Bernard Bryan A, Stebbins Glenn T, Siegel Sandra, Schultz Theresa M, Hays Cynthia, Morrissey Mary J, Leurgans Sue, Goetz Christopher G
Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois 60612, USA.
Mov Disord. 2009 May 15;24(7):1070-3. doi: 10.1002/mds.22487.
The objective of this study is to assess the association between tic severity, attention deficit disorder, obsessive-compulsive behavior, and quality of life (QOL) in children with Gilles de la Tourette syndrome (GTS). GTS is a multidimensional disorder with disturbances in motor function and behavior. However, little is known about what variables are associated with QOL in these patients. We evaluated 56 outpatients with a diagnosis of GTS. The mean age was 10 (range 5-17 years). Tics were assessed with the Yale Global Tic Severity Scale (YGTSS). Behavioral scales included the Leyton Obsessional Inventory-Child Version, Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and Attention-Deficit/Hyperactivity Disorder (ADHD) rating scale. The patient's parent also completed the TNO-AZL Children's Quality of Life scale (TACQOL). YGTSS scores ranged from 4 to 30, indicating mild to moderate tic severity. Motor and phonic tic ratings were not correlated with QOL. However, both ADHD and OCD were significantly related to QOL. Subanalysis of ADHD subtypes demonstrated that inattentiveness but not hyperactivity predicted lower QOL. When ADHD, Leyton OCD, and tic severity were considered simultaneously, tic severity remained non-significant, while both ADHD and OCD remained significant contributors to QOL. In summary, in patients with mild to moderate GTS, QOL relates primarily to co-morbidities of ADHD and obsessive-compulsive behavior. ADHD with predominantly inattentive symptoms, rather than hyperactivity symptoms, was associated with lower QOL. To improve QOL, clinicians must consider treatments of co-morbidities among tic patients.
本研究的目的是评估患有抽动秽语综合征（GTS）的儿童的抽动严重程度、注意力缺陷障碍、强迫行为和生活质量（QOL）之间的关联。GTS是一种具有运动功能和行为障碍的多维度疾病。然而，对于这些患者中哪些变量与生活质量相关，人们知之甚少。我们评估了56名诊断为GTS的门诊患者。平均年龄为10岁（范围为5 - 17岁）。使用耶鲁全球抽动严重程度量表（YGTSS）评估抽动情况。行为量表包括莱顿强迫观念量表 - 儿童版、儿童耶鲁 - 布朗强迫量表（CY - BOCS）和注意力缺陷/多动障碍（ADHD）评定量表。患者的家长还完成了TNO - AZL儿童生活质量量表（TACQOL）。YGTSS评分范围为4至30，表明抽动严重程度为轻度至中度。运动性和发声性抽动评分与生活质量无关。然而，ADHD和OCD均与生活质量显著相关。ADHD亚型的亚分析表明，注意力不集中而非多动预示着较低的生活质量。当同时考虑ADHD、莱顿OCD和抽动严重程度时，抽动严重程度仍无显著意义，而ADHD和OCD仍然是生活质量的重要影响因素。总之，在轻度至中度GTS患者中，生活质量主要与ADHD和强迫行为的共病有关。以注意力不集中症状为主而非多动症状的ADHD与较低的生活质量相关。为了提高生活质量，临床医生必须考虑抽动患者共病的治疗。
