Martino Davide, Mink Jonathan W
Continuum (Minneap Minn). 2013 Oct;19(5 Movement Disorders):1287-311. doi: 10.1212/01.CON.0000436157.31662.af.
Primary tic disorders are complex, multifactorial disorders in which tics are accompanied by other sensory features and an array of comorbid behavioral disorders. Secondary tics are proportionally much less frequent, but their etiology is diverse. This review aims to guide clinicians in the recognition of the phenomenology, pathophysiology, and treatment of these disorders.
Advances include greater phenomenologic insights, particularly of nonmotor (sensory) features; increased knowledge of disease mechanisms, particularly coming from neuropsychological, functional imaging, pathologic, and animal model studies; growing evidence on the efficacy of alpha-2 agonists and the newer generation of dopamine-modulating agents; and recent strides in the evaluation of cognitive-behavioral therapy and deep brain stimulation surgery.
The correct diagnostic approach to tic disorders requires accurate historical gathering, a thorough neurologic examination, and detailed definition of the patient's psychopathologic profile. Treatment should always begin with individualized psychoeducational strategies. Although pharmacologic treatments remain beneficial for most patients, cognitive-behavioral treatments have thus far shown promising efficacy. Deep brain stimulation surgery should still be limited to adult patients refractory to pharmacotherapy and cognitive-behavioral therapy.
原发性抽动障碍是复杂的多因素疾病，其中抽动伴有其他感觉特征和一系列共病行为障碍。继发性抽动的发生率相对低得多，但其病因多种多样。本综述旨在指导临床医生认识这些疾病的现象学、病理生理学及治疗方法。
进展包括对现象学有了更深入的认识，尤其是对非运动（感觉）特征的认识；对疾病机制的了解有所增加，特别是来自神经心理学、功能成像、病理学和动物模型研究的知识；越来越多的证据表明α-2激动剂和新一代多巴胺调节药物的疗效；以及在认知行为疗法和脑深部刺激手术评估方面的最新进展。
抽动障碍的正确诊断方法需要准确收集病史、进行全面的神经系统检查，并详细界定患者的精神病理特征。治疗应始终从个体化的心理教育策略开始。虽然药物治疗对大多数患者仍然有益，但认知行为治疗迄今为止已显示出有前景的疗效。脑深部刺激手术仍应限于对药物治疗和认知行为治疗无效的成年患者。
