Treatments for Tourette syndrome in children and young adults: a systematic review / Tratamento da síndrome de Tourette em crianças e jovens adultos: uma revisão sistemática

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.

[Ticks of Cattle (Bos taurus and Bos indicus) and Grasscutters (Thryonomys swinderianus) in Savannas District of Côte-d'Ivoire]. / Tiques des bovins (Bos taurus et Bos indicus) et des aulacodes (Thryonomys swinderianus) dans le district des Savanes de Côte-d'Ivoire.

During dry season of 2014, some ticks were collected on cattle (Bos taurus and Bos indicus) and grasscutters (Thryonomys swinderianus) in sugar complex areas of Savanna District of Côte-d'Ivoire. Two localities were concerned; SUCAF 1 in Ferkessédougou and SUCAF 2 in Komborodougou. The main objective was to inventory tick species that parasite cattle and grasscutters in this region, then, to identify the shared species between these two groups of animals. To this end, ticks were collected from 70 cattle (35 females and 35 males) and 50 grasscutters (30 females and 20 males). Four tick species were found on cattle: Amblyomma variegatum, Hyalomma truncatum, Rhipicephalus annulatus and Rhipicephalus microplus. On grasscutters, three species of ticks were found: A. variegatum, Ixodes aulacodi and Rhipicephalus simpsoni. The species A. variegatum dominated cattle infestation and was the only tick present in the two groups of animals. But, only immature forms were found on grasscutters. This later specie was mainly infested by adults R. simpsoni.

Pendant la saison sèche de l'année 2014, des tiques ont été collectées sur des bovins (Bos taurus et Bos indicus) et sur des aulacodes (Thryonomys swinderianus), respectivement à Ferkessédougou et Komborodougou au niveau des complexes sucriers SUCAF 1 et 2, dans le district des Savanes de Côte-d'Ivoire. L'objectif principal recherché était d'inventorier les espèces de tiques parasitant les bovins et les aulacodes sauvages dans cette région puis de déterminer les espèces communes à ces deux groupes d'animaux. Au total, les prélèvements de tiques ont été effectués sur 70 bovins et 50 aulacodes. Après identification morphologique, quatre espèces ont été trouvées chez les bovins : Amblyomma variegatum, Hyalomma truncatum, Rhipicephalus annulatus et Rhipicephalus microplus, et trois espèces chez les aulacodes : A. variegatum, Ixodes aulacodi et Rhipicephalus simpsoni. La tique A. variegatum, la seule espèce commune aux deux types d'animaux, était majoritaire chez les bovins. Chez les aulacodes par contre, seules les formes immatures d'A. variegatum ont été trouvées, et les adultes de l'espèce R. simpsoni ont été trouvés en majorité.

Opinion du comité No 399 : Prise en charge des morsures de tiques et de la maladie de Lyme pendant la grossesse.

