Summary
Definition
History and exam
Key diagnostic factors
- observed tics
- premonitory sensation
- ability to suppress tics
- symptoms may improve when distracted
- otherwise normal neurologic exam
Other diagnostic factors
- symptoms worse with stress, anxiety, excitement, or transitions
- variable severity over time
- symptoms of comorbid psychiatric disorder
Risk factors
- onset at age <18 years
- male sex
- family history of tics
- family history of obsessive-compulsive disorder (OCD), ADHD, or depression
- prenatal maternal smoking
- history of OCD or ADHD
- history of autism spectrum disorder (ASD)
Diagnostic investigations
1st investigations to order
- clinical diagnosis
Investigations to consider
- MRI brain with and without contrast
- electroencephalogram
- cerebrospinal fluid analysis (lumbar puncture)
Treatment algorithm
symptoms not interfering with activities of daily living
symptoms interfering with activities of daily living: nonpregnant
severe tics refractory to behavioral and pharmacologic therapies
symptoms interfering with activities of daily living: pregnant
Contributors
Authors
Tamara Pringsheim, MD, FRCPC
Professor
University of Calgary
Department of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences
Calgary
Canada
გაფრთხილება:
TP has received research grants for Tourette syndrome from Alberta Health and the Alberta Children's Hospital Research Institute. TP is an author of several references cited in this topic.
მადლიერება
Professor Tamara Pringsheim would like to gratefully acknowledge Dr Tanya K. Murphy, Dr Fatima Masumova, Dr Cathy L. Budman, Dr Amber Stocco, Dr Migvis Monduy, and Dr Bobbi Hopkins, previous contributors to this topic.
გაფრთხილება:
FM, AS, MM, and BH declare that they have no competing interests. TKM has received research grants from Auspex Pharmaceuticals, the National Institute of Mental Health, Shire Pharmaceuticals, Pfizer Inc., F. Hoffman-La Roche Ltd., AstraZeneca Pharmaceuticals, Centers for Disease Control and Prevention, Massachusetts General Hospital, Sunovion Pharmaceuticals, Neurocrine Bioscience, Psyadon Pharmaceuticals, and PANDAS Network; she is on the advisory board for the International Obsessive Compulsive Foundation; she is also an author of several references cited in this topic. CLB has received research funding from Otsuka, Psyadon, Auspex, Teva, Neurocrine, and Synchroneuron Pharmaceuticals; she is a consultant for Bracket and a paid speaker for the Centers for Disease Control and Prevention (CDC) - National Tourette Syndrome Association Partnership; she is an author of several references cited in this topic.
რეცენზენტები
Francis Filloux, MD
Chief
Division of Pediatric Neurology
University of Utah School of Medicine
Salt Lake City
UT
გაფრთხილება:
FF declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
წყაროები
ძირითადი სტატიები
Murphy TK, Lewin AB, Storch EA, et al. Practice parameter for the assessment and treatment of children and adolescents with tic disorders. J Am Acad Child Adolesc Psychiatry. 2013 Dec;52(12):1341-59.სრული ტექსტი აბსტრაქტი
Plessen KJ, Bansal R, Peterson BS. Imaging evidence for anatomical disturbances and neuroplastic compensation in persons with Tourette syndrome. J Psychosom Res. 2009 Dec;67(6):559-73.სრული ტექსტი აბსტრაქტი
Pringsheim T, Okun MS, Müller-Vahl K, et al. Practice guideline recommendations summary: treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology. 2019 May 7;92(19):896-906.სრული ტექსტი აბსტრაქტი
Pringsheim T, Holler-Managan Y, Okun MS, et al. Comprehensive systematic review summary: treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology. 2019 May 7;92(19):907-15.სრული ტექსტი აბსტრაქტი
Kuo SH, Jimenez-Shahed J. Topiramate in treatment of Tourette syndrome. Clin Neuropharmacol. 2010 Jan-Feb;33(1):32-4. აბსტრაქტი
Bloch MH, Panza KE, Landeros-Weisenberger A, et al. Meta-analysis: treatment of attention-deficit/hyperactivity disorder in children with comorbid tic disorders. J Am Acad Child Adolesc Psychiatry. 2009 Sep;48(9):884-93.სრული ტექსტი აბსტრაქტი
გამოყენებული სტატიები
ამ თემაში მოხსენიებული წყაროების სრული სია ხელმისაწვდომია მომხმარებლებისთვის, რომლებსაც აქვთ წვდომა BMJ Best Practice-ის ყველა ნაწილზე.
დიფერენციული დიაგნოზები
- Functional tic-like behaviors
- Obsessive-compulsive disorder (OCD)
- Stereotypies
მეტი დიფერენციული დიაგნოზებიგაიდლაინები
- Diagnosing tic disorders
- Treatment of tics in people with Tourette syndrome and chronic tic disorders
მეტი გაიდლაინებიპაციენტის ბროშურები
ADHD: what is it?
ADHD in children: what treatments work?
მეტი პაციენტის ბროშურებიშედით სისტემაში ან გამოიწერეთ BMJ Best Practice
ამ მასალის გამოყენება ექვემდებარება ჩვენს განცხადებას