Review Article
Volume 13 Issue 10 - 2021
The Essentials in Tourette Syndrome
Sacristán HE1*, Galati AS2, Canestrari L3 and Gómez Forero AG3
1Department of Neurology, Anselmo Marini Rehabilitation Institut, Professor of Neurology, School of Medicine, University of Morón, Associate Professor of Neurology, School of Medicine, UBA, Buenos Aires, Argentina
2Department of Neurosurgery, Cosme Argerich Hospital, Department of Neurosurgery, Bernardo Houssay Hospital, Buenos Aires, Argentina
3Hospital Teaching Unit, Bernardo Houssay Hospital, Buenos Aires, Argentina
*Corresponding Author: Sacristán HE, Department of Neurology, Anselmo Marini Rehabilitation Institut, Professor of Neurology, School of Medicine, University of Morón, Associate Professor of Neurology, School of Medicine, UBA, Buenos Aires, Argentina.
Received: August 25, 2021; Published: September 28, 2021




Abstract

Tourette's syndrome (TS) is a complex neuro-psychiatric disorder that manifests itself in childhood or adolescence. It is characterized by motor and vocal tics, present at least one year prior to the consultation and of a changing nature in number, frequency and complexity. Patients with TS may manifest psychiatric comorbidities: 1-attention deficit hyperactivity syndrome (ADHD), 2-obsessive-compulsive disorders (OCD), 3-impulse control disorders (ICD), 4-anxiety, 5-depression or 6-self-aggressive behaviors, which can affect their personal, social and work life. Some patients with TS progress to a severe and malignant clinical form, which generates disability, usually refractory to medical treatment. In the course of life, motor and vocal tics diminish or disappear with persistence of neuro-psychiatric manifestations. The pathophysiology of TS is unknown, although serotonergic and dopaminergic cortico-strio-pale-thalamic-cortical circuits are postulated, the involvement of which justifies the motor (tics) and behavioral manifestations. Treatment strategies vary depending on the type and degree of severity of symptoms. Treatment must be adapted to the needs and objectives of the individual patient and with respect to her family environment. Patients should be educated about the condition and, if possible, participate in behavioral therapy targeting tics and comorbidities. Various drugs, alpha adrenergic agonists, topiramate, and mono-amine transport inhibitors, are used as first-line therapies in patients with tics refractory to behavior therapy. Botulinum toxin injections are indicated in patients with severe focal tics. Typical or atypical antipsychotics (fluphenazine, aripiprazole, risperidone, and ziprasidone) are another treatment option. These generally effective medications carry the risk of metabolic syndrome, Parkinsonism, tardive dyskinesias, or other side effects. Clinical trials with ecopipam, a D1 antagonist, are promising. Patients with tics refractory to conventional treatment are candidates for neurosurgical treatment. Injury neurosurgery not exempt from sequelae is currently in disuse. Instead, deep brain stimulation surgery has been tried. The Tourette Syndrome Association and the European Society for the Study of Tourette Syndrome have published guidelines that establish the criteria for the selection of patients who are candidates for DBS. DBS constitutes a programmable and reversible modality of neuromodulation on associative or limbic circuits within the basal ganglia and has been used to treat severe forms of TS. Preliminary results of DBS at the level of associative and/or limbic parts of the striatum, thalamus and/or the pallidum in patients with TS, demonstrated a clear decrease in the severity of tics and self-injurious behaviour. Future studies will make it possible to establish the impact of DBS in the motor sphere and in associated neuro-psychiatric comorbidities. In the present work, the clinical manifestations and the various medical and/or surgical treatment options currently available are reviewed.

Keywords: Tourette; Tics; Cognitive Behavioral Therapy; Drug Therapy; Deep Brain Stimulation

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Citation: Sacristán HE., et al. “The Essentials in Tourette Syndrome”. EC Neurology 13.10 (2021): 91-110.

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