Objectif: La maladie de Lyme est une infection émergente au Canada. Causée par une bactérie appartenant au complexe d'espèces Borrelia burgdorferi sensu lato, elle est transmise par la morsure d'une tique à pattes noires infectée. Les populations de tiques à pattes noires continuent de se propager et sont maintenant établies dans différentes régions du Canada. Il faut habituellement plus de 24 heures de temps d'attachement de la tique pour que la B. burgdorferi soit transmise à l'humain. Le diagnostic de la maladie de Lyme au stade localisé précoce est posé au moyen d'une évaluation clinique, puisque les analyses de laboratoire ne sont pas fiables à ce stade. La plupart des patients atteints de la maladie de Lyme au stade localisé précoce manifestent une lésion cutanée (c.-à-d. érythème migrant) qui s'étend à partir du site de la morsure et/ou des symptômes non spécifiques qui rappellent l'influenza (p. ex. arthralgie, myalgie et fièvre). Les signes et symptômes peuvent se manifester de 3 à 30 jours après la morsure de tique. Il y a lieu de prendre en charge les patientes enceintes qui présentent une morsure de tique ou une maladie de Lyme soupçonnée en leur prodiguant des soins semblables à ceux de la population adulte non enceinte, ce qui implique d'envisager le recours aux antibiotiques pour la prophylaxie et le traitement. L'objectif principal de la présente opinion du comité est de renseigner les praticiens sur la maladie de Lyme et de fournir une façon d'aborder la prise en charge des soins prodigués aux femmes enceintes qui pourraient avoir été infectées par une morsure de tique à pattes noires. Utilisateurs concernés: Les fournisseurs de soins de santé qui prodiguent des soins aux patientes enceintes ou aux femmes en âge de procréer. Population cible: Les femmes en âge de procréer. Données probantes: En novembre 2018, des recherches ont été effectuées dans les bases de données Medline, EMBASE, PubMed et CENTRAL relativement à deux catégories principales : (1) maladie de Lyme, (2) autres maladies transmises par les tiques. Puisque la recherche était principalement axée sur la maladie de Lyme et compte tenu du nombre limité d'articles à ce sujet, aucun filtre supplémentaire n'a été appliqué pour la date de publication ou le type d'étude. Pour ce qui est des autres maladies transmises par les tiques, les résultats ont été restreints à une date de publication qui s'inscrit dans les 10 dernières années (2008­2018). Les termes de recherche ont été déterminés au moyen des termes de recherche MeSH et de mots clés : Lyme Disease, Pregnancy, Pregnant Women, Pregnancy Complications, Ehrlichiosis, Anaplasmosis, Rocky Mountain Spotted Fever, Babesiosis, Tularemia, Powassan Virus, Encephalitis Viruses, Tick-Borne, Tick-Borne Diseases, Colorado Tick Fever, Q Fever, Relapsing Fever, et Southern Tick-Associated Rash Illness. Tous les articles portant sur la maladie de Lyme et autres maladies transmises par les tiques comprenant une population cible de femmes enceintes ont été inclus; les autres groupes et populations ont été exclus. Méthodes de validation: Le contenu et les recommandations de la présente opinion du comité ont été rédigés et acceptés par les auteurs. Le conseil d'administration de la Société des obstétriciens et gynécologues du Canada a approuvé la version définitive aux fins de publication.

[Tick-borne relapsing fever : An unrecognized cause of fever in travellers]. / La fièvre récurrente à tiques : une cause méconnue de fièvre du voyageur.

INTRODUCTION: Tick-borne relapsing fever is a usual cause of fever in West Africa. Except relapsing febrile episodes, there are no pathognomonic signs and diagnosis is difficult because Borrelia density in patient's blood is low. CASE REPORTS: Tick-borne relapsing fever was revealed by the presence of spirochetes in a blood sample to search malaria in two men, 24 and 31 year-old, returned from Mali. CONCLUSION: This diagnosis should be evocated in patients having fever after a trip in infested area, as malaria, both infections can be associated.

Human babesiosis in Alsace.

OBJECTIVES: Human babesiosis is a rare parasitic anthropozoonosis transmitted to humans by tick bites. Fifty-six cases of human babesiosis have been recorded in Europe. Two cases of babesiosis were reported in Alsace, France, in 2009. We performed a retrospective observational descriptive study to assess the epidemiology of the disease in Alsace. METHODS: Patients were included if they had a positive serology result for Babesia and/or a positive blood smear and/or a positive PCR result. The tests were performed in the microbiology laboratories of the university hospitals of Strasbourg, the civil hospitals of Colmar, and the hospital of Mulhouse between January 1, 2005 and December 31, 2015. Included patients were divided into three groups: definite case group (positive PCR or positive blood smear or seroconversion), possible case group (positive serology results without seroconversion with a compatible clinical picture and without other confirmed diagnoses), and incompatible case group (positive serology results without seroconversion, without compatible clinical picture and/or with other confirmed diagnoses). The compatible clinical picture was defined by the presence of flu-like symptoms and fever (≥38°C). RESULTS: Fifty-one patients had at least one positive result. Three cases were excluded (missing files). There were six definite cases, 12 possible cases, and 30 incompatible cases. All patients in the definite case group were immunocompetent. No deaths occurred. CONCLUSIONS: Human babesiosis is probably underdiagnosed due to its non-specific symptoms, lack of awareness about the disease, and the difficulty in making a diagnosis.

