism Center, 1920 Briarcliff Road, Atlanta, GA 30329, USA.
| | - Susanne Hoeppner
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114, USA.
| | - Alan L Peterson
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, 7550 IH-10 West, Suite 1325, San Antonio, TX 78229, USA; Research and Development Service, South Texas Veterans Health Care System, 7400 Merton Minter Blvd., San Antonio, TX 78229, USA.
| | - Douglas W Woods
- Department of Psychology, Cramer Hall 317, Marquette University, Milwaukee, WI 53233, USA.
| | - John T Walkup
- Department of Psychiatry, Anne and Robert H. Lurie Children's Hospital, 225 E. Chicago Ave., Chicago, IL 60611, USA; Department of Psychiatry, Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA.
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angles, 760 Westwood Plaza, Los Angeles, CA 90095-1759, USA.
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114, USA.
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Turner C, O'Gorman B, Nair A, O'Kearney R. Moderators and predictors of response to cognitive behaviour therapy for pediatric obsessive-compulsive disorder: A systematic review. Psychiatry Res 2018; 261:50-60. [PMID: 29287236 DOI: 10.1016/j.psychres.2017.12.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/29/2017] [Accepted: 12/13/2017] [Indexed: 11/15/2022]
Abstract
We report a systematic review of moderators of CBT efficacy for pediatric OCD relative to other treatments. CENTRAL, MEDLINE, EMBASE, CINAHL, and PsycINFO were searched for RCTs reporting on effect moderation for CBT outcomes. Five studies (N = 365) examined 17 variables with three significant moderators identified. Compared to pill-placebo, CBT monotherapy was not effective for children with a family history of OCD but was for those without a family history. For children with a family history, CBT plus sertraline efficacy was attenuated but remained significant. For children with tics, CBT but not sertraline remained superior to pill-placebo. For non-responders to initial treatment with CBT, continuing CBT was inferior to commencing sertraline for those with tics but was not different for those without tics. A supplementary review identified older age, symptom and impairment severity, co-morbidity and family accommodation as consistent predictors of a poorer outcome to CBT. Current evidence for moderation effects is post-hoc, from single RCTs, has small Ns and requires replication. The review identifies family history of OCD and the presence of tics as factors requiring further examination in properly conducted trials and about which clinicians need to show care in their treatment recommendations.
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Affiliation(s)
- Cynthia Turner
- School of Psychology, Australian Catholic University, Brisbane, QLD, Australia; Department of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Beth O'Gorman
- Department of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Archana Nair
- Research School of Psychology, Australian National University, Canberra, ACT 0020, Australia
| | - Richard O'Kearney
- Research School of Psychology, Australian National University, Canberra, ACT 0020, Australia.
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Sørensen CB, Debes NM, Skov L, Miranda MJ. [Tic suppression is a new evidence-based non-farmacological treatment of chronic tic disorder]. Ugeskr Laeger 2017; 179:V09160644. [PMID: 28263157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Chronic tic disorder and Tourette syndrome are both chronic and impairing neurobiological disorders starting in childhood with a prevalence between 0.4 and 1.6%. Traditionally, pharmacological therapies have been first-line treatment but are often associated with adverse effects. Recently behavioural therapy has shown to be effective in treating tics and today both habit reversal (HR) and exposure and response prevention (ERP) are recommended as first-line treatments. HR and ERP are now available for Danish patients. This article describes the evidence and recommendations for both therapies.
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31
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Storch EA, Johnco C, McGuire JF, Wu MS, McBride NM, Lewin AB, Murphy TK. An initial study of family accommodation in children and adolescents with chronic tic disorders. Eur Child Adolesc Psychiatry 2017; 26:99-109. [PMID: 27277754 DOI: 10.1007/s00787-016-0879-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/01/2016] [Indexed: 12/15/2022]
Abstract
This initial study examined the nature, incidence, and clinical correlates of family accommodation in youth with tic disorders, and validated a brief self-report measure of tic-related family accommodation, the Tic Family Accommodation Scale (TFAS). Seventy-five youth aged 6-18 who were diagnosed with a tic disorder and their parent completed a diagnostic clinical interview, and clinician and parent-report measures of tic severity, depressive symptoms, anxiety symptoms, behavioral problems, family accommodation and impairment. An exploratory factor analysis of the TFAS showed a two-factor structure, with good internal consistency for the Total score, Modification of Child Environment and Modification of Parent Environment subscales (α = 0.88, 0.86, and 0.81, respectively). Family accommodation was not associated with tic severity. Family accommodation was associated with increased anxiety and depressive symptoms, higher externalizing, rule breaking, aggressive behaviors and social problems, and with greater tic-related functional impairment. Anxiety and externalizing problems (but not depressive symptoms) predicted family accommodation when controlling for tic severity. Family accommodation predicted high levels of functional impairment over and above the effect of tic severity, anxiety, depression and externalizing problems. Family accommodation is a common phenomenon for youth with tic disorders, with modifications typically encompassing changes to the child and/or parent environments. Accommodation was not associated with tic severity, but was related to higher levels of anxiety, depressive symptoms, externalizing symptoms, aggression, and rule breaking behaviors. Results suggest that other emotional symptoms are more likely to drive accommodation practices than the tic symptoms per se.
