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Ganos C, Martino D, Pringsheim T. Tics in the Pediatric Population: Pragmatic Management. Mov Disord Clin Pract. 2016;4(2):160-172doi: 10.1002/mdc3.12428.
Ganos, C., Martino, D., & Pringsheim, T. (2017). Tics in the Pediatric Population: Pragmatic Management. Movement disorders clinical practice, 4(2), 160-172. https://doi.org/10.1002/mdc3.12428
Ganos, Christos, et al. "Tics in the Pediatric Population: Pragmatic Management." Movement disorders clinical practice vol. 4,2 (2017): 160-172. doi: https://doi.org/10.1002/mdc3.12428
Ganos C, Martino D, Pringsheim T. Tics in the Pediatric Population: Pragmatic Management. Mov Disord Clin Pract. 2017 Mar-Apr;4(2):160-172. doi: 10.1002/mdc3.12428. Epub 2016 Nov 11. PMID: 28451624; PMCID: PMC5396140.
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Mov Disord Clin Pract. 2017 Mar-Apr;4(2):160-172. doi: 10.1002/mdc3.12428. Epub 2016 Nov 11.

Tics in the Pediatric Population: Pragmatic Management.

Movement disorders clinical practice

Christos Ganos, Davide Martino, Tamara Pringsheim

Affiliations

  1. Department of Neurology University Medical Center Hamburg-Eppendorf Hamburg Germany.
  2. Sobell Department of Motor Neuroscience and Movement Disorders University College London Institute of Neurology University College London London United Kingdom.
  3. International Parkinson's Centre of Excellence King's College and King's College Hospital Denmark Hill Campus London United Kingdom.
  4. Queen Elizabeth Hospital, Woolwich Lewisham and Greenwich National Health Service Trust London United Kingdom.
  5. Department of Clinical Neurosciences University of Calgary Calgary Alberta Canada.

PMID: 28451624 PMCID: PMC5396140 DOI: 10.1002/mdc3.12428

Abstract

BACKGROUND: Primary tic disorders, notably Tourette syndrome, are very common movement disorders in childhood. However, the management of such patients still poses great therapeutic challenges to medical professionals.

METHODS: Based on a synthesis of the available guidelines published in Europe, Canada, and the United States, coupled with more recent therapeutic developments, the authors provide a pragmatic guide to aid clinicians in deciding when and how to treat patients who have primary tic disorders.

RESULTS: After a systematic assessment of tics and common neuropsychiatric comorbidities (primarily attention-deficit hyperactivity disorder [ADHD] and obsessive-compulsive disorder [OCD]), the first step in treatment is a comprehensive psychoeducation of patients and families that addresses the protean phenomenology of tics and associated behaviors, coping mechanisms, prognosis, and treatment options. When more active intervention beyond watchful monitoring is indicated, hierarchical evaluation of treatment targets (i.e., tics vs. comorbid behavioral symptoms) is crucial. Behavioral treatments for tics are restricted to older children and are not readily available to all centers, mainly due to the paucity of well-trained therapists. Pharmacological treatments, such as antipsychotics for tics, stimulants and atomoxetine for ADHD, and α2A-agonists for children with tics plus ADHD, represent widely available and effective treatment options, but safety monitoring must be provided. Combined polypharmacological and behavioral/pharmacological approaches, as well as neuromodulation strategies, remain under-investigated in this population of patients.

CONCLUSIONS: The treatment of children with tics and Tourette syndrome is multifaceted. Multidisciplinary teams with expertise in neurology, psychiatry, psychology, and pediatrics may be helpful to address the complex needs of these children.

