Dept. of Neurology and Center of Clinical Neuroscience, First Medical Faculty, Charles University and General Hospital in Prague, Kateřinská 30, 120 00, Czech Republic.
Parkinsonism Relat Disord. 2018 Jan;46 Suppl 1:S75-S79. doi: 10.1016/j.parkreldis.2017.08.004. Epub 2017 Aug 10.
Tourette syndrome (TS) is a common neuropsychiatric disorder, more common in males than females, with onset before age 18. TS is characterized by multiple motor tics and one or more vocal/phonic tics, persisting for more than a year. Tics are unvoluntary, abrupt, rapid, repetitive, but non-rhythmic movements or sounds (vocalizations). They are preceded by an inner urge. Tics can be temporarily suppressed, but this leads to a powerful re-emergence. The performance of tics results in immediate but transient relief. Motor and vocal tics are classified as simple or complex. Tics emerge many times during the day and display spontaneous fluctuations in frequency, type, severity and complexity. Tics improve during concentration, worsen during relaxation or when under stress and occasionally are persistent in sleep. Psychiatric comorbidities such as attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD) and others frequently are present. Patients, families and teachers benefit from receiving instruction regarding the character of TS and its specific symptoms and from receiving counseling. Pharmacological treatment is not always necessary. Atypical antipsychotics (e.g. risperidone, ziprasidone, olanzapine, aripiprazole) are often the first-line treatment; typical antipsychotics (e.g. haloperidol, pimozide, fluphenazine), benzodiazepines (clonazepam) and tetrabenazine are employed less frequently. Alpha adrenergic agonists (clonidine, guanfacine), the selective noradrenaline re-uptake inhibitor, atomoxetine, and the amphetamine-like stimulant, methylphenidate, are useful in patients with tics and ADHD; selective serotonin re-uptake inhibitors can be useful in individuals with tics and OCD. Botulinum toxin can be effective in focal tics. In severe, treatment-resistant TS, deep brain stimulation may be beneficial.
妥瑞氏症（TS）是一种常见的神经精神疾病，男性多于女性，发病年龄在 18 岁之前。TS 的特征是多种运动性抽搐和一种或多种发声/语音性抽搐，持续时间超过一年。抽搐是不由自主的、突然的、快速的、重复的，但无节奏的运动或声音（发声）。它们之前有一个内在的冲动。抽搐可以暂时被抑制，但这会导致强烈的再次出现。抽搐的表现会立即但短暂地缓解。运动性抽搐和发声性抽搐可分为简单或复杂。抽搐在一天中多次出现，并表现出频率、类型、严重程度和复杂性的自发波动。抽搐在集中注意力时会减轻，在放松或压力下会加重，偶尔在睡眠中持续存在。注意力缺陷多动障碍（ADHD）、强迫症（OCD）等精神共病经常存在。患者、家属和教师受益于接受关于妥瑞氏症的性质及其特定症状的指导，并接受咨询。并非总是需要药物治疗。非典型抗精神病药（如利培酮、齐拉西酮、奥氮平、阿立哌唑）通常是一线治疗药物；典型抗精神病药（如氟哌啶醇、匹莫齐特、氟奋乃静）、苯二氮䓬类（氯硝西泮）和四苯嗪则较少使用。α肾上腺素能激动剂（可乐定、胍法辛）、选择性去甲肾上腺素再摄取抑制剂托莫西汀，以及安非他命样兴奋剂哌甲酯，对伴有抽搐和 ADHD 的患者有效；选择性 5-羟色胺再摄取抑制剂对伴有抽搐和强迫症的患者可能有效。肉毒杆菌毒素对局部抽搐有效。在严重、治疗抵抗的妥瑞氏症中，深部脑刺激可能有益。
