Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada; Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France.
Department of Neurology, Pitié-Salpêtrière Hospital, Paris, France; National Reference Center for Tourette Disorder, Pitié-Salpêtrière Hospital, Paris, France.
Handb Clin Neurol. 2023;196:457-474. doi: 10.1016/B978-0-323-98817-9.00002-8.
Tics are repetitive, patterned, and nonrhythmic movements or vocalizations/audible sounds that are misplaced in context. Phenomenology and characteristics of tics (e.g., premonitory urge, suppressibility) differentiate them from compulsions, stereotypies, functional tic-like behaviors, and other types of hyperkinetic movement disorders. With a prevalence of approximately 1% in school-aged boys, Tourette syndrome (TS) is considered a common childhood-onset neurodevelopmental disorder, defined by the combination of at least two motor tics and at least one phonic tic lasting more than 1 year. TS is a highly heritable disorder, with a wide spectrum of severity. In some individuals, tics can cause pain, distress, functional impairment, or stigmatization. About 90% of individuals with TS have at least one mental health comorbidity (attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, anxiety/depressive disorders). These comorbidities significantly impact patients' quality of life and must therefore be screened and managed accordingly in this population. Treatment of tics is based on behavioral therapies targeting tics (habit reversal training included in the comprehensive behavioral intervention for tics, and exposure and response prevention for tics), in association with medication if needed (e.g., alpha-2-agonists, second-generation antipsychotics). Deep brain stimulation is considered an experimental option in the most severe, treatment-resistant patients. In adulthood, less than 25% of individuals still have moderate or severe tics.
抽动是一种重复、刻板且无节律的运动或发声/可听见的声音，其在语境中出现位置不当。抽动的现象学和特征（例如，前驱冲动、可抑制性）将其与强迫症、刻板动作、功能性类似抽动的行为以及其他类型的运动障碍区分开来。妥瑞氏症（TS）在学龄期男孩中的患病率约为 1%，被认为是一种常见的儿童期起病的神经发育障碍，其定义为至少两种运动性抽动和至少一种持续超过 1 年的发音性抽动的组合。TS 是一种高度遗传性疾病，其严重程度差异很大。在某些人中，抽动会引起疼痛、痛苦、功能障碍或污名化。大约 90%的 TS 患者至少有一种心理健康共病（注意力缺陷/多动障碍、强迫症、焦虑/抑郁障碍）。这些共病显著影响患者的生活质量，因此必须在该人群中进行筛查和相应管理。抽动的治疗基于针对抽动的行为疗法（包括抽动的综合行为干预中的习惯逆转训练和抽动的暴露与反应预防），并在必要时联合药物治疗（例如，α-2-激动剂、第二代抗精神病药）。在最严重、治疗抵抗的患者中，深部脑刺激被认为是一种实验性选择。在成年期，仍有不到 25%的人存在中度或重度抽动。
