Poulopoulos Markos, Hajjar Mirna
Department of Neurology, University of Vermont, Bangor, Maine, USA.
BMJ Case Rep. 2013 Dec 5;2013:bcr2013201676. doi: 10.1136/bcr-2013-201676.
Traumatic head injury is a very rare cause of secondary tic disorders. We add another case by describing, for the first time, the response to tetrabenazine in a blinded video assessment. Our patient had a severe traumatic head injury and subsequently developed tics refractory to various agents including neuroleptics. We assessed tetrabenazine treatment by virtue of patient's impression, the treating neurologist's non-blinded (Yale Global Tic Severity Scale) and a second neurologist's blinded assessment (modified Rush Video Scale). The Yale Global Tic Severity Score improved by 24% on 12.5 mg twice daily and 45% on 12.5 mg thrice daily. Subjective improvement was 50% and 70%, respectively. The modified Rush Video scores improved by 21% and 28.5%, respectively. Post-traumatic tourettism can respond to tetrabenazine. The magnitude of benefit though, may be overestimated with open-label observations, thus there is a need for studies examining objectively the effect of tetrabenazine in tic disorders.
创伤性头部损伤是继发性抽动障碍非常罕见的病因。我们首次通过在盲法视频评估中描述对丁苯那嗪的反应，增加了另一例病例。我们的患者曾遭受严重创伤性头部损伤，随后出现对包括抗精神病药物在内的多种药物难治的抽动。我们通过患者的感受、主治神经科医生的非盲法评估（耶鲁全球抽动严重程度量表）以及另一位神经科医生的盲法评估（改良拉什视频量表）来评估丁苯那嗪的治疗效果。耶鲁全球抽动严重程度评分在每日两次服用12.5毫克时提高了24%，在每日三次服用12.5毫克时提高了45%。主观改善分别为50%和70%。改良拉什视频评分分别提高了21%和28.5%。创伤后抽动秽语综合征对丁苯那嗪有反应。不过，开放标签观察可能会高估获益程度，因此需要开展研究客观地考察丁苯那嗪在抽动障碍中的作用。
