感觉症状与Tourette综合征预后的关系

目的：分析Tourette综合征感觉症状对预后的影响.方法：随机选取Tourette综合征男性患儿120例,使用感觉性症状问卷进行评定,其中伴有感觉症状的患儿66例,不伴感觉症状的患儿54例,采用耶鲁抽动障碍严重程度量表（YGTSS）、抑郁自评量表（SDS）以及焦虑自评量表（SAS）评定,使用氟哌啶醇治疗4周后再次评定.结果：不伴有感觉症状的Tourette综合征患儿较伴有感觉症状的患儿抽动症状好转明显（P＜0.01）;抑郁自评、焦虑自评严重程度轻.结论：Tourette综合征常伴有各种感觉症状,重视感觉症状将对疗效可产生有利的影响.     

奎硫平合并舍曲林治疗成人Tourette综合征临床观察

目的：探讨奎硫平合并舍曲林治疗成人Tourette综合征的疗效和安全性。方法：44例成人Tourette综合征患者随机分为奎硫平合并舍曲林组（研究组）和单用奎硫平组（对照组）,疗程8周。采用耶鲁抽动症状严重程度量表（YGTSS）评定疗效,采用治疗中出现的症状量表（TESS）评定安全性。结果：疗效以研究组较好,不良反应相仿。结论：奎硫平合并舍曲林治疗成人Tourette综合征可提高疗效,安全性较好。     

喹硫平治疗儿童抽动障碍的对照研究

目的 探讨喹硫平对儿童抽动障碍的疗效和安全性.方法 将81例抽动障碍患儿随机分为研究组和对照组,治疗前后应用耶鲁抽动症严重程度量表和副反应量表分别评定疗效及不良反应,共治疗8周.结果 治疗第2周末、治疗第4周末及治疗第8周末,研究组和对照组的YGTSS总分较治疗前均有显著性降低(P＜0.05),研究组各阶段的YGTSS总分均显著低于对照组(P＜0.05).在第4周末及第8周末,研究组和对照组的治疗有效率有显著性差异(P＜0.05).研究组的不良反应显著少于对照组(P＜0.05).结论 喹硫平和氟哌啶醇对儿童抽动障碍均有较好疗效,但喹硫平的疗效和安全性更好.     

80例Tourette综合征临床特点及误诊情况分析

目的总结Tourette综合征临床特点,加强诊治工作,减少误诊误治。方法采用自编问卷表核实患儿的一般资料,详细询问患儿的临床表现,填写Tourette严重度量表(YGTSS),并对未经治疗的Tourette患儿进行评分。结果Tourette综合征患儿多表现为轻～中度,抽动症状多样,早期易误诊。结论正确认识Tourette临床特点并准确评价病情严重程度,可避免误诊,做到药物治疗和心理指导个体化。     

利培酮治疗Tourette综合征对照研究

目的:进一步验证利培酮治疗Tourette综合征的疗效和不良反应. 方法:60例Tourette综合征患者分为两组,每组30例,分别给予利培酮和氟哌啶醇治疗.疗程6周.治疗前和治疗6周分别进行耶鲁综合抽动严重性量表(YGTSS)和副反应量表(TESS)评定疗效和不良反应. 结果:两组治疗后YGTSS总分和各维度评分均显著低于治疗前,利培酮组显著高于氟哌啶醇组,利培酮组显效率为67.9%明显低于氟哌啶醇组96.7%;利培酮组不良反应明显小于氟哌啶醇组. 结论:利培酮和氟哌啶醇均能有效治疗Tourette综合征,但利培酮疗效不及氟哌啶醇,利培酮不良反应少而轻.     

80例Tourette综合征临床特点及误诊情况分析

目的总结Tourette综合征临床特点，加强诊治工作，减少误诊误治。方法采用自编问卷表核实患儿的一般资料，详细询问患儿的临床表现，填写Tourette严重度量表（YGTSS），并对未经治疗的Tourette患儿进行评分。结果Tourette综合征患儿多表现为轻～中度，抽动症状多样，早期易误诊。结论正确认识Tourette临床特点并准确评价病情严重程度，可避免误诊，做到药物治疗和心理指导个体化。     