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Affiliation(s)
- Eric A Storch
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA.
- Department of Health Policy and Management, University of South Florida, Tampa, USA.
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, USA.
- Department of Psychology, University of South Florida, Tampa, USA.
- Rogers Behavioral Health, Tampa Bay, Tampa, USA.
- All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, USA.
| | - Carly Johnco
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA
| | - Joseph F McGuire
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - Monica S Wu
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA
- Department of Psychology, University of South Florida, Tampa, USA
| | - Nicole M McBride
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, USA
- Department of Psychology, University of South Florida, Tampa, USA
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, USA
- All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, USA
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Ricketts EJ, Goetz AR, Capriotti MR, Bauer CC, Brei NG, Himle MB, Espil FM, Snorrason Í, Ran D, Woods DW. A randomized waitlist-controlled pilot trial of voice over Internet protocol-delivered behavior therapy for youth with chronic tic disorders. J Telemed Telecare 2016; 22:153-62. [PMID: 26169350 PMCID: PMC6033263 DOI: 10.1177/1357633x15593192] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/14/2015] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Comprehensive Behavioral Intervention for Tics (CBIT) has been shown to be efficacious for chronic tic disorders (CTDs), but utilization is limited by a lack of treatment providers and perceived financial and time burden of commuting to treatment. A promising alternative to in-person delivery is voice over Internet protocol (VoIP), allowing for remote, real-time treatment delivery to patients' homes. However, little is known about the effectiveness of VoIP for CTDs. Therefore, the present study examined the preliminary efficacy, feasibility, and acceptability of VoIP-delivered CBIT (CBIT-VoIP). METHODS Twenty youth (8-16 years) with CTDs participated in a randomized, waitlist-controlled pilot trial of CBIT-VoIP. The main outcome was pre- to post-treatment change in clinician-rated tic severity (Yale Global Tic Severity Scale). The secondary outcome was clinical responder rate (Clinical Global Impressions - Improvement Scale), assessed using ratings of 'very much improved' or 'much improved' indicating positive treatment response. RESULTS Intention-to-treat analyses with the last observation carried forward were performed. At post-treatment (10-weeks), significantly greater reductions in clinician-rated, (F(1,18) = 3.05, p < 0.05, partial η(2 )= 0.15), and parent-reported tic severity, (F(1,18) = 6.37, p < 0.05, partial η(2 )= 0.26) were found in CBIT-VoIP relative to waitlist. One-third (n = 4) of those in CBIT-VoIP were considered treatment responders. Treatment satisfaction and therapeutic alliance were high. DISCUSSION CBIT can be delivered via VoIP with high patient satisfaction, using accessible, low-cost equipment. CBIT-VoIP was generally feasible to implement, with some audio and visual challenges. Modifications to enhance treatment delivery are suggested.
