Berzosa-Gonzalez Irene, Martinez-Horta Saul, Pérez-Pérez Jesus, Kulisevsky Jaime, Pagonabarraga Javier
Movement Disorder Unit, Neurology Department, Hospital de Sant Pau, 08041 Barcelona, Spain.
Department of Medicine, Universitat Autonoma de Barcelona (UAB), 08193 Barcelona, Spain.
Brain Sci. 2024 Dec 7;14(12):1231. doi: 10.3390/brainsci14121231.
BACKGROUND/OBJECTIVES: The treatment of tics and psychiatric comorbidities is crucial when they affect the patient's well-being and relationships. However, the optimal pharmacological treatment (PT) tailored to each patient's phenotype remains unclear. The primary objective of this study is to describe the clinical characteristics and treatment received for tics and psychiatric comorbidities in our cohort of children and adult patients with tic disorders. Additionally, a further aim was to quantify the severity of tics, comorbidities and overall severity, and the overall clinical changes observed during the follow-up.
Retrospective descriptive study of patients with tic disorders under follow-up at our Tic Functional Unit from January 2022 to March 2024. Two independent neurologists retrospectively applied the Clinical Global Impression of Change (CGI-C) and the Clinical Global Impression of Severity (CGI-S) scales at baseline and at last assessment.
A total of 36 individuals were included (63.8% males, median age = 18 years, IQR 19): 94.4% with Tourette syndrome (TS), 2.8% with chronic tic disorder (CTD), and 2.8% with provisional tic disorder (PTD). A total of 86% had at least one psychiatric comorbidity, the most common being obsessive-compulsive symptomatology (OCS) (52%), anxiety (52%), and attention deficit hyperactivity disorder (ADHD) (35%). At last assessment, 26 patients (72.2%) were on undergoing PT for tics and 3 were receiving additional botulinum toxin. The most used medication for tics were aripiprazole (46.2%) and clonazepam (46.2%), and for psychiatric comorbidities, SSRIs (42.9%), methylphenidate (19%), and benzodiazepines (57.1%). Overall improvement according to the CGI-C scale was mild (CGI-C 3). Children and adolescents showed greater improvement than adults (CGI-C 2 vs. 3; = 0.005). Aripiprazole and clonazepam produced similar outcomes in reducing CGI-C.
We observed a favorable clinical course in patients treated with aripiprazole and clonazepam, which appear to be better than that obtained with other treatments. We consider that clonazepam may be useful as a first-line monotherapy and as an adjuvant for both tics and comorbidities in selected cases.
背景/目的：当抽动和精神共病影响患者的幸福感和人际关系时，对其进行治疗至关重要。然而，针对每个患者表型的最佳药物治疗（PT）仍不明确。本研究的主要目的是描述我们队列中患有抽动障碍的儿童和成年患者抽动及精神共病的临床特征和接受的治疗。此外，另一个目的是量化抽动、共病和总体严重程度的严重程度，以及随访期间观察到的总体临床变化。
对2022年1月至2024年3月在我们的抽动功能单元接受随访的抽动障碍患者进行回顾性描述性研究。两名独立的神经科医生在基线和最后评估时回顾性应用临床总体印象变化量表（CGI-C）和临床总体印象严重程度量表（CGI-S）。
共纳入36例个体（男性占63.8%，中位年龄 = 18岁，四分位间距19）：94.4%患有妥瑞氏症（TS），2.8%患有慢性抽动障碍（CTD），2.8%患有暂时性抽动障碍（PTD）。共有86%的患者至少有一种精神共病，最常见的是强迫症状（OCS）（52%）、焦虑（52%）和注意力缺陷多动障碍（ADHD）（35%）。在最后评估时，26例患者（72.2%）正在接受抽动的PT治疗，3例正在接受额外的肉毒杆菌毒素治疗。治疗抽动最常用的药物是阿立哌唑（46.2%）和氯硝西泮（46.2%），治疗精神共病的药物是选择性5-羟色胺再摄取抑制剂（SSRI）（42.9%）、哌醋甲酯（19%）和苯二氮卓类药物（57.1%）。根据CGI-C量表，总体改善为轻度（CGI-C 3）。儿童和青少年的改善程度高于成人（CGI-C 2对3；P = 0.005）。阿立哌唑和氯硝西泮在降低CGI-C方面产生了相似的结果。
我们观察到接受阿立哌唑和氯硝西泮治疗的患者临床病程良好，这两种药物似乎比其他治疗方法效果更好。我们认为氯硝西泮在某些情况下可作为一线单一疗法以及抽动和共病的辅助治疗药物。