利培酮与氟哌啶醇治疗Tourette综合征的临床对照研究

目的 探讨利培酮治疗Tourette综合征的疗效、安全性和耐受性。方法 将100例7～16岁的Tourette综合征患儿随机分为利培酮治疗组和氟哌啶醇治疗组，并于入组时及治疗第2周、第4用、第8周末用耶鲁抽动症整体严重程度量表（Yale Glibal Tic Severity Scale，YGTSS）、副反应评定量表（TESS）和临床疗效总评量表（CGI）评定病情变化、药物副反应和临床总体疗效。结果 在治疗第2周末、第4周末、第8周末，临床疗效及临床总体疗效评定，两组患者间差异无统计学意义（P〉0．05），TESS评分差异具有非常显著意义（t=3．52，P〈0．01）。结论 利培酮治疗Tourette综合征疗效与氟哌啶醇相当，但毒刮反应较轻微，其安全性及耐受性更好。     

阿立哌唑及氟哌啶醇治疗儿童青少年抽动障碍的开放性对照研究

目的 比较非典型抗精神病药物阿立哌唑与经典抗精神病药物氟哌啶醇治疗儿童青少年抽动障碍的疗效及耐受性.方法 对48例符合〈中国精神障碍分类与诊断标准（第3版）〉（CCMD-3）抽动障碍诊断标准的儿童青少年抽动障碍患者按2：1比例随机分配入阿立哌唑或氟哌啶醇治疗组,分别治疗8周,治疗前后分别使用耶鲁抽动症严重程度量表（YGTSS）评定疗效,使用副反应量表（TESS）评定不良反应.结果 两组患者治疗后的YGTSS总分均较治疗前下降,差异有统计学意义（P〈0.001）,但在治疗终点时两组间YGTSS总分差异无统计学意义（P＞0.05）;阿立哌唑组的睡眠过度、锥体外系症状及头痛三种不良反应发生率低于氟哌啶醇组（P〈0.05）.结论 阿立哌唑及氟哌啶醇对儿童青少年抽动障碍疗效相当,但阿立哌唑的耐受性优于氟哌啶醇.     

A型肉毒毒素治疗抽动障碍

目的 探讨A型肉毒毒素治疗抽动障碍患者运动性抽动症状的疗效.方法 25例抽动障碍患者(男性20例,女性5例)接受国产A型肉毒毒素注射,治疗主要针对患者最突出的运动性抽动的表现.治疗前进行耶鲁综合抽动严重程度量表(YGTSS)基线评分,治疗1、4周和1年内分别进行YGTSS和Jankovic评分,并记录疗效的潜伏期、持续时间、副作用、患者的主观感觉和感觉先兆的变化以及再次注射情况.结果 在25例患者总共29人次的治疗中,肉毒毒素疗效平均潜伏期5.0 d,平均总体疗效持续4.6个月,平均最佳疗效Jankovic评分3.4分,根据YGTSS减分率统计62.1%(18/29)明显有效,34.5%(10/29)好转,3.4%(1/29)无效.85.7%(18/21)的患者感觉先兆减轻,平均改善72.4%(20%～100%).主要副作用为注射部位短暂而轻微的无力和皮疹.症状复发者再次注射仍然有效.结论 A型肉毒毒素对于控制抽动障碍的运动性抽动症状安全有效.     

阿立哌唑治疗Tourette综合征共患注意缺陷多动障碍研究

目的探索阿立哌唑治疗Tourette综合征共患注意缺陷多动障碍患儿的疗效及安全性。方法选择Tourette综合征共患注意缺陷多动障碍患儿44例,随机分为阿立哌唑组和氟哌啶醇组,分别给予阿立哌唑和氟哌啶醇治疗12周,治疗前后采用耶鲁综合抽动严重程度量表(Yale global tic severity scale,YGTSS)和Conners(父母)症状问卷提供的多动指数标准评估患儿抽动症状及多动指数改善情况,并记录治疗过程中发生的药物副反应。结果重复测量方差分析示,对于YGTSS评分,分组主效应无统计学意义(P0.05),时间主效应、分组与时间的交互效应有统计学意义(P0.05);对于多动指数,分组主效应、时间主效应、分组与时间的交互效应均有统计学意义(P0.05)。治疗12周时,两组YGTSS评分无统计学差异(P0.05),阿立哌唑组多动指数低于氟哌啶醇组(P0.01)。阿立哌唑组出现副反应者(3/22)比氟哌啶醇组(6/22)少(P0.05)。结论阿立哌唑治疗Tourette综合征共患注意缺陷多动障碍患儿的抽动症状与氟哌啶醇相当,且可一定程度减轻其多动、注意力缺陷等症状,副作用较氟哌啶醇少。     

Treatment of refractory Tourette syndrome with haloperidol decanoate

A 23-year-old male with a history of severe Tourette syndrome refractory to treatment with oral haloperidol is reported. The Tourette symptoms remitted after treatment with haloperidol decanoate. The response has been maintained over 18 months.     