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Affiliation(s)
- Emily J Ricketts
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles, USA Department of Psychology, University of Wisconsin-Milwaukee, USA
| | - Amy R Goetz
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | | | | | - Natalie G Brei
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | | | - Flint M Espil
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | - Ívar Snorrason
- Department of Psychology, University of Wisconsin-Milwaukee, USA
| | - Dagong Ran
- Department of Psychology, University of Wisconsin-Milwaukee, USA
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Peterson AL, McGuire JF, Wilhelm S, Piacentini J, Woods DW, Walkup JT, Hatch JP, Villarreal R, Scahill L. An Empirical Examination of Symptom Substitution Associated With Behavior Therapy for Tourette's Disorder. Behav Ther 2016; 47:29-41. [PMID: 26763495 PMCID: PMC5758863 DOI: 10.1016/j.beth.2015.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 09/02/2015] [Accepted: 09/03/2015] [Indexed: 11/19/2022]
Abstract
Over the past six decades, behavior therapy has been a major contributor to the development of evidence-based psychotherapy treatments. However, a long-standing concern with behavior therapy among many nonbehavioral clinicians has been the potential risk for symptom substitution. Few studies have been conducted to evaluate symptom substitution in response to behavioral treatments, largely due to measurement and definitional challenges associated with treated psychiatric symptoms. Given the overt motor and vocal tics associated with Tourette's disorder, it presents an excellent opportunity to empirically evaluate the potential risk for symptom substitution associated with behavior therapy. The present study examined the possible presence of symptom substitution using four methods: (a) the onset of new tic symptoms, (b) the occurrence of adverse events, (c) change in tic medications, and (d) worsening of co-occurring psychiatric symptoms. Two hundred twenty-eight participants with Tourette's disorder or persistent motor or vocal tic disorders were randomly assigned to receive behavioral therapy or supportive therapy for tics. Both therapies consisted of eight sessions over 10 weeks. Results indicated that participants treated with behavior therapy were not more likely to have an onset of new tic symptoms, experience adverse events, increase tic medications, or have an exacerbation in co-occurring psychiatric symptoms relative to participants treated with supportive therapy. Further analysis suggested that the emergence of new tics was attributed with the normal waxing and waning nature of Tourette's disorder. Findings provide empirical support to counter the long-standing concern of symptom substitution in response to behavior therapy for individuals with Tourette's disorder.
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Affiliation(s)
- Alan L Peterson
- University of Texas Health Science Center at San Antonio, South Texas Veterans Health Care System, and University of Texas at San Antonio.
| | - Joseph F McGuire
- University of California, Los Angeles Semel Institute for Neuroscience
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School
| | - John Piacentini
- University of California, Los Angeles Semel Institute for Neuroscience
| | | | | | - John P Hatch
- University of Texas Health Science Center at San Antonio
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Pasek J, Jędrzejewska A, Jagodziński L, Obuchowicz A, Flak M, Sieroń A. [Variable magnetic fields in the treatment of tics disorders - preliminary results]. Wiad Lek 2016; 69:495-498. [PMID: 28478413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Tics disorders is frequent pathological syndrome, particularly typical for children's age. The symptoms of this disease are differential, and their intensification individualized, which makes difficult unique recognition. Tics disorders concern the most often the muscles of face, head, upper limbs and trunk. MATERIAL AND METHODS The study group consisted of 16 patients (11 boys and 5 girls) with tics complex disorders about unknown etiology particularly relating of face and upper limbs muscles. In the treatment were the interventions with use a magnetotherapy and magnetostimulation applied. The procedures were ones daily by 3 weeks in two series executed. It author's pool was the frequency of occurrence tics disorders as well as the proportional opinion of effectiveness conducted treatment estimated. RESULTS After 10 weeks in 14 patients was the decrease of occurrence frequency involuntary movements observed, in proportional scale about 75%. The results of subjective opinion of mood showed, that decrease the frequency tics disorders had in all children the direct shift on improvement their mood, and also satisfaction in their parents. CONCLUSIONS The use of variable magnetic fields influenced on decrease the occurrence frequency tics disorders, and also on improvement quality of life the treated patients.
