Martino Davide, Ganos Christos, Pringsheim Tamara M
University of Calgary, Calgary, AB, Canada.
University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Int Rev Neurobiol. 2017;134:1461-1490. doi: 10.1016/bs.irn.2017.05.006. Epub 2017 Jun 9.
The clinical surveillance and active management of Tourette syndrome (TS) and other primary chronic tic disorders cannot be limited to tics, as these patients manifest a spectrum of sensory-, behavioral-, cognitive-, and sleep-related problems that have a major impact on their functioning and quality of life, influencing enormously clinical decision making on a routine basis. The sensory phenomena of primary tic disorders consist of premonitory urges and heightened sensitivity to external somatosensory and interoceptive stimuli. Recent evidence suggests that raised interoceptive awareness may be related to the classical premonitory urges associated with tics. The burden of behavioral comorbidities is very important in determining the degree of disability of patients with primary tic disorders. Only 10%-15% of these patients presents exclusively with a tic disorder. Obsessive-compulsive disorder (OCD) are common in TS, and the clinical distinction between compulsions and complex tics may be difficult in some cases. "Tic-related OCD" represents a phenomenologically characteristic subtype of OCD, also associated with "just right" phenomena. Probably the presence of comorbid attention deficit/hyperactivity disorder is the main determinant of cognitive dysfunction in TS patients and influences heavily also the risk of developing disruptive behaviors. Mood and anxiety disorders, impulse control disorders, rage attacks, "impulsive" tic-like behaviors (e.g., nonobscene socially inappropriate behaviors, and self-injurious behaviors), and autism spectrum disorders complete the wide psychopathological spectrum of primary chronic tic disorders. Moreover, specific sleep abnormalities have been reported in TS patients, although more research is needed on this specific clinical problem. As in other areas of clinical neuroscience, a comprehensive approach to both motor and nonmotor aspects of this group of disorders will help personalizing treatment interventions and, ultimately, improve quality of care.
抽动秽语综合征（TS）和其他原发性慢性抽动障碍的临床监测与积极管理不能局限于抽动症状，因为这些患者还表现出一系列与感觉、行为、认知和睡眠相关的问题，这些问题对其功能和生活质量有重大影响，在日常临床决策中起着巨大作用。原发性抽动障碍的感觉现象包括先兆冲动以及对外界躯体感觉和内感受性刺激的高度敏感。最近的证据表明，内感受性意识的提高可能与与抽动相关的经典先兆冲动有关。行为共病的负担在决定原发性抽动障碍患者的残疾程度方面非常重要。这些患者中只有10%-15%仅表现为抽动障碍。强迫症（OCD）在TS中很常见，在某些情况下，强迫行为和复杂抽动之间的临床区分可能很困难。“抽动相关的OCD”代表了OCD一种具有现象学特征的亚型，也与“恰到好处”现象有关。共患注意力缺陷多动障碍可能是TS患者认知功能障碍的主要决定因素，也严重影响出现破坏性行为的风险。情绪和焦虑障碍、冲动控制障碍、愤怒发作、“冲动性”抽动样行为（如非淫秽的社会不适当行为和自我伤害行为）以及自闭症谱系障碍构成了原发性慢性抽动障碍广泛的精神病理学谱系。此外，已有报道称TS患者存在特定的睡眠异常，尽管在这个特定的临床问题上还需要更多研究。与临床神经科学的其他领域一样，对这组疾病的运动和非运动方面采取综合方法将有助于个性化治疗干预，并最终提高护理质量。
