Article

Tourette's Syndrome in Children.

Yale University School of Medicine, Child Study Center, PO Box 207900, New Haven, CT 06520, USA.
Current Treatment Options in Neurology (Impact Factor: 2.18). 08/2003; 5(4):299-308.
Source: PubMed

ABSTRACT This paper will provide a review of the Tourette's syndrome (TS) in children, focusing on treatment options, including a drug-by-drug evaluation of available pharmacologic agents and other treatments. Despite increasing knowledge of the neurophysiologic basis of the tics of TS, ideal and universally effective treatments do not yet exist. Affected children may present a wide variety of phenotypes, which are best managed in a case-by-case manner, with the well-informed patient and family weighing the risks and benefits of interventions together with a knowledgeable and committed clinician. The clinician treating TS will encounter a wide range of tic severity, comorbidity, adherence to treatment, and treatment response. The clinician's most important task is to identify the main sources of distress and impairment, and set priorities for their management. Common treatment may involve education and reassurance, psychosocial and school interventions, and choices from an array of pharmacologic agents. Decisions regarding treatment ought to be made collaboratively with the clinician and family, after a careful discussion of symptom extent and severity, psychosocial impact, desired outcome, and realistic treatment expectations and side effects. Given the waxing and waning course of tics in TS, clinicians often monitor each patient for several weeks before starting a somatic treatment, based on a judgement that even when tics are at their best, they are severe enough to warrant pharmacotherapy. With children for whom the decision has been taken to target tics with medication, the authors recommend beginning with guanfacine or clonidine, especially when there are any hyperactivity symptoms. The next choice would be a low-dose neuroleptic. Patience and close ongoing monitoring of efficacy and side effects is necessary, whenever a clinical trial of medications is undertaken, to achieve an acceptable balance between tic control and side effects. Treatments should be targeted at specific symptoms and comorbidities, such as attention deficit hyperactivity disorder and obsessive-compulsive disorder. Clinicians tend to treat comorbid conditions first because they may be the greatest sources of difficulty. On occasion, the successful treatment of a comorbid condition will lead to an amelioration of tics.

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    • "important period in which to better understand and treat tic disorders. As tic disorders are no longer viewed as unitary conditions (Robertson et al. 2008) and a reliance on global symptom counts as an indicator of severity may misrepresent the diagnoses (Storch et al. 2007), numerous authors have attempted to organize the multifaceted nature of tic phenomenology along meaningful dimensions by drawing on clinical observations and growing empirical data (e.g., Freeman et al. 2000; Jagger et al. 1982; Kuperman 2002; Leckman et al. 1999; Swain and Leckman 2003). Four studies have used cluster analysis, some with subsequent factor analysis, to investigate relative associations among the symptoms of Tourette's disorder, with the notion that, across patients, symptoms classified in a particular cluster co-occur more often with one another than with variables classified in other clusters (Alsobrook and Pauls 2002; Mathews et al. 2007; Robertson and Cavanna 2007; Robertson et al. 2008). "
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