Effects of propranolol in tourette syndrome

Alternate medications for the treatment of Tourette syndrome are required because haloperidol in some patients either may be ineffective or may cause disturbing side effects. Propranolol, a beta-adrenergic blocking agent, has been reported as effective, in uncontrolled trials, in ameliorating symptoms of tic disorder, tardive dyskinesia, and drug-induced extrapyramidal syndrome. Propranolol, in doses up to 120 mg per day, was administered to five patients with Tourette syndrome in a placebo-controlled study and was found ineffective in ameliorating symptoms of Tourette syndrome. Results underscored the importance of placebo-controlled investigation when evaluating the effects of drugs in Tourette syndrome.     

难治性抽动秽语综合征伴强迫症的立体定向手术治疗

目的 总结立体定向手术毁损一侧丘脑腹外侧核(VL)/板中间核(LM)联合未定带(ZI)和双侧扣带回前部(ACG)毁损治疗抽动秽语综合征(GTS)伴强迫症的经验.方法 术前录像记录患者平静下抽动情况.手术采用磁共振引导下立体定向射频毁损方式,一侧ZI+VL/LM毁损控制抽动症状,双侧AC毁损控制强迫症状.抽动严重程度以耶鲁大体抽动量表(YGTSS)评价,强迫行严重程度以耶鲁布朗强迫症量表(YBOCS)评价.结果 23例患者接受一侧ZI+VL/LM联合双侧ACG毁损术,其中左侧ZI+VL/LM毁损14例,右侧ZI+VL/LM 9例.术后患者肢体抽动较术前明显改善,其YGTSS评分由术前(20.3±7.2)分明显下降至术后(9.8±3.2)分(P<0.05);术后患者不自主发声显著缓解,其YGTSS评分由术前(19.6±8.8)分明显下降至术后(10.2±3.1)分(P<0.05);术后患者总体病情、生活质量显著提高,其YGTSS评分由术前(70.3±17.2)分明显下降至术后(30.8±10.9)分(P<0.05).另外,术后强迫症也明显缓解,其YBOCS评分由术前(37.2±3.9)分明显下降至术后(17.2±3.2)分(P<0.05).23例患者均未出现严重并发症.结论 一侧VL/LM联合ZI区和双侧ACG毁损术可有效地控制GTS,对GTS伴发的强迫症也有良好的疗效.     

Dopaminergic dsyfunction in Tourette syndrome

A prospective clinical and biochemical study on the effects of treatment with haloperidol has been performed in seven patients with Tourette syndrome. Pretreatment cerebrospinal fluid levels of homovanillic acid (CSF HVA) were significantly reduce in all patients, whereas 5-hydroxyindoleacetic acid was reduced in only two. With haloperidol treatment, symptoms decreased in all cases (21 to 88%) and clinical improvement was associated with an increased level of CSF HVA, often returning to the normal range. Optimal therapeutic response was found with serum levels of haloperidol between 1 and 4 ng/ml; however, disturbing side effects also occurred within this range. These results support the hypothesis that Tourette syndrome may result from a supersensitivity of dopaminergic receptors.     

A case of Tourette syndrome developing during haloperidol treatment

A ten year old boy developed features of Tourette syndrome while taking haloperidol for behaviour problems. A record of his tics was kept and followed during his admission in hospital. His symptoms worsened as haloperidol was decreased and improved as the haloperidol was increased. The literature regarding tardive Tourette syndrome is reviewed and potential implications of the case are discussed.     

Gilles de la Tourette syndrome: clinical and family study of 50 cases

Fifty patients with Tourette syndrome were evaluated; data included family history, clinical characteristics, response to haloperidol, and side effects during haloperidol therapy. Sixteen patients had a family history of Tourette syndrome, and another 16 had a family history of tics. Twenty-four families had more than 2 members with Tourette syndrome or tics. There was no preponderance of families with a Jewish, Eastern European background in this sample. Thirty-four patients had obsessive-compulsive behavior. Among the 50 patients there was a high frequency of sleep disturbance, learning disability, self-destructive behavior, inappropriate sexual activity, and antisocial behavior. Family history was significantly related to the occurrence of sleep disturbance, obsessive-compulsive behavior, haloperidol response, and the frequency of side effects caused by haloperidol. The precise mode of genetic transmission in familial Tourette syndrome remains to be determined.