ABSTRACT
INTRODUCTION: Tourette's Syndrome (TS) is a neurodevelopmental disorder characterized by motor and / or vocal tics for more than 12 months. TS affects about 0.8% of pediatric patients and is associated with great functional impairment and psychological distress. The present study aims to list and compare the effectiveness of therapies used in children and young people with TS. METHODS: PubMed / MEDLINE, Cochrane Library, ScienceDirect, SciELO and Lilacs were used from September 2020 to April 2021 to search for randomized clinical trials with pharmacological, behavioral, physical or alternative interventions for tics in children and young people with ST. RESULTS: 13 clinical trials were included, of which six pharmacological, six behavioral and one of other conformation. The global score on the Yale Global Tic Severity Scale showed evidence in favor of Habit Reversal Training (HRT) and Comprehensive Behavioral Intervention for Tics (CBIT). Evidence from two studies suggests that antipsychotic medications improve tic scores. Evidence from other interventions has shown no conclusive benefit. CONCLUSIONS: The present study identified benefits with the use of antipsychotics. The study also found that HRT and CBIT showed improvement in reducing the severity of tics, in addition to not having any adverse effects. These therapies showed significant clinical improvement, but there is no comparison between the use of these isolated approaches in relation to their use associated with medications. In view of the different forms of therapy, further studies are needed to identify the effectiveness and the profile of adverse effects of these interventions.
INTRODUÇÃO: A Síndrome de Tourette (ST) é um distúrbio do neurodesenvolvimento caracterizado por tiques motores e/ou vocais por mais de 12 meses. A ST afeta cerca de 0,8% dos pacientes pediátricos e associa-se a grande comprometimento funcional e sofrimento psíquico. O presente estudo tem como objetivo listar e comparar a eficácia das terapias utilizadas em crianças e jovens com ST. MÉTODOS: PubMed/MEDLINE, Cochrane Library, ScienceDirect, SciELO e Lilacs foram usados desde setembro de 2020 até abril de 2021 para a busca de ensaios clínicos randomizados com intervenções farmacológicas, comportamentais, físicas ou alternativas para tiques em crianças e jovens com ST. RESULTADOS: 13 ensaios clínicos foram incluídos, dos quais seis farmacológicos, seis comportamentais e um de outra conformação. A pontuação global na Yale Global Tic Severity Scale, apresentou evidências a favor do Treinamento de Reversão de Hábito (TRH) e Intervenção Comportamental Abrangente para Tiques (ICAT). As evidências de dois estudos sugerem que medicamentos antipsicóticos melhoram os escores de tiques. Evidências de outras intervenções não mostraram nenhum benefício conclusivo. CONCLUSÕES: O presente estudo identificou benefícios com o uso do antipsicóticos. O estudo também identificou que a TRH e a ICAT apresentaram melhora na redução da gravidade dos tiques, além de não apresentarem efeitos adversos. Essas terapias mostraram importante melhora clínica, mas não há comparação entre o uso dessas abordagens isoladas em relação ao seu uso associado com medicamentos. Diante das diferentes formas de terapia, mais estudos são necessários para identificar a eficácia e o perfil de efeitos adversos dessas intervenções.
Subject(s)
Humans , Child , Adolescent , Tic Disorders/therapy , Behavior Therapy , Tourette Syndrome/diagnosis , Tourette Syndrome/drug therapy , Placebos , Antipsychotic Agents/pharmacology , Treatment Outcome , Aripiprazole/pharmacologyABSTRACT
El síndrome de Tourette (ST) se caracteriza por tics motores y fónicos, destacando las dificultades de su manejo farmacológico. El objetivo de este artículo es describir los resultados de una revisión bibliográfica de las alternativas de tratamiento farmacológico existentes en la actualidad para el ST pediátrico. Metodología: Se realizó una búsqueda bibliográfica en base de datos PubMed utilizando los términos meSH "Tourette syndrome", "Tics", "Therapeutics" y "Children" entre los años 1950 y 2020, tras priorización y exclusión se obtuvo un total de 64 artículos. Resultados: Los artículos muestran 21 alternativas terapéuticas, que se detallan en dos niveles según eficacia y efectos adversos. Conclusiones: Existen múltiples alternativas farmacológicas, algunas con efectos adversos que pueden llegar a determinar la imposibilidad de continuar el tratamiento. Esta sigue siendo un área abierta de investigación en la búsqueda de alternativas que disminuyan estos efectos.
