Abstract
Tic disorders (TD) are a group neuropsychiatric disorders with childhood onset characterized by tics, i.e. repetitive, sudden, and involuntary movements or vocalizations; and Tourette syndrome (TS) is the most severe form of TD. Their clinical manifestations are diverse; and are often associated with various psychopathological and/or behavioral comorbidities, including attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, depression, and sleep disorders. Individual severity and response to treatment are highly variable, and there are some refractory cases, which are less responsive to conventional TD treatment. TD/TS are also common in the Chinese pediatric population. To help improve the understanding of TD for pediatricians and other health professionals, and to improve its diagnosis and treatment in China, the Chinese Child Neurology Society (CCNS) has developed an Expert Consensus on Diagnosis and Treatment of TD in China, which is based on our clinical experience and the availability therapeutic avenues. It is focused on clinical diagnosis and evaluation of TD and its comorbidities, psychological and educational intervention, nonpharmacological therapy, pharmacological treatment, including traditional Chinese medicine and acupuncture, as well as prognosis in children with TD in China. A summary of the current status of TD and up-to-date diagnosis and treatment recommendations for TD in China is presented here.
Highlights
Tic disorders (TD) are a group of common neuropsychiatric disorders with onset in childhood and adolescence, characterized by sudden, rapid, recurrent, nonrhythmic movements or vocalizations, including some simple forms, such as eye blinking, facial grimacing, and throat clearing; and some complex forms, such as body twisting, coprolalia or echolalia (1–3)
Clinical diagnosis of TD relies on detailed medical history, careful physical examination, and some auxiliary tests
TD can be disguised by other prominent symptoms, with comorbidities
Summary
Tic disorders (TD) are a group of common neuropsychiatric disorders with onset in childhood and adolescence, characterized by sudden, rapid, recurrent, nonrhythmic movements or vocalizations, including some simple forms, such as eye blinking, facial grimacing, and throat clearing; and some complex forms, such as body twisting, coprolalia (uttering socially inappropriate words, such as swearing) or echolalia (repeating the words or phrases of others) (1–3). Behavioral therapies are much safer than pharmacological medications and have been proven effective in older children with TD/TS (24, 26–28) It has been highly recommended by the Western experts and guidelines, and it could be gradually introduced and implemented in some centers in China with a large volume of TD/TS patients and available resources. For children with moderate to severe TD that affects daily life, school, and social activities, and when psychological education and behavior therapy are not effective or unavailable, pharmacological therapy is needed (28, 85) The patients and their parents need to understand at the beginning of pharmacological therapy that the outcome of the medication(s) is unlikely to be completely tic-free but rather to improve the control and reduction of tic severity. If symptoms reoccur or aggravate at any time during the course, return to the previous step or resume the process from the beginning
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