scholarly journals European clinical guidelines for Tourette syndrome and other tic disorders: summary statement

2021 ◽  
Author(s):  
Kirsten R. Müller-Vahl ◽  
Natalia Szejko ◽  
Cara Verdellen ◽  
Veit Roessner ◽  
Pieter J. Hoekstra ◽  
...  
Keyword(s):  
Tourette Syndrome ◽  
Tic Disorders ◽  
Significant Shift ◽  
New Developments ◽  
European Guidelines ◽  
Assessment And Treatment ◽  
Summary Statement ◽  
Practical Algorithm ◽  
Patient Representative ◽  
Deep Brain

AbstractIn 2011 a working group of the European Society for the Study of Tourette syndrome (ESSTS) developed the first European Guidelines for Tourette syndrome (TS) published in the ECAP journal. After a decade ESSTS now presents updated guidelines, divided into four sections: Part I: assessment, Part II: psychological interventions, Part III: pharmacological treatment and Part IV: deep brain stimulation (DBS). In this paper, we summarise new developments described in the guidelines with respect to assessment and treatment of tics. Further, summary findings from a recent survey conducted amongst TS experts on these same topics are presented, as well as the first European patient representative statement on research. Finally, an updated decision tree is introduced providing a practical algorithm for the treatment of patients with TS. Interestingly, in the last decade there has been a significant shift in assessment and treatment of tics, with more emphasis on non-pharmacological treatments.

Assessment and Treatment of Tourette Syndrome and Other Tic Disorders

2010 ◽  
pp. 516-530
Author(s):  
Lawrence Scahill ◽  
Robert A. King ◽  
Paul Lombroso ◽  
Denis G. Sukhodolsky ◽  
James F. Leckman
Keyword(s):  
Tourette Syndrome ◽  
Tic Disorders ◽  
Assessment And Treatment

scholarly journals European clinical guidelines for Tourette syndrome and other tic disorders. Part IV: deep brain stimulation

2011 ◽  
Vol 20 (4) ◽  
pp. 209-217 ◽  
Author(s):  
Kirsten R. Müller-Vahl ◽  
◽  
Danielle C. Cath ◽  
Andrea E. Cavanna ◽  
Sandra Dehning ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Tourette Syndrome ◽  
Brain Stimulation ◽  
Clinical Guidelines ◽  
Tic Disorders ◽  
Deep Brain

scholarly journals European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part IV: deep brain stimulation

2021 ◽  
Author(s):  
Natalia Szejko ◽  
Yulia Worbe ◽  
Andreas Hartmann ◽  
Veerle Visser-Vandewalle ◽  
Linda Ackermans ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Tourette Syndrome ◽  
Brain Stimulation ◽  
Clinical Guidelines ◽  
Expert Knowledge ◽  
Experimental Treatment ◽  
Small Sample ◽  
Tic Disorders ◽  
Meta Analyses ◽  
Deep Brain

AbstractIn 2011 the European Society for the Study of Tourette Syndrome (ESSTS) published its first European clinical guidelines for the treatment of Tourette Syndrome (TS) with part IV on deep brain stimulation (DBS). Here, we present a revised version of these guidelines with updated recommendations based on the current literature covering the last decade as well as a survey among ESSTS experts. Currently, data from the International Tourette DBS Registry and Database, two meta-analyses, and eight randomized controlled trials (RCTs) are available. Interpretation of outcomes is limited by small sample sizes and short follow-up periods. Compared to open uncontrolled case studies, RCTs report less favorable outcomes with conflicting results. This could be related to several different aspects including methodological issues, but also substantial placebo effects. These guidelines, therefore, not only present currently available data from open and controlled studies, but also include expert knowledge. Although the overall database has increased in size since 2011, definite conclusions regarding the efficacy and tolerability of DBS in TS are still open to debate. Therefore, we continue to consider DBS for TS as an experimental treatment that should be used only in carefully selected, severely affected and otherwise treatment-resistant patients.

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

2021 ◽  
Author(s):  
Veit Roessner ◽  
Heike Eichele ◽  
Jeremy S. Stern ◽  
Liselotte Skov ◽  
Renata Rizzo ◽  
...  
Keyword(s):  
Tourette Syndrome ◽  
Pharmacological Treatment ◽  
Behavioral Therapy ◽  
Evidence Base ◽  
Tic Disorders ◽  
Regulatory Control ◽  
Treatment Preferences ◽  
European Guidelines ◽  
Number Of Patients ◽  
First Choice

AbstractIn 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.

Transitioning towards official clinical guidelines for the diagnostics and treatment of severe behavioural problems in children across Europe: current state and future directions.