Abstract. Introduction: Tourette syndrome (TS) is characterized by motor and phonic tics, and the difficulties of its pharmacological management. The objective of this article is to describe the results of a bibliographic review of the pharmacological treatment alternatives that currently exist for pediatric TS. Methods: A bibliographic search was carried out in the PubMed database using the meSH terms "Tourette syndrome", "Tics", "Therapeutics" and "Children" between 1950 and 2020, after prioritization and exclusion, a total of 64 articles were selected. Results: The articles show 21 therapeutic alternatives, which are categorized into two levels according to efficacy and adverse effects. Conclusions: There are multiple pharmacological alternatives, some with adverse effects that may make it impossible to continue treatment. This continues to be an open area of investigation in the search for alternatives that minimize these side effects.
Subject(s)
Humans , Child , Tourette Syndrome/drug therapyABSTRACT
ABSTRACT BACKGROUND: The therapeutic effects of cannabinoid compounds have been the center of many investigations. This study provides a synthesis on all Cochrane systematic reviews (SRs) that assessed the use of cannabinoids as a therapeutic approach. DESIGN AND SETTING: Review of SRs, conducted in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS: A broad search was conducted in the Cochrane Database of Systematic Reviews to retrieve any Cochrane SRs that assessed the efficacy and safety of cannabinoids as a therapeutic approach. The results and key characteristics of all reviews included were summarized and discussed. RESULTS: Eight SRs were included. They assessed the use of cannabinoids for the following types of conditions: neurological (two SRs), psychiatric (two SRs), rheumatological (one SR), infectious (one SR) and oncological (two SRs). There was moderate-quality evidence showing that the use of cannabinoids reduced nausea and vomiting among adults, compared with placebo. Additionally, there was moderate-quality evidence showing that there was no difference between cannabinoids and prochlorperazine regarding the number of participants who reported vomiting, in this same population. CONCLUSIONS: This review identified eight Cochrane systematic reviews that provided evidence of unknown to moderate quality regarding the use of cannabinoids as a therapeutic intervention. Further studies are still imperative for solid conclusions to be reached regarding practical recommendations.
Subject(s)
Humans , Cannabinoids/therapeutic use , Systematic Reviews as Topic , Schizophrenia/drug therapy , Vomiting/drug therapy , Fibromyalgia/drug therapy , Tourette Syndrome/drug therapy , HIV Infections/drug therapy , Evidence-Based Medicine/standards , Dementia/drug therapy , Epilepsy/drug therapy , Nausea/drug therapyABSTRACT
Introducción: El síndrome de la Tourette constituye un trastorno neuropsiquiátrico que puede afectar seriamente la calidad de vida. Objetivo: Describir las características clínicas y el tratamiento del síndrome de la Tourette en un paciente atendido en el Departamento de Salud Mental del Policlínico Universitario Héroes de Girón. Métodos: Se aplicó el método clínico, anamnesis, examen físico general, neurológico y psiquiátrico. Entrevista semiestructurada, pruebas psicológicas proyectivas, exámenes de laboratorio, electrocardiograma, imagineología cerebral (TAC simple de cráneo); estudios neuropsicológicos (Wisconsin) y neurofisiológicos (electroencefalograma). Se revisó la historia clínica del paciente examinado. Resultados: Paciente masculino de 43 años de edad, soltero, no hijos, electricista. Con historia de hiperactividad y dificultad atencional, asociado a tics motores complejos y