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Affiliation(s)
- Jarosław Pasek
- Wydział Lekarski z.Oddziałem Lekarsko-Dentystycznym w Zabrzu Katedra i.Oddział Kliniczny Chorób Wewnętrznych, Angiologii i.Medycyny Fizykalnej oraz Ośrodek Diagnostyki i.Terapii Laserowej Śląski Uniwersytet Medyczny, Katowice, Instytut Wychowania Fizycznego Turystyki i Fizjoterapii , Akademia im Jana Długosza, Częstochowa
| | - Anna Jędrzejewska
- Poradnia Neurologiczna i Leczenia Padaczek Szpitala Specjalistycznego nr 2, Bytom
| | - Leszek Jagodziński
- Wydział Lekarski z.Oddziałem Lekarsko-Dentystycznym w Zabrzu Katedra i.Oddział Kliniczny Chorób Wewnętrznych, Angiologii i.Medycyny Fizykalnej oraz Ośrodek Diagnostyki i.Terapii Laserowej Śląski Uniwersytet Medyczny, Katowice
| | - Anna Obuchowicz
- Wydział Nauk o Zdrowiu w Katowicach Oddział Kliniczny Pediatrii Katedry Pediatrii Śląskiego Uniwersytet u Medycznego, Katowice
| | - Maria Flak
- Klinika Neurorehabilitacji Śląskiego Uniwersytet u Medycznego, Katowice
| | - Aleksander Sieroń
- Wydział Lekarski z.Oddziałem Lekarsko-Dentystycznym w Zabrzu Katedra i.Oddział Kliniczny Chorób Wewnętrznych, Angiologii i.Medycyny Fizykalnej oraz Ośrodek Diagnostyki i.Terapii Laserowej Śląski Uniwersytet Medyczny, Katowice
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Pasek J, Jędrzejewska A, Jagodziński L, Obuchowicz A, Flak M, Sieroń A. [Variable magnetic fields in the treatment of tics disorders - preliminary results]. Wiad Lek 2016; 69:495-498. [PMID: 27717932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Tics disorders is frequent pathological syndrome, particularly typical for children's age. The symptoms of this disease are differential, and their intensification individualized, which makes difficult unique recognition. Tics disorders concern the most often the muscles of face, head, upper limbs and trunk. MATERIAL AND METHODS The study group consisted of 16 patients (11 boys and 5 girls) with tics complex disorders about unknown etiology particularly relating of face and upper limbs muscles. In the treatment were the interventions with use a magnetotherapy and magnetostimulation applied. The procedures were ones daily by 3 weeks in two series executed. It author's pool was the frequency of occurrence tics disorders as well as the proportional opinion of effectiveness conducted treatment estimated. RESULTS After 10 weeks in 14 patients was the decrease of occurrence frequency involuntary movements observed, in proportional scale about 75%. The results of subjective opinion of mood showed, that decrease the frequency tics disorders had in all children the direct shift on improvement their mood, and also satisfaction in their parents. CONCLUSIONS The use of variable magnetic fields influenced on decrease the occurrence frequency tics disorders, and also on improvement quality of life the treated patients.
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Affiliation(s)
- Jarosław Pasek
- Wydział Lekarski z.Oddziałem Lekarsko-Dentystycznym w Zabrzu Katedra i.Oddział Kliniczny Chorób Wewnętrznych, Angiologii i.Medycyny Fizykalnej oraz Ośrodek Diagnostyki i.Terapii Laserowej Śląski Uniwersytet Medyczny, Katowice, Instytut Wychowania Fizycznego Turystyki i Fizjoterapii , Akademia im Jana Długosza, Częstochowa
| | - Anna Jędrzejewska
- Poradnia Neurologiczna i Leczenia Padaczek Szpitala Specjalistycznego nr 2, Bytom
| | - Leszek Jagodziński
- Wydział Lekarski z.Oddziałem Lekarsko-Dentystycznym w Zabrzu Katedra i.Oddział Kliniczny Chorób Wewnętrznych, Angiologii i.Medycyny Fizykalnej oraz Ośrodek Diagnostyki i.Terapii Laserowej Śląski Uniwersytet Medyczny, Katowice
| | - Anna Obuchowicz
- Wydział Nauk o Zdrowiu w Katowicach Oddział Kliniczny Pediatrii Katedry Pediatrii Śląskiego Uniwersytet u Medycznego, Katowice
| | - Maria Flak
- Klinika Neurorehabilitacji Śląskiego Uniwersytet u Medycznego, Katowice
| | - Aleksander Sieroń
- Wydział Lekarski z.Oddziałem Lekarsko-Dentystycznym w Zabrzu Katedra i.Oddział Kliniczny Chorób Wewnętrznych, Angiologii i.Medycyny Fizykalnej oraz Ośrodek Diagnostyki i.Terapii Laserowej Śląski Uniwersytet Medyczny, Katowice
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Cath D. [Psychiatric aspects of tics]. Tijdschr Psychiatr 2015; 57:143-147. [PMID: 25669954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Tics, the most serious form of which is the Gilles de la Tourette syndrome (GTS), belong to the group of hyperkinetic movement disorders. The most extreme forms of these movement disorders are often characterised by psychiatric comorbidity. AIM To acquaint the reader with the psychiatric aspects of tics and with the role played by comorbidities in OCD and ADHD patients who also suffer from tics. METHOD Recent new insights in psychiatric aspects of GTS are described. RESULTS Tics in GTS have marked psychological characteristics because of their relatively capricious nature, their suppressibility and their reaction to environmental stimuli. Consequently, for the treatment of tics - but not for the treatment of other movement disorders - behaviour therapy is just as effective as dopaminergic medication. Psychiatric comorbidity (present in up to 65% of clinical populations with GTS) plays a crucial role in the course of tics disorder. In particular, ADHD and OCD patients who are also suffering from tics are more likely to be referred to psychiatric outpatiënt clinics because of their ADHD or OCD status than because of their tics. CONCLUSION GTS belongs to the domain of psychiatry because of the psychological aspects of tics, the feasibility of treatment with behaviour therapy and the crucial role played by comorbidity in the course of the disorder.
