Yang Rongwang, Li Rong, Gao Weijia, Zhao Zhengyan
Department of Child Psychology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
J Dev Behav Pediatr. 2017 Feb/Mar;38(2):151-154. doi: 10.1097/DBP.0000000000000371.
Patients with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for tic disorders. Atomoxetine (ATX) has been accepted as an alternative medication for patients with ADHD and a comorbid tic disorder. It is rarely reported that tic symptoms are induced by ATX.
This present report described a boy with ADHD who developed tic symptoms during ATX initiation. We used an ABAB trial to confirm the tics were related to ATX administration. In addition, we reviewed the published literature of patients whose tic symptoms were confirmed or suspected of relating to ATX usage.
This present case with an ABAB design showed on-off control of tics with or without ATX, which allowed us to make a strong conclusion that the tics were related to ATX administration. Literature review also indicated that ATX might induce tic symptoms in children with ADHD, especially in those being boys and having a history of tics. The time from starting ATX to tics symptoms appearing was approximately 19 days. The most common tic symptoms were eye blinking, vocal tics, or throat clearing, and neck movements. These tics symptoms in most cases could be resolved after discontinuing ATX without further pharmacotherapy.
Pediatricians and child psychiatrists should be well aware of this potential adverse effect in children with ADHD receiving ATX.
注意缺陷多动障碍（ADHD）患者患抽动障碍的风险增加。托莫西汀（ATX）已被公认为患有ADHD合并抽动障碍患者的替代药物。很少有报道称ATX会诱发抽动症状。
本报告描述了一名患有ADHD的男孩，在开始使用ATX期间出现了抽动症状。我们采用ABAB试验来证实抽动与ATX给药有关。此外，我们回顾了已发表的关于抽动症状被证实或怀疑与使用ATX有关的患者的文献。
本病例采用ABAB设计，显示了在使用或不使用ATX情况下抽动的开关控制，这使我们能够得出强有力的结论，即抽动与ATX给药有关。文献综述还表明，ATX可能会在患有ADHD的儿童中诱发抽动症状，尤其是在男孩以及有抽动病史的儿童中。从开始使用ATX到出现抽动症状的时间约为19天。最常见的抽动症状是眨眼、发声性抽动、清嗓或颈部运动。在大多数情况下，停用ATX后这些抽动症状无需进一步药物治疗即可缓解。
儿科医生和儿童精神科医生应充分认识到接受ATX治疗的ADHD儿童存在这种潜在的不良反应。