2017 ◽  
Author(s):  
Alexandra-Raluca Gatej ◽  
Audri Lamers ◽  
Robert Vermeiren ◽  
Lieke van Domburgh
Keyword(s):  
Mental Health ◽  
Clinical Guidelines ◽  
Clinical Decision Making ◽  
Daily Practice ◽  
Clinical Decision ◽  
European Guidelines ◽  
Current State ◽  
Assessment And Treatment ◽  
Evidence Based Treatments ◽  
Multifactorial Approach

Severe behaviour problems (SBPs) in early childhood include oppositional and aggressive behaviours and predict negative mental health outcomes later in life. Although effective treatments for this group are available and numerous clinical practice guidelines have been developed to facilitate the incorporation of evidence-based treatments in clinical decision-making (NICE, 2013), many children with SBPs remain unresponsive to treatment (Lahey & Waldman, 2012). At present, it is unknown how many countries in Europe possess official clinical guidelines for SBPs diagnosis and treatment and what is their perceived utility. The aim was to create an inventory of clinical guidelines (and associated critical needs) for the diagnostics and treatment of SBPs in youth mental health across Europe according to academic experts and mental health clinicians’ opinions. To investigate the aim, two separate online semi-structured questionnaires were used, one directed at academics (N=28 academic experts; 23 countries), and the other at clinicians (N=124 clinicians; 24 countries). Three key results were highlighted. First, guidelines for SBPs are perceived as beneficial by both experts and clinicians. However, their implementation needs to be reinforced and content better adapted to daily practice. Improvements may include taking a multifactorial approach to assessment and treatment, involving the systems around the child, and multidisciplinary collaboration. Second, academic experts and clinicians support the need for further developing national / European guidelines. Finally, future guidelines should address current challenges identified by clinicians to be more applicable to daily practice.

scholarly journals Inhibitory Control on a Stop Signal Task in Tourette Syndrome before and after Deep Brain Stimulation of the Internal Segment of the Globus Pallidus

2021 ◽  
Vol 11 (4) ◽  
pp. 461
Author(s):  
Francesca Morreale ◽  
Zinovia Kefalopoulou ◽  
Ludvic Zrinzo ◽  
Patricia Limousin ◽  
Eileen Joyce ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Tourette Syndrome ◽  
Globus Pallidus ◽  
Brain Stimulation ◽  
Stop Signal ◽  
Stop Signal Task ◽  
Healthy Controls ◽  
Reactive Inhibition ◽  
Double Blind ◽  
Deep Brain

As part of the first randomized double-blind trial of deep brain stimulation (DBS) of the globus pallidus (GPi) in Tourette syndrome, we examined the effect of stimulation on response initiation and inhibition. A total of 14 patients with severe Tourette syndrome were recruited and tested on the stop signal task prior to and after GPi-DBS surgery and compared to eight age-matched healthy controls. Tics were significantly improved following GPi-DBS. The main measure of reactive inhibition, the stop signal reaction time did not change from before to after surgery and did not differ from that of healthy controls either before or after GPi-DBS surgery. This suggests that patients with Tourette syndrome have normal reactive inhibition which is not significantly altered by GPi-DBS.

scholarly journals Altered urinary tetrahydroisoquinoline derivatives in patients with Tourette syndrome: reflection of dopaminergic hyperactivity?

2020 ◽  
Author(s):  
Philipp Capetian ◽  
Veit Roessner ◽  
Caroline Korte ◽  
Susanne Walitza ◽  
Franz Riederer ◽  
...  
Keyword(s):  
Tourette Syndrome ◽  
Diagnostic Value ◽  
Tic Disorders ◽  
Operating Characteristics ◽  
Roc Curve Analysis ◽  
Two Phase ◽  
Dopaminergic Neurotransmission ◽  
Hyperactivity Disorder ◽  
The Central Nervous System ◽  
Chronic Tic Disorders

AbstractTetrahydroisoquinolines (TIQs) such as salsolinol (SAL), norsalsolinol (NSAL) and their methylated derivatives N-methyl-norsalsolinol (NMNSAL) and N-methyl-salsolinol (NMSAL), modulate dopaminergic neurotransmission and metabolism in the central nervous system. Dopaminergic neurotransmission is thought to play an important role in the pathophysiology of chronic tic disorders, such as Tourette syndrome (TS). Therefore, the urinary concentrations of these TIQ derivatives were measured in patients with TS and patients with comorbid attention-deficit/hyperactivity disorder (TS + ADHD) compared with controls. Seventeen patients with TS, 12 with TS and ADHD, and 19 age-matched healthy controls with no medication took part in this study. Free levels of NSAL, NMNSAL, SAL, and NMSAL in urine were measured by a two-phase chromatographic approach. Furthermore, individual TIQ concentrations in TS patients were used in receiver-operating characteristics (ROC) curve analysis to examine the diagnostic value. NSAL concentrations were elevated significantly in TS [434.67 ± 55.4 nmol/l (standard error of mean = S.E.M.), two-way ANOVA, p < 0.0001] and TS + ADHD patients [605.18 ± 170.21 nmol/l (S.E.M.), two-way ANOVA, p < 0.0001] compared with controls [107.02 ± 33.18 nmol/l (S.E.M.), two-way ANOVA, p < 0.0001] and NSAL levels in TS + ADHD patients were elevated significantly in comparison with TS patients (two-way ANOVA, p = 0.017). NSAL demonstrated an AUC of 0.93 ± 0.046 (S.E.M) the highest diagnostic value of all metabolites for the diagnosis of TS. Our results suggest a dopaminergic hyperactivity underlying the pathophysiology of TS and ADHD. In addition, NSAL concentrations in urine may be a potential diagnostic biomarker of TS.

scholarly journals Efficacy and Safety of Deep Brain Stimulation in Tourette Syndrome

2018 ◽  
Vol 75 (3) ◽  
pp. 353 ◽  
Author(s):  
Daniel Martinez-Ramirez ◽  
Joohi Jimenez-Shahed ◽  
James Frederick Leckman ◽  
Mauro Porta ◽  
Domenico Servello ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Tourette Syndrome ◽  
Brain Stimulation ◽  
Efficacy And Safety ◽  
Deep Brain
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