Canadian Guidelines for the Evidence-Based Treatment of Tic Disorders: Behavioural Therapy, Deep Brain Stimulation, and Transcranial Magnetic Stimulation

Steeves, Thomas; Mckinlay, B. Duncan; Gorman, Daniel A.; Billinghurst, Lori; Day, Lundy; Carroll, Alan M.; Dion, Yves; Doja, Asif; Luscombe, Sandra; Sandor, Paul; Pringsheim, Tamara

doi:10.1177/070674371205700303

Cited by 138 publications

(93 citation statements)

References 24 publications

(27 reference statements)

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“…The studies on nonpharmacological treatment modalities are described in the companion article in this In Review. 7 Studies performed before 1990 used a wide variety of outcome measures for the measurement of tic severity, and frequently used crossover study designs, with poor reporting of results. Therefore, we were unable to perform a metaanalysis of study results for most medications.…”

Section: Resultsmentioning

confidence: 99%

Canadian Guidelines for the Evidence-Based Treatment of Tic Disorders: Pharmacotherapy

et al. 2012

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This article seeks to provide the practising clinician with guidance on the pharmacological management of tic disorders in children and adults. We performed a systematic review of the literature on the treatment of tic disorders. A multi-institutional group of 14 experts in psychiatry, child psychiatry, neurology, pediatrics, and psychology engaged in a consensus meeting. The evidence was presented and discussed, and nominal group techniques were employed to arrive at consensus on recommendations. A strong recommendation is made when the benefits of treatment clearly outweigh the risks and burdens, and can apply to most patients in most circumstances without reservation. With a weak recommendation, the benefits, risks, and burdens are more closely balanced, and the best action may differ depending on the circumstances. Based on these principles, weak recommendations were made for the use of pimozide, haloperidol, fluphenazine, metoclopramide (children only), risperidone, aripiprazole, olanzapine, quetiapine, ziprasidone, topiramate, baclofen (children only), botulinum toxin injections, tetrabenazine, and cannabinoids (adults only). Strong recommendations were made for the use of clonidine and guanfacine (children only). While the evidence supports the efficacy of many of the antipsychotics for the treatment of tics, the high rates of side effects associated with these medications resulted in only weak recommendations for these drugs. In situations where tics are not severe or disabling, the use of a medication with only a weak recommendation is not warranted. However, when tics are more distressing and interfering, the need for tic suppression to improve quality of life is stronger, and patients and clinicians may be more willing to accept the risks of pharmacotherapy.

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Section: Resultsmentioning

confidence: 99%

Canadian Guidelines for the Evidence-Based Treatment of Tic Disorders: Pharmacotherapy

et al. 2012

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“…162 In one current guideline, relaxation therapy is recommended as a second-line behavioural therapy 158 but, in another, no recommendation regarding relaxation training is made. 159 …”

Section: Relaxation Therapymentioning

confidence: 99%

“…Current guidelines recommend HRT/CBIT for use in children and adults. 158,159 Exposure and response prevention Exposure and response prevention is based on the theory that tics are performed in order to dispel the premonitory urge sensation that precede them. 160 ERP aims to habituate patients to these sensations so that their effect is reduced and patients can avoid performing the tic.…”