fonatorios desde los 7 años de edad sin tratamiento, con afectación de su calidad de vida. Al examen clínico se constatan tics mixtos, al examen psiquiátrico distractibilidad, retraimiento, desmotivación, perseveración, rumiaciones, ideas obsesivas, ansiedad, angustia, hipercinesia, compulsiones, rituales, disfemia, coprolalia e insomnio nocturno. En las pruebas psicológicas marcada ansiedad e impulsividad. Los estudios de laboratorio, electrocardiografía y TAC de cráneo no arrojaron resultados patológicos. Wisconsin positivo. Electroencefalograma con irritación cortical en región frontotemporal izquierda. Conclusiones: El síndrome de la Tourette se presenta con frecuencia en la clínica psiquiátrica del adulto como entidad comórbida con el Trastorno por Déficit de Atención e Hiperactividad y el Trastorno obsesivo compulsivo(AU)
Introduction: Tourette's syndrome constitutes a neuropsychiatric disorder that can seriously affect the quality of life. Objective: To describe the clinical characteristics and the treatment of Tourette's syndrome in a patient treated at the Department of Mental Health of Héroes de Girón University Polyclinic. Methods: The clinical method, anamnesis, general physical, neurological and psychiatric examination were applied. Semi-structured interview, projective psychological tests, laboratory tests, electrocardiogram, brain imaging (simple skull CAT scan); neuropsychological (Wisconsin) and neurophysiological studies (Electroencephalogram). The clinical record of the patient examined was reviewed. Results: Male patient aged 43 years, single, without children, electrician. With a history of hyperactivity and attentional difficulty, associated with complex and phonatory motor tics from the age of 7 and without treatment, affecting his quality of life. The clinical examination shows mixed tics, psychiatric examination, distractibility, withdrawal, demotivation, perseveration, ruminations, obsessive ideas, anxiety, anguish, hyperkinesia, compulsions, rituals, dyspnea, coprolalia and nocturnal insomnia. In psychological tests, marked anxiety and impulsivity. The laboratory studies, electrocardiography and CT scan of the skull did not yield pathological results. Wisconsin positive. Electroencephalogram with cortical irritation in the left frontotemporal region. Conclusions: Tourette's syndrome is frequently seen in the psychiatric clinic of the adult as a comorbid entity with attention deficit hyperactivity disorder and obsessive compulsive disorder(AU)
Subject(s)
Humans , Male , Middle Aged , Quality of Life , Tomography, X-Ray Computed/methods , Tourette Syndrome/drug therapy , Tourette Syndrome/epidemiology , Diagnosis, Dual (Psychiatry) , Mental DisordersABSTRACT
A Síndrome de Gilles de la Tourette (SGT), caracterizada pela presença de tiques motores e vocais, apresenta elevada associação com transtorno obsessivo-compulsivo (TOC) e transtorno de déficit de atenção com hiperatividade (TDAH). Essas condições frequentemente causam mais prejuízo aos pacientes do que os tiques, propriamente. Relata-se o caso clínico de um paciente com SGT e comorbidade com TDAH e TOC. O tratamento com inibidor seletivo de recaptura de serotonina (ISRS) e metilfenidato promoveu melhora significativa dos sintomas de TDAH, sintomas compulsivos e tiques.
Tourette Syndrome (TS), characterized by motor and vocal tics, is often associated with obsessive compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD). These associated conditions frequently cause more impairment in patients than tics themselves. We report the case of TS with comorbid ADHD and OCD. Treatment with selective serotonin reuptake inhibitor and methylphenidate, led to significantly improvement of ADHD symptoms, compulsive symptoms and tics.
