Tourette Syndrome In Children Research Articles

A qualitative study of Chinese parental perspectives on the causes of Tourette syndrome in children

Parents’ beliefs and attitudes toward their children with Tourette syndrome (TS) influence treatment-seeking behaviors. This study aimed to explore and describe the Chinese parents’ perspectives on the causes of TS for their children. A qualitative study using semi-structured interviews was conducted with the parents of TS patients from a children’s hospital in western China from June to July 2021, and thematic analysis was performed to transcribe interviews and identify themes. A total of 13 participants were interviewed in this study. Five themes were developed in relation to the cognition of the causes of TS in parents, including physical problems, parenting and education problems, mental problems, bad habits, and neurological problems. Due to the insufficient awareness of TS, most parents repeatedly seek medical advice that they regarded the symptoms as physical problems or neurological problems. They generally felt guilty and blamed themselves for their parenting styles and education methods. And some parents attributed it to the poor psychological quality or the bad habits of children. Study findings showed a lack of scientific understanding of the causes of TS among parents further hindered the timely effective treatment for patients and affected the family relationships, which highlights the importance of public education and raising awareness of the disease.

Research Progress on Integrated Chinese and Western Medicine Treatment of Tourette Syndrome in Children

Tourette syndrome is a common neuropsychiatric disorder that affects the physical and mental health of children. Early detection, diagnosis, and treatment are crucial to prevent serious impacts on the affected children, their families, and society. In recent years, there has been an increasing trend towards using a combination of methods in the clinical treatment of children with Tourette syndrome. This approach has achieved remarkable results, leading to a reduction in the rate of Tourette syndrome symptoms in children. In recent years, a combination of clinical methods has been used to treat children with Tourette syndrome, resulting in significant improvement in control rates. This article reviews the etiology of infantile Tourette syndrome and the progress made in Chinese and Western medicine treatments, providing a reference for further treatment of the condition.

Analysis of the Treatment of Tourette Syndrome in Children from the Harmonization of Liver and Spleen

Analysis of the Treatment of Tourette Syndrome in Children from the Harmonization of Liver and Spleen

Trends of Tourette Syndrome in children from 2011 to 2021: A bibliometric analysis.

Analyze the research status of Tourette Syndrome (TS) in children by CiteSpace and determine the current research hotspots and frontiers. We chose publications indexed in the Web of Science Core Collection (WoSCC) database for studies related to TS in children from 2011 to 2021. We built online cooperation maps of countries/regions, institutions, authors, journals, references, and keywords by CiteSpace, and identified hotspots and frontiers of study for children's TS. A total of 1,232 publications about TS in children were downloaded from the WoSCC. The USA (414) was the country with the highest rate of production, and University College London (87) was the institution that had the highest publication rate. Andrea Eugenio Cavanna was the most prolific author (39 papers). There was inactive cooperation between institutions, countries/regions, and authors. The Journal of European Child & Adolescent Psychiatry was the most active journal. Hot topics focused on epidemiology, comorbidities, deep brain stimulation, behavioral therapy, basal ganglia, pharmacological treatment, and risk factors of TS in children. According to the CiteSpace results, this study found that authors, countries/regions, and institutions were not actively working together. Current research hotspots mainly consist of epidemiology, comorbidities, deep brain stimulation, behavior therapy, and basal ganglia. The main research trends include comorbidities, pharmacological treatment, and risk factors. Therefore, international cooperation should be strengthened in the future, and it should be mindful of the psychiatric comorbidities of TS, the choice of intervention measures, and early warning of risk factors.

British teachers' knowledge and awareness of Tourette syndrome in children attending mainstream school

Mainstream primary and secondary schools are increasingly committed to the inclusion of students with Tourette Syndrome (TS). This qualitative study explores teachers' perceptions of factors that have contributed to, or hindered, their success in creating an inclusive environment for children with Tourette Syndrome (TS). Eight teachers (two males, six females) from mainstream primary and secondary schools in the United Kingdom (UK) took part in semi‐structured interviews to ascertain their knowledge, training and experience of TS during their professional careers in the UK. Thematic analysis of the transcripts revealed three main themes: teachers' lack of real knowledge and awareness of TS; training provision and marginalisation of TS; and finding solutions and building alliances. Although many of the teachers described their mainstream school as an inclusive environment, many still believed they lacked the professional training to adequately understand the disorder. By enhancing teacher training related to TS, improvements may be seen in the communications between the teachers and parents, and opportunities to educate children and the wider community will also result in a more inclusive environment, reducing specific and generic stressors for children with TS.

