Refractoriness to pharmacological treatment for tics: A multicentre European audit

Macerollo, Antonella; Martino, Davide; Cavanna, Andrea E.; Gulisano, Mariangela; Hartmann, Andreas; Hoekstra, Pieter J.; Hedderly, Tammy; Debes, Nanette Mol; Müller-Vahl, Kirsten; Neuner, Irene; Porta, Mauro; Rickards, Hugh; Rizzo, Renata; Cardona, Francesco; Roessner, Veit

doi:10.1016/j.jns.2016.05.004

Cited by 34 publications

(14 citation statements)

References 4 publications

(3 reference statements)

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“…Specifically, they suggested that the following factors should be taken into consideration: no significant improvement in health-related quality of life in response to trials of conventional (typical and atypical neuroleptics) and other pharmacological agents (botulinum toxin or tetrabenazine) as well as resistance to selective serotonin-reuptake inhibitors (SSRI) or tricyclics for comorbid OCD. Another study by Macerollo et al (77) reported the findings of the European audit survey. The main goal was to establish tentative criteria for treatment refractoriness in GTS as well as evaluate how frequently these criteria are taken into consideration in routine clinical practice.…”

Section: Refractoriness To Pharmacological Treatment In Gtsmentioning

confidence: 99%

Refractory Gilles de la Tourette Syndrome—Many Pieces That Define the Puzzle

et al. 2020

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Gilles de la Tourette syndrome (GTS) is a childhood onset neuropsychiatric disorder characterized by the presence of motor and vocal tics. The clinical spectrum of GTS is heterogeneous and varies from mild cases that do not require any medical attention to cases that are refractory to standard treatments. One of the unresolved issues is the definition of what constitutes treatment-refractory GTS. While for some other neuropsychiatric disorders, such as obsessive–compulsive disorder (OCD), a clear definition has been established, there is still no consensus with regard to GTS. One important issue is that many individuals with GTS also meet criteria for one or more other neurodevelopmental and neuropsychiatric disorders. In many individuals, the severity of these comorbid conditions contributes to the degree to which GTS is treatment refractory. The scope of this paper is to present the current state-of-the-art regarding refractory GTS and indicate possible approaches to define it. In closing, we discuss promising approaches to the treatment of individuals with refractory GTS.

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Section: Refractoriness To Pharmacological Treatment In Gtsmentioning

confidence: 99%

Refractory Gilles de la Tourette Syndrome—Many Pieces That Define the Puzzle

et al. 2020

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“…Another area in need of further evidence is the treatment of patients with co-existing conditions. Moreover, questions around how to deal with treatment refractoriness remain unanswered [ 193 ]. The risk of adverse events when using specific agents needs further exploration, e.g., sudden death due to QTc prolongation [ 116 ], hyperprolactinemia and its consequences [ 109 ], and weight gain [ 128 ].…”

Section: Current Limitations and Future Directionsmentioning

confidence: 99%

European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part III: pharmacological treatment

Roessner

Eichele

Stern

et al. 2021

Eur Child Adolesc Psychiatry

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In 2011, the European Society for the Study of Tourette Syndrome (ESSTS) published the first European guidelines for Tourette Syndrome (TS). We now present an update of the part on pharmacological treatment, based on a review of new literature with special attention to other evidence-based guidelines, meta-analyses, and randomized double-blinded studies. Moreover, our revision took into consideration results of a recent survey on treatment preferences conducted among ESSTS experts. The first preference should be given to psychoeducation and to behavioral approaches, as it strengthens the patients’ self-regulatory control and thus his/her autonomy. Because behavioral approaches are not effective, available, or feasible in all patients, in a substantial number of patients pharmacological treatment is indicated, alone or in combination with behavioral therapy. The largest amount of evidence supports the use of dopamine blocking agents, preferably aripiprazole because of a more favorable profile of adverse events than first- and second-generation antipsychotics. Other agents that can be considered include tiapride, risperidone, and especially in case of co-existing attention deficit hyperactivity disorder (ADHD), clonidine and guanfacine. This view is supported by the results of our survey on medication preference among members of ESSTS, in which aripiprazole was indicated as the drug of first choice both in children and adults. In treatment resistant cases, treatment with agents with either a limited evidence base or risk of extrapyramidal adverse effects might be considered, including pimozide, haloperidol, topiramate, cannabis-based agents, and botulinum toxin injections. Overall, treatment of TS should be individualized, and decisions based on the patient’s needs and preferences, presence of co-existing conditions, latest scientific findings as well as on the physician’s preferences, experience, and local regulatory requirements.