Subject(s)
Humans , Male , Child , Selective Serotonin Reuptake Inhibitors/therapeutic use , Methylphenidate/therapeutic use , Obsessive-Compulsive Disorder , Tourette Syndrome/diagnosis , Tourette Syndrome/drug therapy , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/drug therapy , Brazil , Comorbidity , PrevalenceSubject(s)
Child , Humans , Male , Bipolar Disorder/complications , Tourette Syndrome/complications , Antimanic Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Bipolar Disorder/drug therapy , Drug Therapy, Combination , Risperidone/therapeutic use , Tourette Syndrome/drug therapy , Valproic Acid/therapeutic useABSTRACT
Background: Tourette syndrome is a neuropsychiatric disorder characterized by motor and vocal tics, attentional deficit, poor control of impulses and obsessive compulsive disorder. Pharmacological treatment is often disappointing due to partial response and frequent poor tolerance to neuroleptic drugs which are otherwise the most effective therapy so far. Aim: To report a lasting improvement obtained with a new drug, aripiprazole that acts modulating both dopaminergic and serotoninergic neurotransmission. Material and methods: Ten patients refractory to their usual therapy, aged 10 to 35 years, were switched to aripiprazole in an open trial. Results: Nine of the 10 patients showed a significant response assessed by the Yale severity tics rating scale and the clinical global impression scale (p <0.01). No relevant adverse effects were observed. Conclusions: Aripiprazole may be a good pharmacological option for patients with Tourette syndrome.
Subject(s)
Adolescent , Adult , Child , Humans , Antipsychotic Agents/therapeutic use , Piperazines/therapeutic use , Quinolones/therapeutic use , Tourette Syndrome/drug therapy , Motor Activity/drug effects , Prospective Studies , Treatment OutcomeABSTRACT
Background: Tourette's syndrome is a childhood-onset hereditary neurobehavioural disorder believed to occur without geographical restrictions. Although there have been reports of this disorder worldwide just a few are from Latin America. Aim: To report a preliminary experience with a series of 70 patients and to review recent advances in this disorder. Patients and Method: We reviewed patients seen in pediatric and adult neurological clinics in Santiago, Chile, all of whom fulfilled clinical diagnostic criteria for Tourette Syndrome. Results: Seventy patients were studied, 54 males (77.1 percent) and 16 females (22.8 percent), their mean age at first evaluation was 13.6 years (range 2-46). The mean age of onset of symptoms was 6.4 (range 2-20), the mean time of follow-up was 3 years. Fifty-eight patients showed simple motor tics (blinking, facial grimacing, shoulder shrugging), whereas dystonic tics like head jerking were seen in 38 patients, torticollis in 6 and oculogyric movements in 2. Complex motor tics like jumping, antics, trunk bending and head shaking were present in 16 subjects. Vocal tics were predominantly of the simple type: sniffing, throat clearing, blowing, and whistling. Complex vocal tics were seen in 12 patients, five cases showed palilalia, 3 echolalia and only six displayed coprolalia (8.5 percent). Tics were of mild to moderate severity in most patients. Obsessive-compulsive disorder was observed in 22.8 percent and attention deficit and hyperactivity disorder were present in 35.7 percent. Forty-five patients (64.2 percent) had a first degree relative with tics, nine patients (12.8 percent) had a family history of obsessive-compulsive disorder. The current evidence involving desinhibition of cortico-striatum-thalamic-cortical neuronal circuits in the pathogenesis of this disorder is analyzed. Conclusion: Our report supports the recognized clinical homogeneity and genetical basis of TouretteÕs syndrome regardless of geographical region and ethnic origin
Subject(s)
Humans , Male , Female , Child, Preschool , Adolescent , Adult , Tic Disorders/diagnosis , Tourette Syndrome/diagnosis , Basal Ganglia/abnormalities , Echolalia/epidemiology , Haloperidol/administration & dosage , Obsessive-Compulsive Disorder/complications , Attention Deficit and Disruptive Behavior Disorders/epidemiology , Tourette Syndrome/drug therapyABSTRACT
