实践指南推荐摘要：抽动障碍患者和慢性抽动障碍的治疗。
Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders.
机构信息
From the Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences (T.P., D.M.), Cumming School of Medicine, University of Calgary, Alberta, Canada; Departments of Neurology and Neurosurgery (M.S.O.), Fixel Center for Neurological Diseases, University of Florida, Gainesville; Department of Psychiatry, Social Psychiatry, and Psychotherapy (K.M.-V.), Hannover Medical School, Germany; Department of Neurology (J.J.), Baylor College of Medicine, Houston, TX; Department of Neuropsychiatry (A.E.C.), BSMHFT, University of Birmingham and Aston University, UK; Department of Psychology (D.W.W.), Marquette University, Milwaukee, WI; Massachusetts Chapter (M.R.), Tourette Association of America, Bayside, NY; Waisman Center (E.J.), University Center for Excellence in Developmental Disabilities, University of Wisconsin, Madison; Technische Universitaet Dresden (V.R.), Germany; Departments of Pediatric and Neurology/Neurosurgery (M.O.), McGill University, Montréal, Canada; Department of Pediatrics (Neurology) (Y.H.-M.), Northwestern University Feinberg School of Medicine, Chicago, IL; and Department of Psychiatry and Biobehavioral Sciences (J.P.), Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles.
出版信息
Neurology. 2019 May 7;92(19):896-906. doi: 10.1212/WNL.0000000000007466.
OBJECTIVE
To make recommendations on the assessment and management of tics in people with Tourette syndrome and chronic tic disorders.
METHODS
A multidisciplinary panel consisting of 9 physicians, 2 psychologists, and 2 patient representatives developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine-compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence.
RESULTS
Forty-six recommendations were made regarding the assessment and management of tics in individuals with Tourette syndrome and chronic tic disorders. These include counseling recommendations on the natural history of tic disorders, psychoeducation for teachers and peers, assessment for comorbid disorders, and periodic reassessment of the need for ongoing therapy. Treatment options should be individualized, and the choice should be the result of a collaborative decision among patient, caregiver, and clinician, during which the benefits and harms of individual treatments as well as the presence of comorbid disorders are considered. Treatment options include watchful waiting, the Comprehensive Behavioral Intervention for Tics, and medication; recommendations are provided on how to offer and monitor these therapies. Recommendations on the assessment for and use of deep brain stimulation in adults with severe, treatment-refractory tics are provided as well as suggestions for future research.
目的
就妥瑞氏综合征和慢性抽动障碍患者的抽动评估和管理提出建议。
方法
一个由 9 名医生、2 名心理学家和 2 名患者代表组成的多学科小组制定了实践建议，整合了系统评价的结果，并遵循了符合医学研究所要求的流程，以确保透明度和患者参与度。建议得到了结构化理由的支持，这些理由整合了系统评价、相关证据、护理原则和证据推断中的证据。
结果
就妥瑞氏综合征和慢性抽动障碍患者的抽动评估和管理提出了 46 条建议。这些建议包括关于抽动障碍自然史的咨询建议、教师和同伴的心理教育、共病障碍的评估以及对持续治疗需求的定期重新评估。治疗选择应个体化，选择应是患者、照顾者和临床医生之间合作决策的结果，在此过程中应考虑个体治疗的益处和危害以及共病障碍的存在。治疗选择包括静观等待、全面行为干预治疗和药物治疗；提供了如何提供和监测这些治疗的建议。还提供了关于在成人中严重、治疗抵抗性抽动症的深部脑刺激评估和使用的建议，并提出了未来研究的建议。
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