Keywords: Tourette syndrome; antipsychotics; habit reversal training; pharmacological treatment; primary tic disorder

References

  1. J Am Acad Child Adolesc Psychiatry. 2004 Feb;43(2):206-14 - PubMed
  2. Neurosci Biobehav Rev. 2013 Jul;37(6):1162-71 - PubMed
  3. JAMA. 2004 Oct 27;292(16):1969-76 - PubMed
  4. J Am Acad Child Adolesc Psychiatry. 1997 Jun;36(6):844-52 - PubMed
  5. J Am Acad Child Adolesc Psychiatry. 1989 Jul;28(4):566-73 - PubMed
  6. Neurology. 2002 Feb 26;58(4):527-36 - PubMed
  7. J Am Acad Child Adolesc Psychiatry. 2003 Jan;42(1):98-105 - PubMed
  8. Pediatrics. 2012 Jun;129(6):e1577-86 - PubMed
  9. Dev Med Child Neurol. 2009 Jun;51(6):468-72 - PubMed
  10. J Am Acad Child Adolesc Psychiatry. 2012 Feb;51(2):192-201.e5 - PubMed
  11. Hum Psychopharmacol. 2011 Jan;26(1):51-7 - PubMed
  12. J Formos Med Assoc. 2009 Oct;108(10):788-93 - PubMed
  13. J Clin Psychiatry. 2013 Aug;74(8):e772-80 - PubMed
  14. Mov Disord. 2015 Aug;30(9):1198-202 - PubMed
  15. J Psychiatr Res. 2014 Mar;50:106-12 - PubMed
  16. Pediatrics. 2016 Mar;137(3):e20152749 - PubMed
  17. J Psychosom Res. 2009 Dec;67(6):497-501 - PubMed
  18. F1000Res. 2016 Feb 09;5: - PubMed
  19. J Child Neurol. 1999 May;14(5):316-9 - PubMed
  20. Behav Res Ther. 2004 May;42(5):501-11 - PubMed
  21. Neurology. 2003 Apr 8;60(7):1130-5 - PubMed
  22. J Clin Psychiatry. 2001 Jan;62(1):50-6 - PubMed
  23. Cochrane Database Syst Rev. 2011 Apr 13;(4):CD007990 - PubMed
  24. Neurology. 2002 Aug 13;59(3):414-20 - PubMed
  25. J Am Acad Child Adolesc Psychiatry. 2013 Dec;52(12):1341-59 - PubMed
  26. Clin Drug Investig. 2008;28(7):443-59 - PubMed
  27. Brain. 2000 Mar;123 Pt 3:425-62 - PubMed
  28. Behav Res Ther. 1973 Nov;11(4):619-28 - PubMed
  29. J Child Adolesc Psychopharmacol. 1997 Summer;7(2):75-85 - PubMed
  30. Clin Ther. 2012 Jul;34(7):1487-504 - PubMed
  31. J Neurol Sci. 2016 Jul 15;366:136-138 - PubMed
  32. Mov Disord. 2006 Nov;21(11):1831-8 - PubMed
  33. J Child Adolesc Psychopharmacol. 2003;13 Suppl 1:S19-29 - PubMed
  34. JAMA. 2010 May 19;303(19):1929-37 - PubMed
  35. Eur J Paediatr Neurol. 2016 Jan;20(1):80-4 - PubMed
  36. Eur Arch Psychiatry Neurol Sci. 1988;237(4):223-9 - PubMed
  37. Mov Disord. 2011 Mar;26(4):735-8 - PubMed
  38. J Psychiatr Res. 2013 Aug;47(8):1007-12 - PubMed
  39. J Am Acad Child Adolesc Psychiatry. 2002 Mar;41(3):330-6 - PubMed
  40. Arch Neurol. 1984 Mar;41(3):271-2 - PubMed
  41. J Clin Psychopharmacol. 2011 Apr;31(2):174-9 - PubMed
  42. Eur Child Adolesc Psychiatry. 2011 Apr;20(4):173-96 - PubMed
  43. PLoS One. 2010 Sep 24;5(9):e12959 - PubMed
  44. Cochrane Database Syst Rev. 2010 Dec 08;(12):CD008141 - PubMed
  45. Clin Neuropharmacol. 1993 Apr;16(2):167-72 - PubMed