Muchos niños presentan en algún momento de su vida movimientos involuntarios o tics, los cuales preocupan al paciente y a su familia. La gran mayoría de ellos es de carácter transitorio y se puede manejar por el pediatra. Sin embargo, los tics del síndrome de Gilles de la Tourette son complejos y a veces socialmente invalidantes, por lo que es necesario conocer su sintomatología y posibilidades terapéuticas por el especialista
Subject(s)
Humans , Male , Adolescent , Tourette Syndrome/diagnosis , Tic Disorders/etiology , Antipsychotic Agents/therapeutic use , Clinical Evolution , Diagnosis, Differential , Tourette Syndrome/epidemiology , Tourette Syndrome/etiology , Tourette Syndrome/drug therapy , Tic Disorders/drug therapyABSTRACT
A síndrome de Gilles de la Tourette (SGT) é um distúrbio de caráter flutuante e crônico, caracterizado por tiques motores e vocais involuntários. A SGT tem sido subdiagnosticada devido à ênfase em uma etiologia exclusivamente psicológica, bem como a critérios imprecisos. O haloperidol é seu tratamento habitual desde aproximadamente 1961. O pimozide vem sendo apontado como mais efetivo na SGT, devido a uma quantidade menor de efeitos sedativos e extrapiramidais, e assim proporcionando maior aderência ao tratamento. Apresentamos dois casos de SGT onde säo discutidos aspectos terapêuticos
Subject(s)
Humans , Male , Female , Adolescent , Haloperidol/therapeutic use , Pimozide/therapeutic use , Tourette Syndrome/drug therapyABSTRACT
El síndrome de La Tourette es un transtorno caracterizado por la presencia de movimiento involuntarios (tics motores) y vocalizaciones (tics vocales). Frecuentemente asociado a transtorno obsesivo compulsivo y déficit atencional. Presenta una distribución mundial pero en nuestro medio existen escasas comunicaciones. Se comunican los avances en la fisiopatología y tratamiento de este transtorno y se discute la evidencia actual que plantea la presencia de desinhibición de los circuitos neuronales córticos-subcorticales en la fisiopatología de este cuadro. El Síndrome de la Tourette constituye un verdadero paradigma para un mejor entendimiento de la estrecha relación existente entre la actividad cognitivo-emocional y la función motora. Este cuadro es bastante común y no frecuente reconocido como tal en nuestro medio
Subject(s)
Humans , Attention Deficit Disorder with Hyperactivity/complications , Obsessive-Compulsive Disorder/complications , Tourette Syndrome/complications , Tics/etiology , Antipsychotic Agents/therapeutic use , Attention Deficit Disorder with Hyperactivity/drug therapy , Clonidine/therapeutic use , Compulsive Personality Disorder/drug therapy , Diagnosis, Differential , Tourette Syndrome/diagnosis , Tourette Syndrome/physiopathology , Tourette Syndrome/drug therapy , Tics/classificationABSTRACT
Os autores apresentam dados referentes ao diagnóstico, tratamento e evoluçäo de um caso de um adolescente seguido há 8 anos e periodicamente reavaliado. Por ocasiäo do primeiro atendimento aos 10 anos de idade apresentava crises de agressividade, ecolalia, cropolalia, tiques e gritos compulsivos. Foi nessa ocasiäo submetido a avaliaçäo psiquiátrica, neurológica e psicométrica e tratado com psicofármacos. Os dados colhidos durante a evoluçäo desse caso säo reunidos neste trabalho e comparados com resultados de outros autores. Discutimos os critérios diagnósticos com base nas reavaliaçöes desacando-se a evoluçäo dos sintomas e sinais. Na situaçäo atual o caso parece-nos estar evoluindo para uma sintomatologia mais psicótica. O curso do tratamento mostrou-se flutuante e progressivo, caracterizando períodos de remissäo e exarcebaçäo, contudo, o paciente nunca se tornou inteiramente assintomático. O tratamento psicofarmacológico com diferentes tipos de drogas näo se mostrou efetivo. Pareceu-nos oportuno o relato da evoluçäo desse caso, na medida em que ele evidenciou sintomas e sinais ligados a fatores orgânico=s e psicogênicos de interesse neuro-psiquiátrico e psicológico no estudo dessa síndrome de baixa incidência. A Síndrome de Gilles de la Tourrette tem sido motivo de estudo desde 1810, quando Georges Gilles de la Tourrette descreveu pela primeira vez essa síndrome como sendo uma falsa coréia...
