Leckman James F, King Robert A, Bloch Michael H
Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
J Obsessive Compuls Relat Disord. 2014 Oct;3(4):372-379. doi: 10.1016/j.jocrd.2014.03.004. Epub 2014 Mar 26.
Tourette syndrome (TS) is a neurodevelopmental disorder characterized by motor and vocal tics--rapid, repetitive, stereotyped movements or vocalizations lasting at least one year in duration. The goal of this article was to review the long-term clinical course of tics and frequently co-occurring conditions in children with TS.
We conducted a traditional literature search to locate relevant articles regarding long-term outcome and prognosis in TS and tic disorders.
Tics typically have an onset between the ages of 4 and 6 years and reach their worst-ever severity between the ages of 10 and 12 years. By age 10 years, most children are aware of nearly irresistible somatosensory urges that precede the tics. A momentary sense of relief typically follows the completion of a tic. Over the course of hours, tics occur in bouts, with a regular inter-tic interval. Tics increase during periods of psychosocial stress, emotional excitement and fatigue. Tics can become "complex" in nature and appear to be purposeful. Tics can be willfully suppressed for brief intervals and can be evoked by the mere mention of them. Tics typically diminish during periods of goal-directed behavior. Over the course of months, tics wax and wane. By early adulthood, roughly three-quarters of children with TS will have greatly diminished tic symptoms and more than one-third will be virtually tic free.
Although tics are the defining aspect of TS, they are often not the most enduring or impairing symptoms in children with TS. Indeed in TS tics rarely occur in isolation, and other coexisting conditions--such as behavioral disinhibition, hypersensitivity to a broad range of sensory stimuli, problems with visual motor integration, procedural learning difficulties, attention-deficit hyperactivity disorder, obsessive-compulsive disorder, depression, anxiety, and emotional instability--are often a greater source of impairment than the tics themselves. Measures used to enhance self-esteem, such as encouraging independence, strong friendships and the exploration of interests, are crucial to ensuring positive adulthood outcome.
抽动秽语综合征（TS）是一种神经发育障碍，其特征为运动性和发声性抽动——快速、重复、刻板的动作或发声，持续时间至少一年。本文的目的是回顾TS患儿抽动症状的长期临床病程以及常见的共病情况。
我们进行了传统的文献检索，以查找有关TS和抽动障碍的长期结局及预后的相关文章。
抽动症状通常在4至6岁之间开始出现，在10至12岁之间达到最严重程度。到10岁时，大多数儿童会意识到抽动之前几乎无法抗拒的躯体感觉冲动。抽动完成后通常会有片刻的轻松感。在数小时内，抽动呈发作性出现，抽动间期规律。在心理社会压力、情绪激动和疲劳期间，抽动会加重。抽动在性质上可能会变得“复杂”，看似有目的性。抽动可以在短时间内被有意抑制，仅仅提及它们就可能引发抽动。在目标导向行为期间，抽动通常会减轻。在数月的时间里，抽动症状有波动变化。到成年早期，大约四分之三的TS患儿抽动症状会大大减轻，超过三分之一的患儿几乎没有抽动症状。
尽管抽动是TS的标志性特征，但它们往往不是TS患儿最持久或最具损害性的症状。事实上，在TS中，抽动很少单独出现，其他共存情况——如行为抑制障碍、对广泛的感觉刺激过敏、视运动整合问题、程序性学习困难、注意力缺陷多动障碍、强迫症、抑郁症、焦虑症和情绪不稳定——往往比抽动本身更易造成损害。用于增强自尊的措施，如鼓励独立、建立牢固的友谊和探索兴趣，对于确保成年后的积极结局至关重要。
