Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders
Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders
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DOI：
10.1212/wnl.0000000000007466
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发表时间：
2019-05-07
期刊：
影响因子：
9.9
通讯作者：
Piacentini, John
中科院分区：
文献类型：
--
作者：
Pringsheim, Tamara;Okun, Michael S.;Piacentini, John
ObjectiveTo就抽动秽语综合征（Tourette syndrome）和慢性抽动障碍（chronic tic disorders.MethodsA）患者的抽动评估和管理提出建议。该多学科小组由9名医生、2名心理学家和2名患者代表组成，他们提出了实践建议，整合了系统评价的结果，并遵循符合医学研究所要求的流程，以确保透明度和患者参与度。支持结构化的理由，整合证据的系统评价，相关证据，护理原则，并从evidence.ResultsForty-six的建议，就个人抽动秽语综合征和慢性抽动障碍的评估和管理。这些包括关于抽动障碍自然史的咨询建议，教师和同龄人的心理教育，共病障碍的评估，以及对持续治疗需求的定期重新评估。治疗方案应该个性化，选择应该是患者，护理人员和临床医生之间的合作决定的结果，在此期间，考虑个体治疗的益处和危害以及共病疾病的存在。治疗方案包括观察等待，抽搐综合行为干预和药物治疗;提供了如何提供和监测这些治疗的建议。对严重的、治疗难治性抽搐的成人患者进行脑深部电刺激的评估和使用提出了建议，并对未来的研究提出了建议。
ObjectiveTo make recommendations on the assessment and management of tics in people with Tourette syndrome and chronic tic disorders.MethodsA multidisciplinary panel consisting of 9 physicians, 2 psychologists, and 2 patient representatives developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine-compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence.ResultsForty-six recommendations were made regarding the assessment and management of tics in individuals with Tourette syndrome and chronic tic disorders. These include counseling recommendations on the natural history of tic disorders, psychoeducation for teachers and peers, assessment for comorbid disorders, and periodic reassessment of the need for ongoing therapy. Treatment options should be individualized, and the choice should be the result of a collaborative decision among patient, caregiver, and clinician, during which the benefits and harms of individual treatments as well as the presence of comorbid disorders are considered. Treatment options include watchful waiting, the Comprehensive Behavioral Intervention for Tics, and medication; recommendations are provided on how to offer and monitor these therapies. Recommendations on the assessment for and use of deep brain stimulation in adults with severe, treatment-refractory tics are provided as well as suggestions for future research.