Safety and Efficacy of Flexible-Dose Deutetrabenazine in Children and Adolescents With Tourette Syndrome

Tourette syndrome is a neurodevelopmental disorder characterized by childhood onset of motor and phonic tics; treatments for tics are associated with safety concerns. Deutetrabenazine is a selective vesicular monoamine transporter 2 inhibitor approved for the treatment of chorea associated with Huntington disease and tardive dyskinesia in adults. To examine whether deutetrabenazine is effective and safe for the treatment of Tourette syndrome in children and adolescents. This phase 2/3, randomized, double-masked, placebo-controlled, parallel-group, dose-titration study included children and adolescents (aged 6-16 years) with Tourette syndrome with active tics causing distress or impairment (ie, Yale Global Tic Severity Scale-Total Tic Score [YGTSS-TTS] ≥20). The trial was conducted over 12 weeks, with 1 week of follow-up from February 2018 to November 2019 at 36 centers in the United States, Canada, Denmark, Russia, Serbia, and Spain. Data analysis was conducted from January 31 to April 22, 2020. Patients were randomized (1:1) to receive deutetrabenazine or placebo, titrated during 7 weeks to an optimal level, followed by a 5-week maintenance period. The maximum total daily deutetrabenazine dose was 48 mg/d. The primary efficacy end point was change from baseline to week 12 in YGTSS-TTS. Key secondary end points included changes in Tourette Syndrome-Clinical Global Impression, Tourette Syndrome-Patient Global Impression of Impact, and Child and Adolescent Gilles de la Tourette Syndrome-Quality of Life Activities of Daily Living subscale score. Safety was assessed based on treatment-emergent adverse events, vital signs, questionnaires, and laboratory parameters. A total of 119 participants were randomized to deutetrabenazine (59 participants; mean [SD] age, 11.5 [2.5] years; 53 [90%] boys; 49 [83%] White; 3 [5%] Black) and placebo (60 participants; mean [SD] age, 11.5 [2.6] years; 51 [85%] boys; 53 [88%] White; 3 [5%] Black). At week 12, the difference in YGTSS-TTS score was not significant between deutetrabenazine and placebo (least squares mean difference, -0.7; 95% CI, -4.1 to 2.8; P = .69; Cohen d, -0.07). There were no nominally significant differences between groups for key secondary end points. Treatment-emergent adverse events were reported for 38 patients (66%) and 33 patients (56%) receiving deutetrabenazine and placebo, respectively, and were generally mild or moderate. In this study of deutetrabenazine in children and adolescents with Tourette syndrome, the primary efficacy end point was not met. No new safety signals were identified. These results may be informative for future studies of treatments for tics in Tourette syndrome. ClinicalTrials.gov Identifier: NCT03452943.

Comorbid chronic tic disorder and tourette syndrome in children requiring inpatient mental health treatment.

Children needing admission to an inpatient mental health unit often present with severe neuropsychiatric disorders characterised by complex psychopathology. We aimed to examine all admitted children with comorbid chronic tic disorder (CTD) and Tourette syndrome (TS) over a 10-year period and determine the clinical significance of these diagnoses. A retrospective, naturalistic study was conducted, comparing children with and without CTD/TS in terms of co-morbid diagnoses, medication use, access to education, aggression contributing to the admission, duration of admission, functional outcomes and satisfaction with treatment. Data were analysed using Chi-square/Fisher's exact test and t-test for categorical and continuous variables, respectively, and subsequently with unadjusted and adjusted linear and logistic regression analyses. A relatively high proportion of children had co-morbid CTD/TS (19.7%). There was a significant association with co-morbid obsessive-compulsive disorder, intellectual disability and autism spectrum disorder but not attention deficit hyperactivity disorder. CTD/TS were associated with longer admissions even after adjustments for confounding but did not seem to be independently associated with other examined clinical characteristics. The prevalence of CTD/TS in children needing inpatient treatment is significant. In our sample, comorbid CTD/TS seem to represent a marker of overall symptom severity as evidenced by longer admissions.