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Abstract
PURPOSE OF REVIEW Primary tic disorders are complex, multifactorial disorders in which tics are accompanied by other sensory features and an array of comorbid behavioral disorders. Secondary tics are proportionally much less frequent, but their etiology is diverse. This review aims to guide clinicians in the recognition of the phenomenology, pathophysiology, and treatment of these disorders. RECENT FINDINGS Advances include greater phenomenologic insights, particularly of nonmotor (sensory) features; increased knowledge of disease mechanisms, particularly coming from neuropsychological, functional imaging, pathologic, and animal model studies; growing evidence on the efficacy of alpha-2 agonists and the newer generation of dopamine-modulating agents; and recent strides in the evaluation of cognitive-behavioral therapy and deep brain stimulation surgery. SUMMARY The correct diagnostic approach to tic disorders requires accurate historical gathering, a thorough neurologic examination, and detailed definition of the patient's psychopathologic profile. Treatment should always begin with individualized psychoeducational strategies. Although pharmacologic treatments remain beneficial for most patients, cognitive-behavioral treatments have thus far shown promising efficacy. Deep brain stimulation surgery should still be limited to adult patients refractory to pharmacotherapy and cognitive-behavioral therapy.
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Fourneret P, Desombre H, Broussolle E. [From tic disorders to Tourette syndrome: current data, comorbidities, and therapeutic approach in children]. Arch Pediatr 2014; 21:646-51. [PMID: 24815597 DOI: 10.1016/j.arcped.2014.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 01/02/2014] [Accepted: 03/21/2014] [Indexed: 11/19/2022]
Abstract
Motor tics are frequently observed in children during development. Usually transient and benign, they can become chronic over time, join various morbid disorders (vocal tics, attention deficit and hyperactivity disorder, and obsessive-compulsive disorders) and move toward genuine Tourette syndrome. In this case, it will be necessary to prevent impacts - mainly in terms of quality of life and emotional and relational problems - using a global therapeutic strategy combining psychoeducational approaches with appropriate medication.
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Affiliation(s)
- P Fourneret
- Service de psychopathologie du développement, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69677 Bron cedex, France; Institut des sciences cognitives, CNRS UMR 5304, 67, boulevard Pinel, 69675 Bron cedex, France; Faculté de médecine Lyon-Est, université Claude-Bernard - Lyon 1, 69003 Lyon, France.
| | - H Desombre
- Service de psychopathologie du développement, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69677 Bron cedex, France
| | - E Broussolle
- Service de neurologie C, centre de compétence Gilles-de-la-Tourette, hôpital neurologique Pierre-Wertheimer, hospices civils de Lyon, 69677 Bron cedex, France; Centre de neurosciences cognitives, CNRS UMR 5229, 69675 Bron cedex, France; Faculté de médecine Lyon-Sud - Charles-Mérieux, université Claude-Bernard - Lyon 1, 69921 Oullins, France
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Reese HE, Scahill L, Peterson AL, Crowe K, Woods DW, Piacentini J, Walkup JT, Wilhelm S. The premonitory urge to tic: measurement, characteristics, and correlates in older adolescents and adults. Behav Ther 2014; 45:177-86. [PMID: 24491193 PMCID: PMC4445415 DOI: 10.1016/j.beth.2013.09.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 09/12/2013] [Accepted: 09/13/2013] [Indexed: 10/26/2022]
Abstract
In addition to motor and/or vocal tics, many individuals with Tourette syndrome (TS) or chronic tic disorder (CTD) report frequent, uncomfortable sensory phenomena that immediately precede the tics. To date, examination of these premonitory sensations or urges has been limited by inconsistent assessment tools. In this paper, we examine the psychometric properties of a nine-item self-report measure, the Premonitory Urge to Tic Scale (PUTS) and examine the characteristics and correlates of the premonitory urge to tic in a clinical sample of 122 older adolescents and adults with TS or CTD. The PUTS demonstrated adequate internal consistency, temporal stability, and concurrent validity. Premonitory urges were endorsed by the majority of individuals. Most individuals reported some relief from the urges after completing a tic and being able to stop their tics even if only temporarily. Degree of premonitory urges was not significantly correlated with age, and we did not observe any gender differences. Degree of premonitory urges was significantly correlated with estimated IQ and tic severity, but not severity of comorbid obsessive-compulsive disorder or attention-deficit hyperactivity disorder. Also, it was not related to concomitant medication status. These findings represent another step forward in our understanding of the premonitory sensations associated with TS and CTD.