Crimean-Congo hemorrhagic fever: An update.

Crimean-Congo hemorrhagic fever (CCHF) is a severe form of hemorrhagic fever caused by a virus of the genus Nairovirus. The amplifying hosts are various mammal species that remain asymptomatic. Humans are infected by tick bites or contact with animal blood. CCHF has a broad geographic distribution and is endemic in Africa, Asia (in particular the Middle East) and South East Europe. This area has expanded in recent years with two indigenous cases reported in Spain in 2016 and 2018. The incubation period is short with the onset of symptoms in generally less than a week. The initial symptoms are common to other infectious syndromes with fever, headache, myalgia and gastrointestinal symptoms. The hemorrhagic syndrome occurs during a second phase with sometimes major bleeding in and from the mucous membranes and the skin. Strict barrier precautionary measures are required to prevent secondary and nosocomial spread. CCHF may be documented by PCR detection of the virus genome during the first days after the onset of illness, and then by serological testing for IgM antibodies as from the 2nd week after infection. Patient management is mainly based on supportive care. Despite a few encouraging retrospective reports, there is no confirmed evidence that supports the use of ribavirin for curative treatment. Nevertheless, the World Health Organization continues to recommend the use of ribavirin to treat CCHF, considering the limited medical risk related to short-term treatment. The prescription of ribavirin should however be encouraged post-exposure for medical professionals, to prevent secondary infection.

Lyme borreliosis and other tick-borne diseases. Guidelines from the French Scientific Societies (I): prevention, epidemiology, diagnosis.

Lyme borreliosis is transmitted en France by the tick Ixodes ricinus, endemic in metropolitan France. In the absence of vaccine licensed for use in humans, primary prevention mostly relies on mechanical protection (clothes covering most parts of the body) that may be completed by chemical protection (repulsives). Secondary prevention relies on early detection of ticks after exposure, and mechanical extraction. There is currently no situation in France when prophylactic antibiotics would be recommended. The incidence of Lyme borreliosis in France, estimated through a network of general practitioners (réseau Sentinelles), and nationwide coding system for hospital stays, has not significantly changed between 2009 and 2017, with a mean incidence estimated at 53 cases/100,000 inhabitants/year, leading to 1.3 hospital admission/100,000 inhabitants/year. Other tick-borne diseases are much more seldom in France: tick-borne encephalitis (around 20 cases/year), spotted-fever rickettsiosis (primarily mediterranean spotted fever, around 10 cases/year), tularemia (50-100 cases/year, of which 20% are transmitted by ticks), human granulocytic anaplasmosis (<10 cases/year), and babesiosis (<5 cases/year). The main circumstances of diagnosis for Lyme borreliosis are cutaneous manifestations (primarily erythema migrans, much more rarely borrelial lymphocytoma and atrophic chronic acrodermatitis), neurological (<15% of cases, mostly meningoradiculitis and cranial nerve palsy, especially facial nerve) and rheumatologic (mostly knee monoarthritis, with recurrences). Cardiac and ophtalmologic manifestations are very rarely encountered.

Ticks and tick-borne diseases.

Ticks are a major group of arthropod vectors, characterized by the diversity of pathogens they transmit, by their impact on human and animal health, and by their socioeconomic implication especially in countries of the Southern Hemisphere. In Europe, Ixodes is the most important tick due to its wide distribution in the ecosystems and the variety of transmitted pathogens, in particular Borrelia (responsible for Lyme borreliosis), but also the tick-borne encephalitis virus. Their increased presence in the environment since the beginning of the 20th century is undeniable, because of major modifications in the biodiversity caused by humans. Increasing the awareness of health professionals and the general population is required to achieve better control of these infections. Thus, "a better understanding of these tick-borne diseases for a better control" is a simple but effective approach, considering their ubiquity in the environment and their particular mode of pathogen transmission (long-lasting blood meal for hard ticks and delayed transmission for bacteria and parasites). Finally, these ectoparasites are problematic due to the potential allergic reactions and other damages caused by their saliva, in humans and animals.