GILLES DE LA TOURETTE SYNDROME (GTS)- A RARELY DIAGNOSED AND UNDER REPORTED DISORDER IN NIGERIA

Background: Tourette Syndrome (TS) is an uncommon neuropsychiatric disorder and less frequently diagnosed. The population prevalence estimate of TS in children was 0.3% to 0.9%. In Nigeria, this suggests that approximately 100,000 people are affected considering the estimated population of 200,000,000. Objective: To present a case report of a teenager with a diagnosis of Gilles de la Tourette Syndrome. Case Report: This is case report of a 15-year-old female secondary school student who presented to psychiatric department of a Nigerian Teaching Hospital with 3 years history of verbal and physical aggression towards parents and siblings. She was abusive and sometimes beats her siblings and parents for no obvious reason. She talks repeatedly to imaginary person, saying “leave me alone, I am not killing your child, you do not have respect” She sometimes hits the imaginary person. She blinks, hisses, grunts and shouts. These behaviours are repetitive, usually last for about 3 minutes. Tourette syndrome diagnosis was made after comprehensive evaluation using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. Conclusion: The appropriate referral of this patient is of great benefit in the course of her illness. She achieved significant improvement to enable her continue education.

Tourette syndrome in children.

Gilles de la Tourette syndrome (GTS), characterised by motor and vocal tics, has a prevalence of approximately 1% inschool-aged children. Commonly encountered comorbidities of GTS include attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive behaviour/disorder (OCB/OCD). Genetic factors play an important part in the aetiology of GTS, and family members may exhibit tics or related disorders such as ADHD, OCB or OCD. The aim of this article is to present a summary of the current evidence to assist the assessment and management of GTS in primary care. A comprehensive assessment should include exploration of not only tics butalso associated features and comorbidities. The stigmatising and impairing nature of tics can have a significant impact on the quality of life ofthe young person and their parents/carers, as well as on family functioning. Management includes education and explanation, behavioural treatments and(sometimes) medication.

Therapist-Supported Online Remote Behavioural Intervention for Tics (ORBIT) in Children and Adolescents: A Single-Blind Randomised Controlled Trial

Background: Behaviour therapy is an effective treatment in children and adolescents with tic disorders but is rarely available. Online delivery could widen access to therapy. We evaluated the efficacy of internet-delivered, therapist-supported and parent-assisted Exposure and Response Prevention (ERP) for tics. Methods: Multi-centre, parallel group, single-blind, randomised controlled trial. Eligible participants were aged 9-17 years with Tourette syndrome/chronic tic disorder, who had not received behaviour therapy for tics within 12 months, and had a Yale Global Tic Severity Scale (YGTSS) Total Tic Severity Score (TTSS) of >15, or >10 if motor or vocal tics only. Participants were recruited via 16 patient identification centres, two study sites, or online self-referral, and were randomised (1:1) by blinded outcome-assessors to receive either 10 weeks of ERP or psychoeducation (active control). The primary outcome was YGTSS-TTSS at 3 months’ post-randomisation, analysis was by intention-to-treat. The mean cost per patient for the intervention and health care costs were calculated. Registrations are ISRCTN (ISRCTN70758207) and ClinicalTrials.gov (NCT03483493). Findings: Between 8 th May 2018 and 30 th September 2019, 224 participants were enrolled; 112 to ERP and 112 to psychoeducation. The ERP intervention reduced YGTSS-TTSS by 2 . 29 points (95% CI: ‑3 . 86 to -0 . 71) compared to the psychoeducation group at 3 months, an effect that increased by 6 months post-randomisation (-2 . 64, 95% CI: -4 . 56 to -0 . 73). The average therapist time spent supporting the intervention was 2 . 5 hours. The additional cost per participant of the ERP intervention compared to psychoeducation was £159 (95% CI -£53 to £370). There were two unrelated serious adverse events, both in the psychoeducation group. Interpretation: Online-delivered, therapist-supported ERP therapy is clinically effective at reducing tics, with minimal therapist contact time. Online delivery could improve access to evidence-based treatment for tics in children and adolescents. Trial Registration: Registrations are ISRCTN (ISRCTN70758207) and ClinicalTrials.gov (NCT03483493). Funding: National Institute for Health Research, Health and Technology Assessment (HTA) Declaration of Interest: All authors have completed the ICMJE uniform disclosure from. Aside from receiving funding from NIHR to support their salaries CLH, LM, EBD, RJ, KK, BJB, CS, CM, ES, PA, TM, IS, JK, RH, MLN, AE, LRC, NK, SB, CG, EM declare no conflict of interests. CH declares he was Principal Investigator on a grant from the National Institute of Health Research (NIHR) Health Technology Assessment programme to conduct an Evidence Synthesis on the treatments for tics and Tourette syndrome in children and young people’ HTA Project:10/142/01. DM-C reports personal fees from Elsevier, personal fees from UpToDate Inc. outside the submitted work. Ethical Approval: Ethical and Health Research Authority (HRA) approval was received from North West Greater Manchester Research Ethics Committee on 23 March 2018 (ref.:18/NW/0079). The published trial protocol is available online15 and was approved by an independent trial steering committee (TSC) and data monitoring committee (DMC). Two substantial amendments were made and can be found in the appendix p1. The trial was prospectively registered with the ISRCTN (ISRCTN70758207) and ClinicalTrials.gov (NCT03483493).