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Affiliation(s)
- Hannah E. Reese
- Massachusetts General Hospital/Harvard Medical School, Department of Psychiatry, 55 Fruit St., Boston, MA 02114, USA
| | - Lawrence Scahill
- Yale Child Study Center, 230 South Frontage Road, New Haven, CT 06519, USA
| | - Alan L. Peterson
- Division of Behavioral Medicine, Department of Psychiatry, University of Texas Health Science Center at San Antonio, 77550 IH-10 West, Suite 1325, San Antonio, TX 78229, USA
| | - Katherine Crowe
- Massachusetts General Hospital/Harvard Medical School, Department of Psychiatry, 55 Fruit St., Boston, MA 02114, USA
| | - Douglas W. Woods
- University of Wisconsin-Milwaukee, Department of Psychology, 224 Garland Hall, 2441 E. Hartford Ave., Milwaukee, WI 53211, USA
| | - John Piacentini
- University of California at Los Angeles Psychiatry & Biobehavioral Sciences, BOX 951759, 760 Westwood Plaza, 67-455 Semel Institute, Los Angeles, CA 90095-1759, USA
| | | | - Sabine Wilhelm
- Massachusetts General Hospital/Harvard Medical School, Department of Psychiatry, 55 Fruit St., Boston, MA 02114, USA
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Kano Y. [Treatment-refractory OCD from the viewpoint of obsessive-compulsive spectrum disorders: impact of comorbid child and adolescent psychiatric disorders]. Seishin Shinkeigaku Zasshi 2013; 115:990-996. [PMID: 24228477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
More than a half of patients with OCD are classified as early-onset. Early-onset OCD has been indicated to be associated with a greater OCD global severity and more frequently comorbid with tic disorders and other obsessive-compulsive (OC) spectrum disorders, compared with late-onset OCD. Early-onset OCD patients with severe impairment caused by both OC symptoms and comorbid OC spectrum disorders may be identified as being refractory. Tic disorders and autism spectrum disorder (ASD) are child and adolescent psychiatric disorders included in OC spectrum disorders. OCD comorbid with chronic tic disorders including Tourette syndrome (TS) is specified as tic-related OCD. Tic-related OCD is characterized by the high prevalence of early-onset and sensory phenomena including "just right" feeling. Self-injurious behaviors (SIB) such as head banging and body punching often occur in patients with TS. The patients' concern about SIB is likely to trigger them, suggesting that an impulse-control problem is a feature of TS. More than a half of patients with TS have OC symptoms. When OC symptoms in patients with TS were assessed with a dimensional approach, symmetry dimension symptoms were found most frequently over the lifetime. On the other hand, the severity of aggression dimension symptoms was the most stable during the course among all dimensions. Aggression dimension symptoms also exhibited a close relationship with impairment of global functioning and sensory phenomena. This tendency may be characteristic of tic-related OCD. It is sometimes difficult to differentiate between OC symptoms and restricted, repetitive behaviors which are core symptoms of ASD. Recently, ego-dystonia and insight are considered non-essential to diagnose OCD, whereas high-functioning and/or atypical ASD is recognized as being more prevalent than previously estimated. In this situation, attention to comorbidity of OCD and ASD is increasing, and the prevalence of OCD in children and adolescents with ASD was reported to be about 20%. One study on the impact of comorbid ASD in adults with OCD indicated that comorbid patients had higher scores for the Autism Questionnaire (AQ) subscales of attention switching and imagination but showed little difference in OC symptoms except for the predominance of compulsion compared to patients with pure OCD. "Just right" feeling and impulse-control problems were evident in OC patients comorbid with both ASD and TS. Out of five adults with TS who underwent deep brain stimulation (DBS) because of refractory tics, four had impulse-control problems including SIB, leading to very severe physical injuries in two patients. After DBS, tics and SIB improved in all patients; however, one patient experienced their re-aggravation. To improve understanding of and treatment/support for refractory OCD, OC spectrum disorders should also be considered.
