Pringsheim Tamara, Davenport William Jeptha, Lang Anthony
Neurology Program, University of Toronto, Toronto, Ontario M5T 2S8, Canada.
Curr Opin Neurol. 2003 Aug;16(4):523-7. doi: 10.1097/01.wco.0000084232.82329.47.
This paper reviews the recent literature concerning Tourette syndrome and related disorders.
Tourette syndrome is a common disorder in children and adolescents, with an established association with attention deficit hyperactivity disorder, obsessive compulsive disorder, and a number of other psychiatric disorders. Both autoimmune and genetic mechanisms are implicated in the pathophysiology of the syndrome, while neuroimaging studies have identified abnormalities in the composition of the basal ganglia and frontal lobe white matter, as well as alterations in dopaminergic activity. When necessary, treatment of tics can be successful with neuroleptics and alpha-2-adrenergic agonists. The use of stimulants in children with Tourette syndrome and comorbid attention deficit hyperactivity disorder does not appear to worsen tics.
As a result of the recent literature, clinicians can feel comfortable treating children with co-morbid attention deficit hyperactivity disorder and Tourette syndrome with stimulant medications. It has also been established that transient tics are very common in children, and for the most part, non-disabling. In those children with persistent tics, behavioural disorders are associated which may impair success in school and psychosocial functioning. Clinicians have a number of therapeutic options, with recent double-blinded randomized trials of clonidine, risperidone, and desipramine showing benefit. Scientists continue to search for the cause of Tourette syndrome.
本文综述了近期有关抽动秽语综合征及相关疾病的文献。
抽动秽语综合征是儿童和青少年中的常见疾病，与注意力缺陷多动障碍、强迫症及其他多种精神疾病存在既定关联。自身免疫机制和遗传机制均与该综合征的病理生理学有关，而神经影像学研究已确定基底神经节和额叶白质的组成存在异常，以及多巴胺能活动发生改变。必要时，使用抗精神病药物和α-2-肾上腺素能激动剂治疗抽动可取得成功。在患有抽动秽语综合征和共病注意力缺陷多动障碍的儿童中使用兴奋剂似乎不会使抽动加重。
鉴于近期的文献，临床医生在使用兴奋剂药物治疗患有共病注意力缺陷多动障碍和抽动秽语综合征的儿童时可以放心。还已确定短暂性抽动在儿童中非常常见，并且在大多数情况下不会造成功能障碍。在那些患有持续性抽动的儿童中，会伴有行为障碍，这可能会影响学业成绩和心理社会功能。临床医生有多种治疗选择，近期可乐定、利培酮和地昔帕明的双盲随机试验显示出疗效。科学家们继续寻找抽动秽语综合征的病因。