Treatment use among children with Tourette syndrome living in the United States, 2014

Treatment of Tourette syndrome (TS) can be complicated by changes over time in tic expression, severity, and co-occurring disorders. Using the 2014 National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome, this study provides descriptive estimates of the use of behavioral interventions and medication among children living with TS. Parent-reported data on 115 children aged 5–17 years ever diagnosed with TS were analyzed to provide descriptive, unweighted results. Overall, 77.4% of children had current or past use of any TS treatment; 59.1% ever used behavioral interventions and 56.1% had ever taken TS medication. Children with "moderate” or “severe” versus “mild” TS, ≥1 co-occurring disorders, and tics that interfered with functioning were significantly more likely to have used one or more TS treatments. Side effects were reported for 84.4% of children who took TS medication. Most parents of children with current TS (87.2%) were satisfied with the management of their child's TS. However, parents of children with “moderate” or “severe” current TS were significantly more dissatisfied compared to parents of children with “mild” TS. Findings from this study could be used to inform efforts to support children living with TS and their families.

152 Development of Deutetrabenazine as a Potential New Non-Antipsychotic Treatment for Tourette Syndrome in Children and Adolescents

Tourette syndrome (TS) is a neurodevelopmental disorder characterized by the hyperkinetic movements of motor and phonic tics manifested in young age. Currently approved treatments in the United States are antipsychotics: haloperidol, pimozide, and aripiprazole, which are associated with serious side effects, including tardive dyskinesia (TD). Deutetrabenazine, a vesicular monoamine transporter type 2 (VMAT2) inhibitor, was approved in 2017 by the US FDA for the treatment of chorea associated with Huntington's disease and TD. Three ongoing studies (Alternatives for Reducing Tics in TS [ARTISTS]) are evaluating the efficacy, safety, and tolerability of deutetrabenazine in reducing tics in TS in children and adolescents (age 6-16 years). ARTISTS 1, a phase 2/3, response-driven, dose-titration, placebo-controlled study, randomizes patients (N=116) 1:1 to deutetrabenazine or placebo for 12 weeks. ARTISTS 2, a phase 3, fixed-dose study, randomizes patients (N=150) 1:1:1 to deutetrabenazine high or low dose, or placebo for 8 weeks. The primary efficacy outcome in these pivotal studies is change from baseline to end of treatment in the Total Tic Score (TTS) of the Yale Global Tic Severity Scale (YGTSS). Additional efficacy endpoints and safety/tolerability are also evaluated. ARTISTS is a 56-week, open-label, single-arm, long-term safety/tolerability study in patients who have successfully completed either ARTISTS 1 or ARTISTS 2. Not available yet. TS can have potentially long-term life impact, and there remains unmet medical need for effective and well-tolerated treatments. Three ARTISTS studies will evaluate the efficacy, safety, and tolerability of deutetrabenazine in patients with tics in TS. The studies are sponsored by Teva Pharmaceuticals and operationalized by Teva's development partner, Nuvelution TS Pharma INC.