  46. Health Technol Assess. 2016 Jan;20(4):1-450, vii-viii - PubMed
  47. J Neurol Neurosurg Psychiatry. 2010 Jan;81(1):70-3 - PubMed
  48. J Child Adolesc Psychopharmacol. 2008 Apr;18(2):197-205 - PubMed
  49. J Am Acad Child Adolesc Psychiatry. 2007 Jul;46(7):840-8 - PubMed
  50. J Am Acad Child Adolesc Psychiatry. 2006 Nov;45(11):1346-1353 - PubMed
  51. Eur Child Adolesc Psychiatry. 2011 Apr;20(4):197-207 - PubMed
  52. J Clin Psychiatry. 2007 Jul;68(7):1088-93 - PubMed
  53. Prog Brain Res. 2008;172:495-513 - PubMed
  54. Am J Psychiatry. 1993 Jan;150(1):93-7 - PubMed
  55. Clin Neuropharmacol. 2014 Jan-Feb;37(1):26-30 - PubMed
  56. Psychiatry Res. 2010 Jul 30;178(2):317-22 - PubMed
  57. Hum Psychopharmacol. 2016 Jan;31(1):11-8 - PubMed
  58. Pediatr Neurol. 2012 Aug;47(2):77-90 - PubMed
  59. Neurology. 2001 Mar 13;56(5):605-10 - PubMed
  60. Br J Psychiatry. 1994 Apr;164(4):469-73 - PubMed
  61. Curr Neurol Neurosci Rep. 2016 Apr;16(4):37 - PubMed
  62. Dev Med Child Neurol. 2000 Jul;42(7):436-47 - PubMed
  63. Neurology. 2001 Mar 13;56(5):599-604 - PubMed
  64. Mov Disord. 2014 Jan;29(1):126-30 - PubMed
  65. Mov Disord. 2015 Feb;30(2):221-8 - PubMed
  66. Brain Dev. 2012 Sep;34(8):667-73 - PubMed
  67. J Am Acad Child Adolesc Psychiatry. 1997 May;36(5):589-96 - PubMed
  68. Neurology. 1988 Mar;38(3):391-4 - PubMed
  69. Anxiety. 1994-1995;1(5):208-15 - PubMed
  70. Neurology. 1984 May;34(5):688-92 - PubMed
  71. Can J Psychiatry. 2015 Feb;60(2):62-76 - PubMed
  72. J Child Adolesc Psychopharmacol. 2010 Aug;20(4):291-8 - PubMed
  73. Curr Treat Options Neurol. 2013 Aug;15(4):385-95 - PubMed
  74. Arch Gen Psychiatry. 1993 Sep;50(9):734-8 - PubMed
  75. Biol Psychiatry. 2007 Feb 1;61(3):344-7 - PubMed
  76. J Clin Psychopharmacol. 2002 Feb;22(1):31-9 - PubMed
  77. J Child Adolesc Psychopharmacol. 2008 Oct;18(5):509-15 - PubMed
  78. Dev Med Child Neurol. 2002 May;44(5):330-8 - PubMed
  79. J Child Adolesc Psychopharmacol. 2009 Dec;19(6):623-33 - PubMed
  80. Can J Psychiatry. 2012 Mar;57(3):133-43 - PubMed
  81. JAMA. 1982 Mar 26;247(12):1729-31 - PubMed
  82. Clin Neuropharmacol. 1990 Jun;13(3):229-35 - PubMed
  83. JAMA Psychiatry. 2015 Apr;72(4):325-33 - PubMed
  84. Annu Rev Pharmacol Toxicol. 1993;33:639-77 - PubMed
  85. Dev Med Child Neurol. 1974 Feb;16(1):76-8 - PubMed
  86. Psychiatry Res. 2001 Mar 25;101(2):171-85 - PubMed
  87. Am J Psychiatry. 1978 May;135(5):585-7 - PubMed
  88. J Am Acad Child Adolesc Psychiatry. 2000 Mar;39(3):292-9 - PubMed
  89. Hum Psychopharmacol. 2015 Nov;30(6):435-41 - PubMed
  90. Neurol Clin. 2015 Feb;33(1):115-36 - PubMed
  91. Mov Disord. 2015 Apr;30(4):448-71 - PubMed
  92. J Nerv Ment Dis. 1998 Apr;186(4):201-6 - PubMed

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