Current Management of Tics and Tourette Syndrome: Behavioral, Pharmacologic, and Surgical Treatments
- PDF / 557,907 Bytes
- 13 Pages / 595.276 x 790.866 pts Page_size
- 93 Downloads / 146 Views
REVIEW
Current Management of Tics and Tourette Syndrome: Behavioral, Pharmacologic, and Surgical Treatments Andrew Billnitzer 1 & Joseph Jankovic 1
# The American Society for Experimental NeuroTherapeutics, Inc. 2020
Abstract Tourette syndrome is a heterogeneous neurobehavioral disorder manifested by childhood-onset motor and phonic tics, often accompanied by a variety of behavioral comorbidities, including attention deficit and obsessive compulsive disorder. Treatment must be tailored to the needs and goals of the individual patients and their families. All patients should receive education on the condition and, if possible, engage behavioral therapy targeted towards tics and/or comorbidities. Pharmacological therapies, such as alpha agonists, topiramate, and vesicular monoamine transport type 2 inhibitors, are generally used as first-line therapies in patients with troublesome tics that are not controlled by behavioral therapy or when the latter is not available or accessible. Botulinum toxin injections can be used in patients with bothersome focal tics. Second-line therapy includes antipsychotics, such as fluphenazine, aripiprazole, risperidone, and ziprasidone. These medications are generally efficacious but carry the risk of metabolic syndrome, tardive dyskinesia, and other side effects. Much more research is needed before novel therapies such as cannabis-derived products or transcranial magnetic stimulation can be recommended. There is promise in ongoing clinical trials with D1 receptor antagonist ecopipam and other experimental therapeutics. Patients with tics that are refractory to conventional treatments may be candidates for deep brain stimulation, but further studies are needed to determine the optimal target selection. Key Words Tourette syndrome (TS) . Tics . Deep brain stimulation (DBS) . Vesicular monoamine transport inhibitor (VMAT2) . Comprehensive behavioral therapy in tics (CBIT)
Introduction Tourette syndrome (TS) is a neurodevelopmental disorder defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the presence of both motor and phonic tics prior to the age of 18 and persisting for a period of greater than 12 months without a secondary cause [1]. It is more common in males compared to females (3:1), with a reported prevalence ranging between 0.3 and 1% [2]. TS is often accompanied by a variety of behavioral comorbidities such as obsessive compulsive disorder (OCD) or attention deficit hyperactivity disorder (ADHD). The tics and behavioral
* Joseph Jankovic [email protected]; https://www.jankovic.org 1
Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 7200 Cambridge, Suite 9A, Houston, TX 77030-4202, USA
comorbidities can lead to marked impairment in family and social interactions and school and job performance, and often seriously impact patients’ quality of life. Treatment strategies must be individualized and tailored to the patient’s specific needs, and should be accompanied by education to improve un
Data Loading...
