Efficacy of Behavioural Intervention, Antipsychotics, and Alpha Agonists in the Treatment of Tics Disorder in Tourette’s Syndrome

Abstract

Tourette's Syndrome (TS), in which patients have sudden, repeated, involuntary twitches and movements, called tics, is a condition of the nervous system. They can be motor, vocal, simple, or complex tics. It can be physically, emotionally, mentally, and socially distressing and challenging for those suffering from it. Usually, it is accompanied by various comorbidities like attention-deficit hyperactivity disorder, obsessivecompulsive disorder, and sleep disorders. A variety of environmental and genetic factors are also associated with tics in TS like the first-degree relatives are more at risk of developing TS.TS is heterogeneous with complicated patterns of inheritance and phenotypic manifestations. There is a strong association between common single nucleotide polymorphisms (SNP, s) in the SLITRK1 gene and TS. Environmental factors like prenatal, postnatal, and perinatal factors directly influence tics in TS. These factors are low birth weight, intrauterine growth retardation (IGR), and various infections. The treatment of TS can be broadly classified into non-pharmacological and pharmacological treatment. Non-pharmacological therapy includes various behavioural interventions that can be helpful in situations when patients are tolerant of medical treatments. Psychoeducation and counselling play an essential role in the treatment of TS. It is vital to give a proper understanding to the patient and their family about the disease. Cognitive-behavioral intervention for tics, cognitive-behavioral therapy, exposure and response prevention, relaxation techniques, deep brain stimulation, and habit reversal training are the commonly used therapies for tics. These therapies have shown good efficacy because it improves the Yale Global Tic Severity Scale score (YGTSS) significantly. And they show effectiveness in patients who are irresponsive to medical treatment. The main lines of medical treatment are antipsychotics and alpha agonists. Typical (haloperidol, pimozide) or atypical (aripiprazole, risperidone, olanzapine) Antipsychotics differ in their side effects, efficacy, and tolerance in different age groups of children. Haloperidol was the first drug approved by the Food and Drug Administration for tics, but later on, new developments and improvements were made as far as drug therapy is concerned. The alphaagonist most commonly used is clonidine which is also available in the form of adhesive patches. Another alpha agonist which is also widely used is guanfacine. Botulinum toxin and baclofen have also shown efficacy in dealing with tics in TS with other comorbidities. We will review in this article all the main lines of treatment and their effectiveness in TS.

Trends of Tourette Syndrome in children from 2011 to 2021: A bibliometric analysis

“…In 2021, the European Society for the Study of Tourette Syndrome (ESSTS) published online the latest European guidelines for TS in the European Journal of Child and Adolescent Psychiatry , which pointed out that when the curative effect of behavioral therapy is poor or ineffective or unavailable, additional pharmacological treatment should be considered ( Rizwan et al, 2022 ), including antipsychotics, α-agonists, botulinum toxin injections, cannabis-based medications, antiseizure medications, and traditional Chinese medicines ( Pringsheim et al, 2019b ). The ESSTS recommended aripiprazole, tiapride, and risperidone for TS, in which aripiprazole was considered to be the first choice for children and adults ( Roessner et al, 2022 ).…”

Evidence-Based Interventions for Tourette Syndrome: An Updated Review of Pharmacological, Behavioral and Non-Pharmacological Therapies

“…With regard to self-regulation, behavioral therapy emerges as the standard treatment for tics, with emphasis on habit reversal therapy, widely adopted in patients (RIZWAN M. et al, 2022). Although the complete understanding of the neurophysiology of this approach still requires further studies (EAPEN V. et al, 2022), it is known that the mechanism of action involves, initially, training the patient to recognize the tic and, subsequently, to associate it with a competitive response, preventing the occurrence of involuntary movement.…”

“…Recent studies converge to the recommendation of behavioral therapy as the first-line non-pharmacological treatment, both for its effectiveness and the advantage over pharmacological treatment, especially with regard to side effects. In addition to habit reversal therapy, other strategies can be adopted, such as exposure and response prevention, in which patients are instructed to tolerate premonitory impulses for a prolonged period, with the aim of reducing tics (RIZWAN M. et al, 2022), and psychoeducation, which still lacks robust evidence regarding its implementation method (ANDRÉN P. et al, 2021). It is important, however, that the physician takes into account the individuality of each case and thus chooses the best course of action within current possibilities.…”

Trends of Tourette Syndrome in children From 2011 to 2021: A Bibliometric Analysis

“…In 2021, the European Society for the of Tourette Syndrome (ESSTS) published online the latest European guidelines for TS in the European Journal of Child and Adolescent Psychiatry, which pointed out that when the curative effect of behavioral therapy is poor or ineffective or unavailable, additional pharmacological treatment should be considered (41), including antipsychotics, α-agonists, botulinum toxin injections, cannabis-based medications, antiseizure medications, and traditional Chinese medicines (38). The ESSTS recommended aripiprazole, tiapride, and risperidone for TS, in which aripiprazole was considered to be the rst choice for children and adults (42).…”