East London NHS Foundation Trust, Bedford, UK.
University College London, London, UK.
J Psychopharmacol. 2021 Sep;35(9):1037-1061. doi: 10.1177/02698811211032445. Epub 2021 Jul 21.
Tourette syndrome (TS) is a neurodevelopmental disorder characterised by involuntary muscle movements manifesting as motor and vocal tics. In the majority, tics are manageable without medication. Where tics cause discomfort or impair function, behavioural or pharmaceutical treatments may be considered.
To provide a meticulous examination of the quality of evidence for the current pharmacological treatments for TS.
PubMed and Google Scholar were searched to identify randomised, placebo-controlled trials (RCTs) of aripiprazole, risperidone, clonidine, guanfacine, haloperidol, pimozide, tiapride and sulpiride for the treatment of tics in children and adults with TS. Quality of reporting and risk of bias were assessed against the CONSORT checklist and Cochrane risk of bias criteria, respectively.
Seventeen RCTs were identified. Response rates reached 88.6% for aripiprazole, 68.9% for clonidine, 62.5% for risperidone and 19% for guanfacine. Statistically significant improvements were reported for all medications compared to placebo in at least one study and for at least one measure of tic severity. Most studies predated the CONSORT and Cochrane criteria and did not score highly when assessed on these measures.
There are relatively few placebo-controlled trials of commonly prescribed medications. Studies are often of poor quality and short duration. There is evidence for the efficacy of each medication, but no drug is clearly superior. Clonidine and guanfacine are better tolerated than antipsychotics, but less effective. There is too little evidence to determine whether adults respond differently from children.
妥瑞氏综合征（TS）是一种神经发育障碍，其特征是表现为运动和发声抽动的不自主肌肉运动。在大多数情况下，无需药物即可控制抽动。如果抽动引起不适或影响功能，可以考虑行为或药物治疗。
仔细检查目前用于 TS 的药物治疗的证据质量。
通过 PubMed 和 Google Scholar 搜索了阿立哌唑、利培酮、可乐定、胍法辛、氟哌啶醇、匹莫齐特、硫必利和舒必利治疗儿童和成人 TS 患者抽动的随机、安慰剂对照试验（RCT）。分别根据 CONSORT 清单和 Cochrane 偏倚风险标准评估报告质量和偏倚风险。
确定了 17 项 RCT。阿立哌唑的反应率达到 88.6%，可乐定的反应率为 68.9%，利培酮的反应率为 62.5%，胍法辛的反应率为 19%。与安慰剂相比，所有药物在至少一项研究和至少一项抽动严重程度测量中均报告了统计学显著改善。大多数研究都早于 CONSORT 和 Cochrane 标准，在这些措施上评分不高。
常用处方药物的安慰剂对照试验相对较少。研究质量通常较差且持续时间短。每种药物都有疗效证据，但没有一种药物明显更优。可乐定和胍法辛比抗精神病药更耐受，但效果较差。对于成年人和儿童的反应是否不同，证据还不够充分。