Identification of Borrelia bissettii in Ixodes scapularis ticks from New Brunswick, Canada.

Lyme disease is a tick-borne disease that is emerging in Canada. The disease is caused by spirochetes of the Lyme borreliosis group, which is expanding as new species are discovered. In Canada, Lyme disease risk has so far been assessed primarily by detection of Borrelia burgdorferi sensu stricto. Of Ixodes scapularis ticks collected between 2014 and 2016 in New Brunswick, Canada, 7 were shown to be infected with Borrelia bissettii by nested PCR and sequencing of 5 B. bissettii genes. Since different Borrelia species are associated with different clinical manifestations and are not detected with the same diagnostic tests, the identification of a previously undocumented or underreported pathogenic Borrelia species has important implications for public and veterinary medicine.

Misofonia: características clínicas e relato de caso / Misophonia: clinical aspects and case report

RESUMO Misofonia refere-se a uma condição em que há uma forte aversão a certos sons, em resposta aos quais a pessoa relata experiências emocionais desagradáveis e excitação autonômica. O objetivo deste trabalho é apresentar um caso de portadora de misofonia e discutir características diagnósticas. Paciente do sexo feminino, 32 anos, casada. Na anamnese relatou sintomas compatíveis com transtorno obsessivo-compulsivo (TOC), como verificação de portas e janelas, preocupação com ordem e simetria de objetos, ler tudo o que está à frente, colocar a mão duas ou três vezes em móveis da casa, além de tiques faciais e guturais. Também relatou desencadeantes das situações de raiva: intolerância a alguns ruídos e sons, como mastigação de terceiros, teclado de celular, clique no "mouse" do computador, impressora e esfregar as mãos. Na presença desses ruídos, ela tenta se afastar e já atacou fisicamente parentes e colegas de trabalho. Foi tratada com escitalopram e reavaliada depois de quarenta e cinco dias, relatando alívio parcial da misofonia e redução dos sintomas TOC. A condição foi descrita pela primeira vez no início de 2000 por dois audiologistas e tornou-se foco de interesse no campo da psiquiatria. Alguns relatos sugerem que os sintomas misofônicos podem ser parte de outras condições, como síndrome de Tourette, TOC e transtorno de ansiedade generalizada. No caso descrito, a paciente apresentou quadro comórbido de misofonia, TOC e transtorno de tique.

ABSTRACT Misophonia refers to a condition in which there is a strong aversion to certain sounds, in response to it the person reports unpleasant emotional experiences and autonomic arousal. The objective of this paper is to present a case of misophonia carrier and discuss diagnostic features. Female, 32 years old, married. In anamnesis reported obsessive compulsive symptoms such as checking doors and windows, concerned with order and symmetry of objects; read all that lies ahead, pull the hand two or three times on furnitures. Also reported triggering situations of anger: intolerance to some noises and sounds, like chewing third, mobile keyboard, click the "mouse" computer, printer and rub hands. In the presence of these noises, she tries to move away, and already tried to attack physically relatives and coworkers. She was treated with escitalopram and reevaluation after forty five days, reported partial relief misophonia and reduction of obsessional symptoms. The condition was first described in the early 2000s by two audiologists, and has become the focus of interest in the field of psychiatry. Some reports suggest that misophonic symptoms may be part of other conditions such as Tourette's syndrome, obsessive compulsive disorder (OCD) and Generalized Anxiety Disorder. In the case described, the patient presented comorbid condition of Misophonia, OCD and tic disorder.

DNA barcodes identify medically important tick species in Canada.