Subject(s)
Child , Humans , Male , Tourette Syndrome , Follow-Up Studies , Tourette Syndrome/diagnosis , Tourette Syndrome/drug therapyABSTRACT
A Síndrome de Gilles de la Tourette (SGT) é uma interessante desordem do movimento, a qual tem sido pouco compreendida e pouco diagnosticada pelos clínicos. Os autores descrevem a SGT, enfatizando sua história, etiologia, epidemiologia, diagnóstico diferencial e aspectos clínicos e terapêuticos. A etiologia relacionada ao sistema dopaminérgico tem como base a açäo das drogas bloqueadoras de receptores dopaminérgicos, que säo eficazes no tratamento, e de seus agonistas que exacerbam os sintomas. A relaçäo da SGT com a Discinesia Tardia está baseada nestes achados e no aparecimento de SGT em pacientes com uso crônico de neurolépticos. O tratamento com haloperidol, sendo o pimozide uma segunda opçäo, é aconselhado
Subject(s)
Humans , Tourette Syndrome/etiology , Haloperidol/therapeutic use , Pimozide/therapeutic use , Tourette Syndrome/drug therapyABSTRACT
A Síndrome de Gilles de la Tourette (SGT) é uma interessante desordem do movimento, a qual tem sido pouco compreendida e pouco diagnosticada pelos clínicos. Descreve-se a SGT, enfatizando-se sua história, etiologia, epidemiologia, diagnóstico diferencial e aspectos clínicos e terapêuticos. A etiologia relacionada ao sistema dopaminérgico tem como base a açäo das drogas bloqueadoras de receptores dopaminérgicos, que säo eficazes no tratamento, e de seus agonistas que exacerbam os sintomas. A relaçäo da SGT com a Discinesia Tardia está baseada nestes achados e no aparecimento de SGT em pacientes com uso crônico de neurolépticos. O tratamento com haloperidol, sendo o pimozide uma segunda opçäo, é aconselhado
Subject(s)
Child, Preschool , Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Tourette Syndrome , Haloperidol/therapeutic use , Pimozide/therapeutic use , Tourette Syndrome/drug therapyABSTRACT
Tabulam-se os achados clínicos de 15 casos de síndrome de Gilles de la Tourette e múltiplos tiques e revisa-se a literatura quanto a manifestaçöes clínicas, classificaçäo etiopatogenia e tratamento. Observam-se bons resultados com o uso de clonidina em quatro casos, fixam-se critérios para o tratamento e sugerem estudos controlados para a verificaçäo da associaçäo da síndrome de Gilles de la Tourette e coréia reumática num "continuun" de disfunçäo do sistema extrapiramidal em indivíduos susceptíveis
Subject(s)
Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Tic Disorders , Tourette Syndrome/physiopathology , Clonidine/therapeutic use , Tourette Syndrome/drug therapyABSTRACT
Apresenta-se um caso da enfermidade de Gilles de la Tourette, em um adolescente de 15 anos. Os primeiros sintomas apareceram na idade de 8 anos, constituídos pela tríade tics parciais, movimentos involuntários e coprolalia . Instituiu-se tratamento terapêutico a base do haloperidal, produzindo a regressäo do quadro neurológico. A discussäo clínica passa em revista o estado atual das pesquisas clínicas e fundamentais acerca da doença, como também sobre os problemas neuro-psicológicos encontrados