Section: Comprehensive Behavioural Intervention For Ticsmentioning

confidence: 99%

Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis

Hollis

Pennant

Cuenca

et al. 2016

Health Technol Assess

126

106

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BackgroundTourette syndrome (TS) is a neurodevelopmental condition characterised by chronic motor and vocal tics affecting up to 1% of school-age children and young people and is associated with significant distress and psychosocial impairment.ObjectiveTo conduct a systematic review of the benefits and risks of pharmacological, behavioural and physical interventions for tics in children and young people with TS (part 1) and to explore the experience of treatment and services from the perspective of young people with TS and their parents (part 2).Data SourcesFor the systematic reviews (parts 1 and 2), mainstream bibliographic databases, The Cochrane Library, education, social care and grey literature databases were searched using subject headings and text words for tic* and Tourette* from database inception to January 2013.Review/research methodsFor part 1, randomised controlled trials and controlled before-and-after studies of pharmacological, behavioural or physical interventions in children or young people (aged < 18 years) with TS or chronic tic disorder were included. Mixed studies and studies in adults were considered as supporting evidence. Risk of bias associated with each study was evaluated using the Cochrane tool. When there was sufficient data, random-effects meta-analysis was used to synthesize the evidence and the quality of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. For part 2, qualitative studies and survey literature conducted in populations of children/young people with TS or their carers or in health professionals with experience of treating TS were included in the qualitative review. Results were synthesized narratively. In addition, a national parent/carer survey was conducted via the Tourettes Action website. Participants included parents of children and young people with TS aged under 18 years. Participants (young people with TS aged 10–17 years) for the in-depth interviews were recruited via a national survey and specialist Tourettes clinics in the UK.ResultsFor part 1, 70 studies were included in the quantitative systematic review. The evidence suggested that for treating tics in children and young people with TS, antipsychotic drugs [standardised mean difference (SMD) –0.74, 95% confidence interval (CI) –1.08 to –0.41;n = 75] and noradrenergic agents [clonidine (Dixarit®, Boehringer Ingelheim) and guanfacine: SMD –0.72, 95% CI –1.03 to –0.40;n = 164] are effective in the short term. There was little difference among antipsychotics in terms of benefits, but adverse effect profiles do differ. Habit reversal training (HRT)/comprehensive behavioural intervention for tics (CBIT) was also shown to be effective (SMD –0.64, 95% CI –0.99 to –0.29;n = 133). For part 2, 295 parents/carers of children and young people with TS contributed useable survey data. Forty young people with TS participated in in-depth interviews. Four studies were in the qualitative review. Key themes were difficulties in accessing specialist care and behavioural interventions, delay in diagnosis, importance of anxiety and emotional symptoms, lack of provision of information to schools and inadequate information regarding medication and adverse effects.LimitationsThe number and quality of clinical trials is low and this downgrades the strength of the evidence and conclusions.ConclusionsAntipsychotics, noradrenergic agents and HRT/CBIT are effective in reducing tics in children and young people with TS. The balance of benefits and harms favours the most commonly used medications: risperidone (Risperdal®, Janssen), clonidine and aripiprazole (Abilify®, Otsuka). Larger and better-conducted trials addressing important clinical uncertainties are required. Further research is needed into widening access to behavioural interventions through use of technology including mobile applications (‘apps’) and video consultation.Study registrationThis study is registered as PROSPERO CRD42012002059.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…VoIP treatments for insomnia (Lichstein, Scogin, Thomas, DiNapoli, Dillon, & McFadden, 2013), social phobia (Yuen et al, 2013), OCD (Storch et al, 2011), substance abuse (King, Brooner, Peirce, Kolodner, & Kidorf, 2014), and depression in older adults (Choi et al, 2014a;Choi, Wilson, Sirrianni, Marinucci, & Hegel, 2014b ) have been associated with significant decreases in target symptoms. Additionally, high satisfaction (Choi et al, 2014a;King et al, 2014;Storch et al; and a strong therapeutic alliance (King et al;Lichstein et al, 2013;Yuen et al, 2013) have been observed. With respect to feasibility, patients have found the modality to be convenient, but technical difficulties (Choi et al, 2014b;King et al, 2014;Lichstein et al, 2013;Yuen et al, 2013) and challenges reading body language (Lichstein et al, 2013;Storch et al, 2011) are common.…”

mentioning

confidence: 98%

“…Additionally, high satisfaction (Choi et al, 2014a;King et al, 2014;Storch et al; and a strong therapeutic alliance (King et al;Lichstein et al, 2013;Yuen et al, 2013) have been observed. With respect to feasibility, patients have found the modality to be convenient, but technical difficulties (Choi et al, 2014b;King et al, 2014;Lichstein et al, 2013;Yuen et al, 2013) and challenges reading body language (Lichstein et al, 2013;Storch et al, 2011) are common. Despite preliminary evidence, research on the efficacy and feasibility of VoIP-delivered therapy is still rather limited; and the validity and reliability of administering clinician-rated measures via this modality have yet to be assessed.…”

mentioning

confidence: 98%

Pilot Open Case Series of Voice over Internet Protocol-Delivered Assessment and Behavior Therapy for Chronic Tic Disorders

Ricketts

Bauer

Ran³

et al. 2016

Cognitive and Behavioral Practice

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Comprehensive Behavioral Intervention for Tics (CBIT) is an efficacious treatment for children with Chronic Tic Disorders (CTDs). Nevertheless, many families of children with CTDs are unable to access CBIT due to a lack of adequately trained treatment providers, time commitment, and travel distance. This study established the interrater reliability between in-person and VoIP administrations of the Yale Global Tic Severity Scale (YGTSS), and examined the preliminary efficacy, feasibility, and acceptability of Voice over Internet Protocol (VoIP)-delivered CBIT for reducing tics in children with CTDs in an open case series. Across in-person and VoIP administrations of the YGTSS, results showed mean agreement of 91%, 96%, and 95% for motor, phonic, and total tic severity subscales. In the pilot feasibility study, four children received 8-weekly sessions of CBIT via VoIP and were assessed at pre- and post-treatment by an independent evaluator. Results showed a 29.44% decrease in clinician-rated tic severity from pre to post-assessment on the YGTSS. Two of the four patients were considered treatment responders at post treatment, using Clinical Global Impressions-Improvement ratings. Therapeutic alliance, parent and child treatment satisfaction and videoconferencing satisfaction ratings were high. CBIT was considered feasible to implement via VoIP, although further testing is recommended.

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Canadian Guidelines for the Evidence-Based Treatment of Tic Disorders: Behavioural Therapy, Deep Brain Stimulation, and Transcranial Magnetic Stimulation

Cited by 138 publications

References 24 publications

Canadian Guidelines for the Evidence-Based Treatment of Tic Disorders: Pharmacotherapy

Canadian Guidelines for the Evidence-Based Treatment of Tic Disorders: Pharmacotherapy

Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis

Pilot Open Case Series of Voice over Internet Protocol-Delivered Assessment and Behavior Therapy for Chronic Tic Disorders

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