Medically important ticks (Acari: Ixodidae) are often difficult to identify morphologically. A standardized, molecular approach using a 658 base pair DNA barcode sequence (from the 5' region of the mitochondrial cytochrome c oxidase subunit I gene) was evaluated for its effectiveness in discriminating ticks in North America, with an emphasis on Canadian ticks. DNA barcodes were generated for 96 of 154 specimens representing 26 ixodid species. A genetic cluster analysis was performed on the barcode sequences, which separated specimens into haplogroups closely corresponding with morphologically identified species. The tree topology was further supported by a BIN analysis. COI sequences generated were found to have a mean maximum intraspecific divergence of 1.59% and a mean nearest neighbour divergence of 12.8%, indicating a significant "barcode gap". This study also revealed possible cryptic diversity among specimens morphologically identified as Ixodes soricis and Ixodes texanus. A PCR-based test for Borrelia burgdorferi determined that 18.1% of Lyme-competent ticks in this study were positive. This study is also the first to record a B. burgdorferi-positive exoskeleton. In conclusion, DNA barcoding is a powerful tool that clinicians can use to determine the identification of tick specimens which can help them to suggest whether an attached tick is a potential health risk.

Molecular detection of Crimean-Congo haemorrhagic fever virus in ticks collected from infested livestock populations in a New Endemic Area, South of Iran.

OBJECTIVE: Crimean-Congo haemorrhagic fever (CCHF) is a viral zoonotic disease with potentially fatal systemic effects on man. We aimed to determine the presence of CCHF virus among collected ticks from domestic livestock from October 2012 to September 2013. METHODS: A total of 1245 hard and soft ticks were collected from naturally infested ruminants in Marvdasht County, Fars Province, south of Iran. Nine tick species and one unidentified species in four disparate genera were detected. A total of 200 ticks were randomly selected and analysed by reverse transcription-polymerase chain reaction (RT-PCR) for the presence of CCHF virus genome. RESULTS: The viral genome was detected in 4.5% (9 samples) of the studied tick population. The infected ticks belonged to the species of Hyalomma marginatum' Hyalomma anatolicum and Rhipicephalus sanguineus. The viruses detected in these three tick species were clustered in the same lineage as Matin and SR3 strains in Pakistan and some other Iranian strains. These results indicate that the ticks were wildly infected with a genetically closely related CCHF virus in the region. CONCLUSION: Regular controls and monitoring of livestock to reduce the dispersion of ticks and providing information to those involved in high-risk occupations are urgently required.

Tourette's syndrome in famous musicians / A síndrome de Tourette em músicos famosos

Tourette's syndrome (TS) is defined as a disorder characterized by multiple motor tics and at least one vocal tic that have lasted for not less than one year. It is a relatively complex neurobehavioral disorder, in which patients may present with coexistent attention deficit hyperactivity disorder, obsessive-compulsive disorder or other behavioral comorbidities. The musical genius Wolfgang Amadeus Mozart (1756-1791) and the rock star Kurt Cobain (1967-1994) may both have suffered from TS, and some contemporary musicians have had their clinical condition confirmed as TS. Our hypothetical diagnosis of TS in Mozart and Cobain is based on the presence of tics and psychiatric comorbidities. In contemporary musicians, such as Michael Wolff, Nick Van Bloss and James Durbin, TS has often only been diagnosed after a considerable delay. This delay in diagnosis and the controversies surrounding the clinical case of Mozart show how difficult a confirmatory diagnosis of this complex disease is.

A síndrome de Tourette (TS) é definida como uma desordem caracterizada por múltiplos tiques motores e pelo menos um tique vocal com duração de ao menos um ano. TS é um distúrbio neuro-comportamental relativamente complexo, em que os pacientes teriam coexistente transtorno de déficit de atenção e hiperatividade, transtorno obsessivo-compulsivo, distúrbio de comportamento ou outras co-morbidades. Talvez sejam casos de TS o do gênio musical Wolfgang Amadeus Mozart (1756-1791) e da estrela do rock, Kurt Cobain (1967-1994). Alguns músicos contemporâneos tiveram a sua condição clínica confirmada como TS. Em conclusão, os diagnósticos hipotéticos de TS nos casos de Mozart e Cobain podem ter embasamento na possibilidade de tiques e comorbidades psiquiátricas. Observou-se um atraso de diagnóstico de TS em músicos contemporâneos (Michael Wolff, Nick Van Bloss, James Durbin). Essa situação e as controvérsias sobre a clínica no caso de Mozart mostram a dificuldade para confirmação do diagnóstico dessa complexa doença.