Profile Of Tourette Syndrome In Children And Adolescents From A Tertiary Care Child Psychiatry Centre In India

Introduction: Tourette Syndrome is a type of tic disorder that is not as rare as it was once thought to be. There is a paucity of literature on Tourette syndrome in children and adolescents in the Indian setting. The objectives of this study were to elucidate sociodemographic and clinical profile of children and adolescents with Tourette syndrome. 
 Material and Method: The present study is a retrospective chart review of children and adolescents up to age 18 years diagnosed with Tourette Syndrome in a tertiary care centre, India. This sample is from a subset of a larger sample of case records of patients with a diagnosis of tic disorder, coded as F 95, according to ICD 10 from 1st January 2014 to 31st December 2017 (4 years duration). 
 Results: The sample included 28 children. All of them were male, and the mean age of onset was 8.2 years. The period prevalence of Tourette syndrome was 0.22%. The entire sample received pharmacotherapy and the most common medication prescribed was Risperidone followed by Clonidine, Aripiprazole, Haloperidol, and Tetrabenazine. Majority (64.28%) of the sample had a comorbid condition. The most common comorbid conditions were Hyperkinetic Disorders followed by Obsessive Compulsive Disorder Specific and Specific Developmental Disorder of Scholastic skills 
 Conclusion: Tourette syndrome can be a disabling condition in school-going children. There is a need for population-based studies for estimating its prevalence in Indian subcontinent., and there is also a great need to increase awareness and sensitize the public to seek help to improve the quality of life of children and adolescents with Tourette syndrome.

Tourette syndrome in children in Norway.

Tourette syndrome first appears in childhood and is characterised by chronic motor and vocal tics. In other countries, the mean prevalence is estimated at 0.77% in children aged 6-15 years. Diagnostic practice and treatment have not been investigated in Norway. We used data retrieved from the Norwegian Patient Registry and the National Registry to calculate the percentage of children born during the period 2002-10 diagnosed with Tourette syndrome. The calculations were made for the country as a whole as well as by county. Drug therapy was investigated using data from the Norwegian Prescription Database. By the age of 12, altogether 0.43% had received a diagnosis of Tourette syndrome, broken down into 0.71% for boys and 0.15% for girls. The overall percentage varied from 0.15% to 1.23% between the counties. For Norway as a whole, the percentage of diagnoses remained stable between 2008 and 2016. Psychiatric and neurological conditions were often present - the most common being hyperkinetic disorder (50%) and autism spectrum disorder (11%). Antipsychotic drugs, probably for the treatment of tics, were prescribed for 16% in the year following the diagnosis. The percentage of children with a diagnosis of Tourette syndrome is lower than the mean prevalence in population studies internationally. The diagnostic practice varies considerably from county to county.

Ecopipam Tablets to Study Tourette Syndrome in Children and Adolescents - Open Label Extension

Ecopipam Tablets to Study Tourette Syndrome in Children and Adolescents - Open Label Extension

Deep brain stimulation for Gilles de la Tourette syndrome in children and youth: a meta-analysis with individual participant data.

