Pringsheim Tamara, Ganos Christos, Nilles Christelle, Cavanna Andrea E, Gilbert Donald L, Greenberg Erica, Hartmann Andreas, Hedderly Tammy, Heyman Isobel, Liang Holan, Malaty Irene, Malik Osman, Debes Nanette Mol, Vahl Kirsten Muller, Munchau Alexander, Murphy Tara, Nagy Peter, Owen Tamsin, Rizzo Renata, Skov Liselotte, Stern Jeremy, Szejko Natalia, Worbe Yulia, Martino Davide
Department of Clinical Neurosciences, Psychiatry, Pediatrics, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Eur J Neurol. 2023 Apr;30(4):902-910. doi: 10.1111/ene.15672. Epub 2023 Jan 13.
In 2020, health professionals witnessed a dramatic increase in referrals of young people with rapid onset of severe tic-like behaviours. We assembled a working group to develop criteria for the clinical diagnosis of functional tic-like behaviours (FTLBs) to help neurologists, pediatricians, psychiatrists, and psychologists recognize and diagnose this condition.
We used a formal consensus development process, using a multiround, web-based Delphi survey. The survey was based on an in-person discussion at the European Society for the Study of Tourette Syndrome (ESSTS) meeting in Lausanne in June 2022. Members of an invited group with extensive clinical experience working with patients with Tourette syndrome and FTLBs discussed potential clinical criteria for diagnosis of FTLBs. An initial set of criteria were developed based on common clinical experiences and review of the literature on FTLBs and revised through iterative discussions, resulting in the survey items for voting.
In total, 24 members of the working group were invited to participate in the Delphi process. We propose that there are three major criteria and two minor criteria to support the clinical diagnosis of FTLBs. A clinically definite diagnosis of FTLBs can be confirmed by the presence of all three major criteria. A clinically probable diagnosis of FTLBs can be confirmed by the presence of two major criteria and one minor criterion.
Distinguishing FTLBs from primary tics is important due to the distinct treatment paths required for these two conditions. A limitation of the ESSTS 2022 criteria is that they lack prospective testing of their sensitivity and specificity.
2020年，卫生专业人员发现，患有快速发作的严重抽动样行为的年轻人转诊数量急剧增加。我们组建了一个工作组，以制定功能性抽动样行为（FTLB）的临床诊断标准，帮助神经科医生、儿科医生、精神科医生和心理学家识别和诊断这种疾病。
我们采用了正式的共识制定流程，通过基于网络的多轮德尔菲调查进行。该调查基于2022年6月在洛桑举行的欧洲抽动秽语综合征研究学会（ESSTS）会议上的一次面对面讨论。一个由在抽动秽语综合征和FTLB患者治疗方面具有丰富临床经验的受邀小组的成员，讨论了FTLB诊断的潜在临床标准。基于常见临床经验以及对FTLB相关文献的回顾，制定了一套初步标准，并通过反复讨论进行修订，形成了供投票的调查项目。
共有24名工作组成员受邀参与德尔菲流程。我们提出，支持FTLB临床诊断有三项主要标准和两项次要标准。具备所有三项主要标准可确诊为临床确诊的FTLB。具备两项主要标准和一项次要标准可确诊为临床很可能的FTLB。
区分FTLB与原发性抽动很重要，因为这两种疾病需要不同的治疗路径。ESSTS 2022标准的一个局限性是缺乏对其敏感性和特异性的前瞻性测试。