The prevalence of tic disorders in children and adolescents in Brazil / A prevalência dos transtornos dos tiques em crianças e adolescentes no Brasil

Tourette syndrome (TS) and tic disorders represent events of familiar magnitude characterized by involuntary movements and/or vocalization. To determine the prevalence of TS/tic disorders we studied a sample of 762 subjects (388 M, 374 F), between 1992 and 1997, age 6 to 43 years old, taken out of a population of 10,155 subjects (4,918 M, 5,237 F; age: 3-56 years old). A structured 4-item questionnaire, direct interview (multistaged), >1 yr follow-up, were used. 9,565 subjects (4,614 M, 4,951 F) sent back the questionnaires, 3,354 of these (1,671 M, 1,683 F) with positive answers to tics. 42 subjects (31 M, 11 F, age: 7-21 years old, mean: 11 years old) met the DSM-III-R criteria. The total minimal prevalence of TS is 0.43%, with a 3:1 ratio male/female. The minimal prevalence of chronic tic disorder is 2.27%. The total minimal prevalence for tic disorders at all is 2.91%. No special education students participation.

Síndrome de Tourette e transtornos de tiques representam eventos de magnitude familiar caracterizados por movimentos involuntários e/ou vocalização. Para determinar a prevalência de TS/transtornos de tiques, estudamos uma amostra de 762 indivíduos (286 M, 376 F), entre 1992 e 1997, de 6 a 43 anos de idade, retirados de uma população de 10.155 indivíduos (4.918 M, 5.237 F, idade: 3-56 anos). Questionário de avaliação inicial (4 itens), entrevista direta, follow-up >1 ano, foram utilizados. 9.565 indivíduos (4.614 M, 4.951 F) retornaram seus questionários, 3.354 (1.671 M, 1.683 F), com respostas positivas para tiques. 42 sujeitos (idade 31 M, 11 F, 7-21 anos, média: 11 anos) preencheram os critérios diagnósticos do DSM-III-R. A prevalência total mínima para TS é de 0,43% (3 M:1 F), e para transtornos de tiques crônicos é de 2,27%. A prevalência total mínima para transtornos dos tiques é 2,91%. Nenhuma participação de estudantes de classe especial.

Tourette's syndrome and associated disorders: a systematic review / Cruzamento de patologias na síndrome de Tourette: uma revisão sistemática

Objective: To compile data on Tourette's syndrome (TS), tics and associated disorders. Methods: A systematic review of the literature was conducted using the 5S levels of organization of healthcare research evidence (systems, summaries, synopses, syntheses, studies), based on the model described by Haynes. The search keywords were Tourette, tics and comorbidity, which were cross-referenced. Studies provided by publishers and articles being processed on July 31, 2013, were also included. Results: Of all studies retrieved during the search, 64 were selected because they analyzed the epidemiology, clinical features and etiopathogenesis of TS and its comorbidities. TS is classified as a hyperkinetic movement disorder, and at least 90% of the patients have neuropsychiatric comorbidities, of which attention deficit hyperactivity and obsessive-compulsive disorders are the most common. The syndrome is clinically heterogeneous and has been associated with a dysfunction of cortico-striatal-thalamic-cortical circuits involving various neurotransmitters. Although its genetic etiology has been widely studied, other factors may be important to understand this syndrome and its associated disorders. Conclusions: TS is a neurodevelopmental disorder that results from the impact of stress factors on a vulnerable biological substrate during the critical periods of neurodevelopment. The study of TS and its comorbidities may contribute, at different levels, to the understanding of several neuropsychiatric disorders of clinical and therapeutic relevance (AU)

