Therapeutic Approach to Primary Tic Disorders and Associated Psychiatric Comorbidities
Berzosa-Gonzalez, Irene (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Martínez-Horta, Saul (Institut de Recerca Sant Pau)
Pérez-Pérez, Jesús (Institut de Recerca Sant Pau)
Kulisevsky, Jaime (Institut de Recerca Sant Pau)
Pagonabarraga Mora, Javier (Institut de Recerca Sant Pau)
Universitat Autònoma de Barcelona

Data:	2024
Resum:	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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Tourette syndrome ; Clonazepam ; Psychiatric comorbidities ; Tics ; Treatment
Publicat a:	Brain sciences, Vol. 14 Núm. 12 (december 2024) , p. 1231, ISSN 2076-3425

DOI: 10.3390/brainsci14121231
PMID: 39766430

14 p, 1.2 MB

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