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“…For those who do not respond to a particular agent, a switch to another dopamine receptor blocker or group of agents as well as combining two agents will generally lead to the desired benefits. There is only a minority of patients who evidence refractoriness to psychopharmacological treatment for tics, however the exact percentage is difficult to quantify, partly because the first definition has only recently been published 140 .…”

Section: Only (30 To50 Words Is Ideal and 70 Maximum)mentioning

confidence: 99%

Gilles de la Tourette syndrome

Robertson

Eapen

Singer

et al. 2017

Nat Rev Dis Primers

284

244

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The unstructured abstract of 200 words maximum should summarize the main points of the article. All information mentioned in the abstract must be addressed somewhere in the main article. The abstract should not contain references or display item citations. Gilles de la Tourette Syndrome (GTS), a reasonably common disorder, has had a long, tortuous and somewhat controversial history. First and well described in the 18th century 1,2 , the main features of GTS have, however, remained fairly constant. The core diagnostic features are multiple motor and one or more vocal (phonic) tics lasting for over a year. In addition, almost pathognomic, but not necessary, features described in the early documentations include coprolalia (involuntary, inappropriate swearing), and echophenomena (copying behaviours), as well as many co-morbidities and psychopathologies 3 . Introduction [suggested 500 words, is 544 words -8 refs] Mary Robertson Thoughts for Mary -Your word count when combining sections 1 and 2 is 1001 (1000 limit)-so OKGTS was originally described in France and the majority of early literature came from and standardised schedules such as diagnostic confidence, measurement of severity, QoL, and assessment of both co-morbidities and co-existent psychopathologies are currently available.Large international collaborative consortia are engaged in studies exploring aetiological factors in particular, and some international treatment studies are also underway. Perhaps as a result of earlier small patient numbers, the treatment trials have given good clues to management, but unsurprisingly systematic reviews and meta-analyses have been hampered, giving disappointing, if not unexpected, results. Intriguingly medications from the typical NRDP -Gilles de la Tourette Syndrome 3 antipsychotic family including haloperidol, which first had documented success in 1961 6,7 are still being used, although successive generations of "atypicals" are currently more in vogue,as are medications such as alpha-2-adrenergic agonists. Interestingly, haloperidol remains the only medication prescribed on licence in many parts of the world. In contrast to disorders such as ADHD, in which it is clear which treatments work and which do not require further study 8 , a variety of treatment studies in GTS are still being undertaken, including using other medications (trying to improve efficacy and reduce side effects), behavioural therapies, deep brain stimulation (for refractory cases), and other more "alternative" methods such as "orthotics" (teeth braces). The GTS community has to first agree on how common GTS is and then seek funding for research in the areas of major importance.2. Epidemiology [suggested 500 words, is 444 words, 6 additional refs] Mary Robertson GTS was for many years thought to be not only very rare, but a bizarre curiosity, with sporadic case reports peppering the literature. The belief that GTS was uncommon at the very least was held by many until Comings 9 controversially suggested that GTS occurred in between 0.66% and...

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Refractoriness to pharmacological treatment for tics: A multicentre European audit

Cited by 34 publications

References 4 publications

Refractory Gilles de la Tourette Syndrome—Many Pieces That Define the Puzzle

Refractory Gilles de la Tourette Syndrome—Many Pieces That Define the Puzzle

European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part III: pharmacological treatment

Gilles de la Tourette syndrome

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