Black Kevin J, Black Elizabeth Rose, Greene Deanna J, Schlaggar Bradley L
Departments of Psychiatry, Washington University School of Medicine, St. Louis, USA; Departments of Neurology, Washington University School of Medicine, St. Louis, USA; Departments of Radiology, Washington University School of Medicine, St. Louis, USA; Departments of Neuroscience, Washington University School of Medicine, St. Louis, USA.
Brigham Young University, Utah, USA.
F1000Res. 2016 Apr 18;5:696. doi: 10.12688/f1000research.8428.1. eCollection 2016.
The child with recent onset of tics is a common patient in a pediatrics or child neurology practice. If the child's first tic was less than a year in the past, the diagnosis is usually Provisional Tic Disorder (PTD). Published reviews by experts reveal substantial consensus on prognosis in this situation: the tics will almost always disappear in a few months, having remained mild while they lasted. Surprisingly, however, the sparse existing data may not support these opinions. PTD may have just as much importance for science as for clinical care. It provides an opportunity to prospectively observe the spontaneous remission of tics. Such prospective studies may aid identification of genes or biomarkers specifically associated with remission rather than onset of tics. A better understanding of tic remission may also suggest novel treatment strategies for Tourette syndrome, or may lead to secondary prevention of tic disorders. This review summarizes the limited existing data on the epidemiology, phenomenology, and outcome of PTD, highlights areas in which prospective study is sorely needed, and proposes that tic disorders may completely remit much less often than is generally believed.
近期出现抽动症状的儿童是儿科或儿童神经科门诊常见的患者。如果儿童的首次抽动症状出现在过去不到一年的时间里，通常诊断为暂时性抽动障碍（PTD）。专家发表的综述显示，在这种情况下，对于预后存在相当大的共识：抽动症状几乎总是会在几个月内消失，在持续期间症状一直较轻。然而，令人惊讶的是，现有的少量数据可能并不支持这些观点。PTD对科学和临床护理可能同样重要。它为前瞻性观察抽动症状的自发缓解提供了机会。此类前瞻性研究可能有助于识别与抽动症状缓解而非发作特别相关的基因或生物标志物。对抽动症状缓解的更好理解也可能提示针对妥瑞氏症的新治疗策略，或者可能导致抽动障碍的二级预防。本综述总结了关于PTD的流行病学、现象学和结局的现有有限数据，强调了迫切需要进行前瞻性研究的领域，并提出抽动障碍完全缓解的情况可能比普遍认为的要少得多。