Gilles de la Tourette syndrome (GTS) is a disorder characterized by motor and vocal tics. Although by definition the onset of GTS is before age 18 years, clinical trials of deep brain stimulation (DBS) have been conducted only in adults. Using individual participant data (IPD) meta-analysis methodology, the current study investigated the safety and efficacy of DBS as a treatment for GTS in children and youth. A systematic review with no date or language restrictions was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Three electronic databases were searched: PubMed, EMBASE, and Web of Science. From 843 articles screened, the IPD of 58 children and youth (ages 12–21 years) extracted from 21 articles were collected and analyzed. A mixed-effects univariable analysis followed by multivariable hierarchical regression was performed using change in the Yale Global Tic Severity Scale (YGTSS) score as the primary outcome and reported measures of comorbidities as secondary outcomes. The authors’ results showed an average improvement of 57.5% ± 24.6% across studies on the YGTSS. They also found that comorbid depression and stimulation pulse width each correlated negatively with outcome (p < 0.05). In patients with less severe GTS, greater improvements were evident following thalamic stimulation. More than one-quarter (n = 16, 27.6%) of participants experienced side effects, the majority of which were minor. DBS in the pediatric population may be an effective option with a moderate safety profile for treatment of GTS in carefully selected children and youth. Large, prospective studies with long-term follow-up are necessary to understand how DBS influences tic symptoms and may alter the natural course of GTS in children.

Repetitive transcranial magnetic stimulation as a treatment for Tourette's syndrome in children: A pilot study

Repetitive transcranial magnetic stimulation as a treatment for Tourette's syndrome in children: A pilot study

Syndrome differentiation of Zang-Fu for Tourette syndrome in children

Syndrome differentiation of Zang-Fu for Tourette syndrome in children

Differentiating tic-related from non-tic-related impairment in children with persistent tic disorders

Children with persistent (chronic) tic disorders (PTDs) experience impairment across multiple domains of functioning, but given high rates of other non-tic-related conditions, it is often difficult to differentiate the extent to which such impairment is related to tics or to other problems. The current study used the Child Tourette's Syndrome Impairment Scale - Parent Report (CTIM-P) to examine parents' attributions of their child's impairment in home, school, and social domains in a sample of 58 children with PTD. Each domain was rated on the extent to which the parents perceived that impairment was related to tics versus non-tic-related concerns. In addition, the Yale Global Tic Severity Scale (YGTSS) was used to explore the relationship between tic-related impairment and tic severity. Results showed impairment in school and social activities was not differentially attributed to tics versus non-tic-related impairment, but impairment in home activities was attributed more to non-tic-related concerns than tics themselves. Moreover, tic severity was significantly correlated with tic-related impairment in home, school, and social activities, and when the dimensions of tic severity were explored, impairment correlated most strongly with motor tic complexity. Results suggest that differentiating tic-related from non-tic-related impairment may be clinically beneficial and could lead to treatments that more effectively target problems experienced by children with PTDs.

Ecopipam, a D1 receptor antagonist, for treatment of tourette syndrome in children: A randomized, placebo-controlled crossover study.

Dopamine D2 receptor antagonists used to treat Tourette syndrome may have inadequate responses or intolerable side effects. We present results of a 4-week randomized, double-blind, placebo-controlled crossover study evaluating the safety, tolerability, and efficacy of the D1 receptor antagonist ecopipam in children and adolescents with Tourette syndrome. Forty youth aged 7 to 17 years with Tourette syndrome and a Yale Global Tic Severity Scale - total tic score of ≥20 were enrolled and randomized to either ecopipam (50 mg/day for weight of <34 kg, 100 mg/day for weight of >34 kg) or placebo for 30 days, followed by a 2-week washout and then crossed to the alternative treatment for 30 days. Stimulants and tic-suppressing medications were excluded. The primary outcome measure was the total tic score. Secondary outcomes included obsessive compulsive and attention deficit/hyperactivity disorder scales. Relative to changes in placebo, reduction in total tic score was greater for ecopipam at 16 days (mean difference, -3.7; 95% CI, -6.5 to -0.9; P = 0.011) and 30 days (mean difference, -3.2; 95% CI, -6.1 to -0.3; P = 0.033). There were no weight gain, drug-induced dyskinesias, or changes in laboratory tests, electrocardiograms, vital signs, or comorbid symptoms. Dropout rate was 5% (2 of 40). Adverse events reported for both treatments were rated predominantly mild to moderate, with only 5 rated severe (2 for ecopipam and 3 for placebo). Ecopipam reduced tics and was well tolerated. This placebo-controlled study of ecopipam supports further clinical trials in children and adolescents with Tourette syndrome. © 2018 International Parkinson and Movement Disorder Society.