Objetivo: Compilar o conhecimento existente sobre a síndrome de Tourette (ST), tiques e patologias associadas. Metodologia: Foi realizada uma revisão sistemática da literatura usando os níveis 5S (sistemas, sumários, sinopses, sínteses e estudos) de organização de evidência de pesquisa em saúde, com base no modelo proposto por Haynes. Os termos de busca foram Tourette, tiques e comorbidades, completados por pesquisa por referência cruzada. Os artigos fornecidos pelos editores e aqueles a serem processados para publicação em 31 de julho de 2013 também foram incluídos. Resultados: De todos os artigos encontrados durante a pesquisa, 64 foram selecionados porque analisavam a epidemiologia, as características clínicas e a etiopatogenia da ST. A ST define-se como um distúrbio hipercinético do movimento, e pelo menos 90% dos pacientes apresentam comorbidades neuropsiquiátricas, das quais as mais comuns são a perturbação de déficit de atenção com hiperatividade e a perturbação obsessivo- -compulsiva. Esta síndrome é clinicamente heterogênea e tem sido relacionada com a disfunção dos circuitos córtico-estriado- -tálamo-corticais envolvendo vários neurotransmissores. Apesar de sua etiologia genética ter sido amplamente estudada, outros fatores podem ser importantes para entender esta síndrome e as perturbações relacionadas. Conclusões: A ST resulta de uma perturbação do desenvolvimento neurológico causado pelo impacto de fatores de estresse num substrato biológico vulnerável durante os períodos críticos do desenvolvimento neurológico. O estudo da ST e das suas comorbidades poderá contribuir, em diferentes níveis, para o entendimento de várias perturbações neuropsiquiátricas com relevância clínica e terapêutica (AU)

A interação escolar de uma criança com síndrome de Tourette, de acordo com as percepções de pais e professores: um estudo de caso exporatório / Scholar interaction of a child whith Tourette disorder by the perspectiveof parents and educators: case study exploration

A Síndrome de Gilles de La Tourette (ST) pode gerar acentuado sofrimento em diversas áreas da vida do indivíduo. A literatura refere que a criança com ST pode apresentar dificuldades no relacionamento com educadores e colegas. O objetivo deste estudo de caso exploratório visou conhecer e descrever as percepções de pais e educadores sobre aspectos da dinâmica de interação escolar de uma criança com ST, matriculada no ensino fundamental regular. Foram realizadas entrevistas com os pais de uma criança de 8 anos de idade diagnosticada com ST e comtrês educadores. Foram também realizadas sessões de observaçãoparticipante do cotidiano escolar. O conjunto dos relatos revela dúvidas por parte dos entrevistados, no sentido de identificar comportamentos involuntários da criança ou de identificar ações intencionais. Observou-se que ainda não existe articulação entre pais e educadores no atendimento às necessidades da criança. Supõe-se que estratégias de intervenção em perspectiva multiprofissional poderiam contribuir para que pais, educadores e profissionais de saúde atuem de forma articulada, no sentido de promover melhorias na interação escolar e social da criança.

The syndrome of Gilles de la Tourette (ST) can cause marked distress in several areas of functioning. The literature indicates that children with TS may present diffi culties in relationships with teachers and peers. This case study exploration aimed to discover and describe the perceptions of parents and teachers of child with TS enrolled in regular school, regardingthe child-school relationships. Interviews were conducted with parents of a 8 years-old child, diagnosed with ST and three educators. Participant observation of everyday children’s school was also performed. The set of reports reveals doubts on the part of respondents to identify involuntary behaviors of the child orto identify intentional actions. It was observed that there is still no connection between parents and educators in meeting the needs of the child. It is assumed that intervention strategies in a multidisciplinary perspective could help parents, educators and health care professionals act in a coordinated way in order toimprove the school and social interaction of the child.

[Update on SENLAT syndrome: scalp eschar and neck lymph adenopathy after a tick bite]. / Les nouveautés sur le syndrome SENLAT : Scalp Eschar and Neck LymphAdenopathy after Tick bite.

SENLAT syndrome, also known as TIBOLA/DEBONEL, is an emerging disease in France. The major symptoms are necrotic eschar on the scalp associated with painful cervical lymphadenopathy. It occurs mainly in women and children during the cold seasons after a bite by a Dermacentor tick, responsible for transmitting Rickettsia slovaca or Rickettsia raoultii. Cutaneous swabs are safe, easy and reliable tools that should be used routinely by physicians to confirm diagnosis. In this particular disease, they should be preferred to serology, which is less sensitive. Doxycycline is the antibiotic of choice for this syndrome.