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: 1.94). 08/2003; 5(4):299-308.
Source: PubMed


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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    ABSTRACT: Tic disorders are heterogeneous, with symptoms varying widely both within and across patients. Exploration of symptom clusters may aid in the identification of symptom dimensions of empirical and treatment import. This article presents the results of two studies investigating tic symptom clusters using a sample of 99 youth (M age = 10.7, 81% male, 77% Caucasian) diagnosed with a primary tic disorder (Tourette's disorder or chronic tic disorder), across two university-based outpatient clinics specializing in tic and related disorders. In Study 1, a cluster analysis of the Yale Global Tic Severity Scale (YGTSS) identified four symptom dimensions: predominantly complex tics; simple head/face tics; simple body tics; and simple vocal/facial tics. In Study 2, these clusters were shown to be differentially associated with demographic and clinical characteristics. Findings lend support to prior research on tic phenomenology, help to organize treatment goals, and suggest symptom dimensions of tic disorders for further evaluation.
    Full-text · Article · Apr 2010 · Journal of Abnormal Child Psychology
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    ABSTRACT: Objective: This is a practical review of Tourette syndrome, including phenomenology, natural history, and state-of-the-art assessment and treatment. Method: Computerized literature searches were conducted under the keywords Tourette syndrome,tics, and children-adolescents. Results: Studies have documented the natural history of Tourette syndrome and its frequent co-occurrence with attention problems, obsessive-compulsive disorder (OCD), and a range of other mood and anxiety disorders, which are often of primary concern to patients and their families. Proper diagnosis and education are often very helpful for patients, parents, siblings, teachers, and peers. When necessary, available anti-tic treatments have proven efficacious. First-line options include the alpha adrenergic agents and the atypical neuroleptics, as well as behavioral interventions such as habit reversal. Conclusions: The study of tics and Tourette symdrome has led to the development of several pathophysiological models and helped in the development of management options. However, fully explanatory models are still needed that would allow for accurate prognostication in the course of illness and the development of improved treatments.
    Full-text · Article · Jul 2005 · Psychiatry
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    ABSTRACT: This is a review of progress made in the understanding of Tourette syndrome (TS) during the past decade including models of pathogenesis, state-of-the-art assessment techniques, and treatment. Computerized literature searches were conducted under the key words "Tourette syndrome," "Tourette disorder," and "tics." Only references from 1996-2006 were included. Studies have documented the natural history of TS and the finding that tics usually improve by the end of the second decade of life. It has also become clear that TS frequently co-occurs with attention-deficit/hyperactivity disorder), obsessive-compulsive disorder, and a range of other mood and anxiety disorders. These comorbid conditions are often the major source of impairment for the affected child. Advances have also been made in understanding the underlying neurobiology of TS using in vivo neuroimaging and neurophysiology techniques. Progress on the genetic front has been less rapid. Proper diagnosis and education (involving the affected child and his or her parents, teachers, and peers) are essential prerequisites to the successful management of children with TS. When necessary, modestly effective antitic medications are available, although intervening to treat the comorbid attention-deficit/hyperactivity disorder and/or obsessive-compulsive disorder is usually the place to start. Prospective longitudinal studies and randomized clinical trials have led to the refinement of several models of pathogenesis and advanced our evidence base regarding treatment options. However, fully explanatory models are needed that would allow for more accurate prognosis and the development of targeted and efficacious treatments.
    Full-text · Article · Sep 2007 · Journal of the American Academy of Child & Adolescent Psychiatry
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