Randomized Controlled Trial of Probiotic PS128 in Children with Tourette Syndrome

Chang-Chun Wu,Chianne-Wen Yang,Ying-Chieh Tsai,Wang-Tso Lee,Hsiao-Yun Hu,Feng-Shiang Cheng,Chia-Jui Hsu,Lee-Chin Wong

doi:10.3390/nu13113698

Abstract

Tourette syndrome results from a complex interaction between social–environmental factors, multiple genetic abnormalities, and neurotransmitter disturbances. This study is a double-blinded, randomized controlled trial using probiotics Lactobacillus plantarum PS128 as an intervention to examine if probiotics improve symptoms of children with Tourette syndrome. This study enrolled children aged 5 to 18 years old who fulfilled DSM-V diagnostic criteria for Tourette syndrome. Patients were assessed before initiating the trial, at one month, and at two months after randomization. The primary outcome was evaluated by Yale Global Tic Severity Scale (YGTSS), and the secondary outcome studied the possible comorbidities in these children. The results revealed no significant difference in improvement in YGTSS between the control group and the PS128 group. As for secondary endpoints, an analysis of Conners’ Continuous Performance Test (CPT) showed improvement in commission and detectability in the PS128 group. In conclusion, although probiotics may not have tic-reducing effects in children with Tourette syndrome, it may have benefits on comorbidities such as attention deficit and hyperactivity disorder (ADHD). Further studies are needed to clarify the effects of probiotics on the comorbidities of Tourette syndrome children.

Highlights

Tourette syndrome results from a complex interaction between social–environmental factors, multiple genetic abnormalities, and neurotransmitter disturbances
This is a randomized clinical trial with a double-blind, placebo-controlled design to examine if probiotic PS128 may have a positive effect on Tourette syndrome children
The present study reflected that intervention with PS128 did not have a superior response in tic severity improvement compared to the control group

Summary

Introduction

Tourette syndrome results from a complex interaction between social–environmental factors, multiple genetic abnormalities, and neurotransmitter disturbances. The proposed pathogenesis of Tourette syndrome includes disturbance in the cortico– striatal–thalamic–cortical (mesolimbic) circuit, stronger neural activity and interregional causality throughout the motor pathway [2], reduced neuroplastic changes in control systems reflected by the reduced caudate volume over time [3], hyperresponsive spikedependent dopamine release following stimulation [4], reduction in cerebrospinal fluid of 5-hydroxyindoleacetic acid [5], and gene polymorphism [6,7]. Studies examining the effects of probiotics and pediatric neurodevelopmental and neuropsychiatric diseases have been done [18]. The contribution of gut microbiota to neurodevelopmental or neuropsychiatric diseases is complicated, and there are many other influencing factors such as genetic, epigenetic, diet, social environment, exercise, and time frame of probiotic intervention; the mechanism behind these factors is yet fully elucidated [19]. More studies are needed to explore microbiome modulation as a possible intervention for pediatric neurodevelopment and neuropsychiatric diseases

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Discussion

Conclusion