178e51449245fbea61a3f88312927d4b 308690.pdf b86c5b81fa622bd1580cc4cf89468bec362ec7e1 308690.pdf 3d8382b796ed72669e915545efca68f7b9d1023d6f6f7e5026a987b6e73162cd 308690.pdf Title: Therapeutic Approach to Primary Tic Disorders and Associated Psychiatric Comorbidities Subject: 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. Methods: 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. Results: 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; p = 0.005). Aripiprazole and clonazepam produced similar outcomes in reducing CGI-C. Conclusions: 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. Keywords: Tourette syndrome; tics; treatment; psychiatric comorbidities; clonazepam Author: Irene Berzosa-Gonzalez, Saul Martinez-Horta, Jesus Pérez-Pérez, Jaime Kulisevsky and Javier Pagonabarraga Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Mon Dec 9 07:22:00 2024 CET ModDate: Mon Dec 9 07:44:39 2024 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 14 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1243488 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- BTFGED+VnURWPalladioL-Bold Type 1 Custom yes yes yes 10 0 OIWKVU+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 VHMFMW+URWPalladioL-Roma Type 1 Custom yes yes yes 22 0 MJCBLO+URWPalladioL-Ital Type 1 Custom yes yes yes 27 0 OPZDHV+VnURWPalladioL Type 1 Custom yes yes yes 32 0 FJBUXO+CMSY10 Type 1 Builtin yes yes yes 65 0 QLBIEB+URWPalladioL-BoldItal Type 1 Custom yes yes yes 73 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 89 0 BCDLEE+PalatinoLinotype-BoldItalic CID TrueType Identity-H yes yes yes 93 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 101 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 105 0 BCDHEE+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 109 0 BCDIEE+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 116 0 BCDJEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 123 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 140 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 144 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 148 0 BCDHEE+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 152 0 BCDIEE+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 159 0 BCDJEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 166 0 BCDEEE+PalatinoLinotype-Bold TrueType WinAnsi yes yes no 178 0 BCDFEE+PalatinoLinotype-Roman TrueType WinAnsi yes yes no 182 0 BCDGEE+PalatinoLinotype-Italic TrueType WinAnsi yes yes no 186 0 BCDHEE+PalatinoLinotype-Italic CID TrueType Identity-H yes yes yes 190 0 BCDIEE+PalatinoLinotype-Bold CID TrueType Identity-H yes yes yes 197 0 BCDJEE+PalatinoLinotype-Roman CID TrueType Identity-H yes yes yes 204 0 CRUZTT+VnURWPalladioL-Italic Type 1 Custom yes yes yes 234 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-03-11 02:43:06 CET RepresentationInformation: 308690.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-03-10 13:46:19 CET Size: 1243488 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 399 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Item: Title: Results Destination: section.3 Children: Item: Title: Demographic Data Destination: subsection.3.1 Item: Title: Tic Disorders Destination: subsection.3.2 Item: Title: Psychiatric Comorbidities Destination: subsection.3.3 Item: Title: Treatment of Tics Destination: subsection.3.4 Children: Item: Title: Pharmacological Treatment Destination: subsubsection.3.4.1 Item: Title: Botulinum Toxin Treatment Destination: subsubsection.3.4.2 Item: Title: Treatment of Psychiatric Comorbidities Destination: subsubsection.3.4.3 Item: Title: Indicators of Severity and Response to Medication Destination: subsection.3.5 Item: Title: Discussion Destination: section.4 Children: Item: Title: Demographic Data Destination: subsection.4.1 Item: Title: Tic Disorders Destination: subsection.4.2 Item: Title: Psychiatric Comorbidities Destination: subsection.4.3 Item: Title: Treatment of Tics Destination: subsection.4.4 Children: Item: Title: Behavioral Treatment Destination: subsubsection.4.4.1 Item: Title: Pharmacological Treatment Destination: subsubsection.4.4.2 Item: Title: Botulinum Toxin Treatment Destination: subsubsection.4.4.3 Item: Title: Treatment of Psychiatric Comorbidities Destination: subsection.4.5 Item: Title: Severity Indicators and Drug Response Destination: subsection.4.6 Item: Title: Limitations and Strengths Destination: subsection.4.7 Item: Title: Future Research and Practical Implications Destination: subsection.4.8 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: appendix.A. Info: Title: Therapeutic Approach to Primary Tic Disorders and Associated Psychiatric Comorbidities Author: Irene Berzosa-Gonzalez, Saul Martinez-Horta, Jesus Pérez-Pérez, Jaime Kulisevsky and Javier Pagonabarraga Subject: 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. Methods: 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. Results: 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; p = 0.005). Aripiprazole and clonazepam produced similar outcomes in reducing CGI-C. Conclusions: 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. 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