Tourette syndrome: current data, comorbidities, and therapeutic approach in children
Italian Journal of Pediatrics volume 40, Article number: A68 (2014)
Tourette syndrome (TS) is the primary tic disorder with an estimated prevalence close to 1% between 5 and 18 years of age . Motor and phonic tics are the core features of TS . In addition to their well-characterized phenomenology, tics display a peculiar variability over time, which is strongly influenced by a variety of contextual factors. A relevant proportion of patients with TS display complex, tic-like, repetitive behaviors that include echophenomena, coprophenomena, and nonobscene socially inappropriate behaviors (NOSIBs). Co-morbid conditions are attention deficit hyperactivity disorder (ADHD), obsessive compulsive behaviours/disorder (OCB/D) and autistic spectrum disorder (ASD); co-existent psychopathologies include depression, anxiety, oppositional defiant disorder (ODD), conduct disorder (CD) and personality disorders (PDs) . The complexity of the Tourette spectrum has been confirmed by cluster and factor analytical approaches . It is suggested that TS is not a unitary condition and that one phenotype ("Pure TS" [tics only]) occurs in about 10-14 % . The presence of comorbid attention deficit hyperactivity disorder (ADHD) is the main determinant of cognitive dysfunction in TS patients and influences heavily also the risk of developing disruptive behaviors .The burden of behavioral comorbidities is very important in determining significant impairment, poor self-esteem, and a low quality of life [7, 8].While the evidence for a genetic contribution is strong, several genes, including SLITRK1, LIM homeobox (LHX6, LHX8), and HDC have been suggested to be responsible for the different clinical phenotypes [9, 10].However its exact nature has yet to be clarified fully. Aetiological factors include genetic vulnerability pre- and peri-natal difficulties (PNDs), and probably neuro-immunological factors. Neuro-imaging are helpful to exclude other conditions, and although abnormalities are described, in an individual patient, they are not diagnostic. Treatment includes psycho-education and reassurance, medications, target-specific botulinum toxin injections  and in a few severe refractory adult cases, deep brain stimulation life .This review will summarise and highlight selected main findings from the author's clinic.
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Rizzo, R. Tourette syndrome: current data, comorbidities, and therapeutic approach in children. Ital J Pediatr 40 (Suppl 1), A68 (2014). https://doi.org/10.1186/1824-7288-40-S1-A68
- Autistic Spectrum Disorder
- Attention Deficit Hyperactivity Disorder
- Deep Brain Stimulation
- Personality Disorder
- Oppositional Defiant Disorder