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Affiliation(s)
- Yukiko Kano
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo
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Subspecialty Group of Neurology, The Society of Pediatrics, Chinese Medical Association. [Diagnosis and treatment recommendations for tic disorders in children]. Zhonghua Er Ke Za Zhi 2013; 51:72-5. [PMID: 23527937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Dutta N, Cavanna AE. The effectiveness of habit reversal therapy in the treatment of Tourette syndrome and other chronic tic disorders: a systematic review. Funct Neurol 2013; 28:7-12. [PMID: 23731910 PMCID: PMC3812724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Tourette syndrome (TS) is a neurodevelopmental disorder characterized by multiple tics, which can require active intervention. It is recognized that behavioral techniques, especially habit reversal therapy (HRT), can offer an effective alternative or complement to pharmacotherapy in this setting. We conducted a systematic literature review to evaluate the efficacy of HRT in TS and other chronic tic disorders (CTDs). Our search was restricted to randomized controlled trials that used standardized diagnostic and outcome measures to compare the efficacy of HRT against a control treatment. We identified five relevant studies, which included 353 patients. Significant post-treatment reductions in tic severity scores (range: 18.3%-37.5%) were seen in the HRT groups across all studies. Current evidence suggests that HRT can significantly reduce tic severity in both adults and children with TS and other CTDs. Further head-to-head studies are needed to compare the efficacy of HRT with other behavioral interventions for tic management.
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Affiliation(s)
- Neeladri Dutta
- College of Medical and Dental Sciences, University of Birmingham, United Kingdom
- The Michael Trimble Neuropsychiatry Research Group, Department of Neuropsychiatry, BSMHFT and University of Birmingham, United Kingdom
| | - Andrea E. Cavanna
- College of Medical and Dental Sciences, University of Birmingham, United Kingdom
- The Michael Trimble Neuropsychiatry Research Group, Department of Neuropsychiatry, BSMHFT and University of Birmingham, United Kingdom
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London, United Kingdom
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Knight T, Steeves T, Day L, Lowerison M, Jette N, Pringsheim T. Prevalence of tic disorders: a systematic review and meta-analysis. Pediatr Neurol 2012; 47:77-90. [PMID: 22759682 DOI: 10.1016/j.pediatrneurol.2012.05.002] [Citation(s) in RCA: 276] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 05/09/2012] [Indexed: 12/19/2022]
Abstract
This study evaluated the prevalence of tic disorders. MEDLINE and EMBASE databases were searched, using terms specific to Tourette syndrome and tic disorders, for studies of incidence, prevalence, and epidemiology. Thirty-five studies reporting data from 1985-2011 on the incidence or prevalence of tic disorders in a defined population were included. One reported incidence, and 34 reported prevalence. Meta-analysis of 13 studies of children yielded a prevalence of Tourette syndrome at 0.77% (95% confidence interval, 0.39-1.51%). Prevalence is higher in boys: 1.06% of boys were affected (95% confidence interval, 0.54-2.09%) vs 0.25% of girls (95% confidence interval, 0.05-1.20%). Transient tic disorder comprised the most common tic disorder in children, affecting 2.99% (95% confidence interval, 1.60-5.61%). Meta-analysis of two studies assessing adults for Tourette syndrome revealed a prevalence of 0.05% (95% confidence interval, 0.03-0.08%). The prevalence of tic disorders was higher in all studies performed in special education populations. Tic disorders are more common in children than adults, in boys than girls, and in special education populations. Parents, educators, healthcare professionals, and administrators should be aware of the frequency with which tic disorders occur, and ensure proper access to appropriate care.
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Abstract
This article presents an overview of the existing, as well as newly developed, cognitive behavior therapy methods for treating the child anxiety triad (separation anxiety disorder, generalized anxiety disorder, and social phobia). For each disorder of the triad, the authors review diagnostic criteria, clinical presentation, disorder-specific treatment methods and innovations, and future directions for research.
