Treatment of tics associated with Tourette syndrome

Jankovic, Joseph

doi:10.1007/s00702-019-02105-w

Cited by 39 publications

(37 citation statements)

References 62 publications

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“…There is some emerging evidence for use in severe dyskinetic movement exacerbations observed in patients with GNAO1-related movement disorders, 94 in tardive dyskinesia 95 and in status dystonicus in general. 96,97 Tetrabenazine or deutetrabenazine are also used in Tourette's syndrome, 98,99 particularly in adults, although in our experience these are less well tolerated compared to the neuroleptics.…”

Section: Dopaminergic Therapiesmentioning

confidence: 77%

Current therapies and therapeutic decision making for childhood‐onset movement disorders

2019

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Movement disorders differ in children to adults. First, neurodevelopmental movement disorders such as tics and stereotypies are more prevalent than parkinsonism, and second, there is a genomic revolution which is now explaining many early‐onset dystonic syndromes. We outline an approach to children with movement disorders starting with defining the movement phenomenology, determining the level of functional impairment due to abnormal movements, and screening for comorbid psychiatric conditions and cognitive impairments which often contribute more to disability than the movements themselves. The rapid improvement in our understanding of the etiology of movement disorders has resulted in an increasing focus on precision medicine, targeting treatable conditions and defining modifiable disease processes. We profile some of the key disease‐modifying therapies in metabolic, neurotransmitter, inflammatory, and autoimmune conditions and the increasing focus on gene or cellular therapies. When no disease‐modifying therapies are possible, symptomatic therapies are often all that is available. These classically target dopaminergic, cholinergic, alpha‐adrenergic, or GABAergic neurochemistry. Increasing interest in neuromodulation has highlighted that some clinical syndromes respond better to DBS, and further highlights the importance of “disease‐specific” therapies with a future focus on individualized therapies according to the genomic findings or disease pathways that are disrupted. We summarize some pragmatic applications of symptomatic therapies, neuromodulation techniques, and some rehabilitative interventions and provide a contemporary overview of treatment in childhood‐onset movement disorders. © 2019 International Parkinson and Movement Disorder Society

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Section: Dopaminergic Therapiesmentioning

confidence: 77%

Current therapies and therapeutic decision making for childhood‐onset movement disorders

2019

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“…In recent years, DBS has been considered a last resort treatment option for severe TS resistant to medical and behavioral therapy (2). There is currently no consensus on the optimal brain target for tics treatment; however, our studies indicated that targeting the anteromedial globus pallidus (am GPi) or thalamic centromedian-parafascicular (CM-Pf) are more likely to reduce tic severity (101).…”

Section: Tele-programming Dbsmentioning

confidence: 82%

“…Although some tics may be mild, others can result in significant psychosocial, physical, and functional difficulties that impair social activities, academic achievements, and employment performance. Additionally, up to 90% of patients with TS exhibit one or more comorbidities, including attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), sleep disorders, and other behavioral and psychosocial problems (2). These comorbid conditions cause many patients with TS to suffer from varying degrees of additional functional impairment across multiple domains.…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary Telemedicine Care for Tourette Syndrome: Minireview

Cen

Wang

et al. 2020

Front. Neurol.

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Tourette syndrome (TS) is a childhood-onset, chronic neuropsychiatric disorder characterized by multiple motor and vocal tics. TS poses a considerable burden on both patients and health care providers, leading to a major detriment of educational success, occupation, and interpersonal relationships. A multidisciplinary, specialist-driven management approach is required due to the complexity of TS. However, access to such specialty care is often dramatically limited by the patients' locations and the specialists' geographic clustering in large urban centers. Telemedicine uses electronic information and communication technology to provide and support health care when distance separates participants. Therefore, we conducted this mini-review to describe the latest information on telemedicine in the assessment and management of TS and discuss the potential contributions to care for TS patients with a multidisciplinary approach. We believe that telemedicine could be a revolutionary method in improving medical access to patients with TS.

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“…27,28 To date, results of studies of vesicular monoamine transporter-2 inhibitors for tic suppression have been mixed. 29,30 The results of this study, although undertaken in both neurology and psychiatry clinics where children with TS plus common comorbidities are treated, should be interpreted with caution. 31 Specifically, not all families of children or adolescents with severe tics or comorbid symptoms may be willing to participate in a study involving placebo and periods of washout or no treatment.…”

Section: Discussionmentioning

confidence: 95%