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Affiliation(s)
- Martin E Franklin
- Department of Psychiatry, University of Pennsylvania School of Medicine, 3535 Market Street, 6th Floor, Philadelphia, PA 19104, USA.
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Müller-Vahl KR, Cath DC, Cavanna AE, Dehning S, Porta M, Robertson MM, Visser-Vandewalle V. European clinical guidelines for Tourette syndrome and other tic disorders. Part IV: deep brain stimulation. Eur Child Adolesc Psychiatry 2011; 20:209-17. [PMID: 21445726 DOI: 10.1007/s00787-011-0166-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ten years ago deep brain stimulation (DBS) has been introduced as an alternative and promising treatment option for patients suffering from severe Tourette syndrome (TS). It seemed timely to develop a European guideline on DBS by a working group of the European Society for the Study of Tourette Syndrome (ESSTS). For a narrative review a systematic literature search was conducted and expert opinions of the guidelines group contributed also to the suggestions. Of 63 patients reported so far in the literature 59 had a beneficial outcome following DBS with moderate to marked tic improvement. However, randomized controlled studies including a larger number of patients are still lacking. Although persistent serious adverse effects (AEs) have hardly been reported, surgery-related (e.g., bleeding, infection) as well as stimulation-related AEs (e.g., sedation, anxiety, altered mood, changes in sexual function) may occur. At present time, DBS in TS is still in its infancy. Due to both different legality and practical facilities in different European countries these guidelines, therefore, have to be understood as recommendations of experts. However, among the ESSTS working group on DBS in TS there is general agreement that, at present time, DBS should only be used in adult, treatment resistant, and severely affected patients. It is highly recommended to perform DBS in the context of controlled trials.
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Affiliation(s)
- Kirsten R Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
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Abstract
This article provides an overview of cognitive-behavioral therapy (CBT) for repetitive behavior disorders. Because tic disorders and trichotillomania are the most often studied and most debilitating of these conditions, this article focuses on the efficacy of CBT for these 2 conditions. An overview of CBT for children presenting with these concerns is provided. This review focuses particularly on habit reversal training, which is at the core of most CBT-based interventions. Two recent empirical studies on the immense potential of CBT in treating childhood repetitive behavior disorders and future areas of research are also discussed.
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Affiliation(s)
- Christopher A Flessner
- Division of Child and Family Psychiatry, Rhode Island Hospital, Warren Alpert School of Medicine at Brown University, Providence, RI 02903, USA.
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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
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Xiang SJ, Cai YH, Zhang ZD. [Observation on therapeutic effect of tic disorders treated with local acupuncture]. Zhongguo Zhen Jiu 2010; 30:469-472. [PMID: 20578384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To observe the clinical efficacy on tic disorders (TD) treated with local acupuncture. METHODS The entire data of 196 cases, of which, 114 cases in acupuncture group were treated mainly with local acupuncture and 82 cases in western medication group were taken Tiapride tablets orally. YGTSS method was adopted for scoring and assessing the clinical efficacy. RESULTS The apparent improvement was achieved in YGTSS motor tic score in two groups. The markedly effective rates were 90.4% and 84.2% in acupuncture group and western medication group, respectively (P < 0.05), without significant difference in statistics. The effective rates of transient tic disorder (TTD) in acupuncture group and western medication group were 100.0% and 83.3%, respectively (P < 0.05), which indicated that the efficacy of acupuncture on TTD was advantageous to medical therapy. The effective rates of three kinds of TD in acupuncture group were 100.0%, 88.2% and 84.2% separately, of which, the efficacy of acupuncture on TTD was advantageous as compared with that on chronic tic disorder (CTD) and Toureett's syndrome (TS) (P < 0.05). CONCLUSION The overall efficacy on TD is similar between acupuncture and medical therapy, but the clinical efficacy of acupuncture on TTD is superior to medical therapy. Meanwhile, the efficacy of acupuncture on TTD is advantageous to that on CTD and TS. Hence, the intervention at early time can achieve satisfactory efficacy and probably prevent from CTD or TS.
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Affiliation(s)
- Sheng-Jin Xiang
- Eye Department of Chinese Medicine, Affiliated Optic Hospital of Wenzhou Medical College, Wenzhou 325027, China.
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