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DOI: 10.1055/a-1133-6915
Tics und Tourette-Störung für die Praxis
Publication History
Publication Date:
05 May 2020 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00034916/202005/lookinside/thumbnails/10.1055-a-1133-6915-1.jpg)
ZUSAMMENFASSUNG
Primäre Tic-Störungen und das Tourette-Syndrom (TS) sind häufige neuropsychiatrische Erkrankungen, die sich im frühen Lebensalter manifestieren und durch motorische und/oder vokale Tics gekennzeichnet sind. Oftmals bestehen bei den Betroffenen psychiatrische Komorbiditäten wie Zwangsstörungen, Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung, Angst- und affektive Störungen. Differenzialdiagnostisch stellen neben anderen Bewegungsstörungen wie zum Beispiel Chorea oder Stereotypien, die funktionellen Tic-ähnlichen Störungen eine besondere Herausforderung dar. Tiermodelle, Post-mortem-Studien, behaviorale und bildgebende Studienbefunde weisen auf Veränderungen im kortiko-striato-thalamo-kortikalen Regelkreis in der primären Tic-Störung und dem TS hin, wobei in der Genese dieser Erkrankungen das dopaminerge System eine wichtige Rolle zu spielen scheint. Therapeutisch werden spezifische verhaltenstherapeutische Strategien wie das Habit Reversal Learning oder das Exposure and Response Prevention in erster Linie empfohlen. Pharmakotherapien beinhalten antipsychotische Medikation, Botulinumtoxin-Injektionen sowie cannabisbasierte Medikamente. In therapieresistent verlaufenden Fällen kann die tiefe Hirnstimulation erwogen werden.
ABSTRACT
Primary tic disorders, including Tourette syndrome (TS) are neuropsychiatric disorders characterized by childhood onset motor and/or vocal tics. Beyond the defining feature of repetitive tic movements or sounds, the large majority of affected individuals also fulfil diagnostic criteria for other psychiatric disorders, most commonly obsessive-compulsive disorder, attention deficit hyperactivity disorder AD(H)D, anxiety, and affective disorders. Primary tics should be distinguished from other hyperkinesias, as for example chorea or myoclonus, and also functional neurological disorders presenting with tic-like movements. Although the exact pathophysiology of tic disorders still remains elusive, studies on animal models, post-mortem findings and results from behavioral and neuroimaging investigations point towards specific alterations of the cortico-striato-thalamo-cortical loops. Behavioral interventions, particularly habit reversal therapy and exposure and response prevention are first line treatments. Pharmacological approaches include antipsychotic medication, botulinum toxin injections as well as cannabis-based therapies. In severe, treatment refractory cases, the application of deep brain stimulation can be considered.
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Literatur
- 1 Ganos C, Martino D. Tics and tourette syndrome. Neurol Clin 2015; 33: 115-136
- 2 Yang J, Hirsch L, Osland S. The prevalence of diagnosed tourette syndrome in Canada: A national population-based study. Psychiatry Research 2017; 250: 228-233
- 3 Meige H, Feindel EnCL, Wilson SAK. Tics and their treatment. London: S. Appleton; 1907
- 4 Kwak C, Dat Vuong K, Jankovic J. Premonitory sensory phenomenon in Tourette’s syndrome. Mov Disord 2003; 18: 1530-1533
- 5 Ganos C, Bongert J, Asmuss L. et al The somatotopy of tic inhibition: Where and how much?. Mov Disord 2015; 30: 1184-1189
- 6 Ganos C, Rothwell J, Haggard P. Voluntary inhibitory motor control over involuntary tic movements. Mov Disord 2018 doi:10.1002/mds.27346
- 7 Jankovic J. Tourette syndrome. Phenomenology and classification of tics. Neurol Clin 1997; 15: 267-275
- 8 Baizabal-Carvallo JF, Jankovic J. The clinical features of psychogenic movement disorders resembling tics. J Neurol Neurosurg Psychiatry 2014; 85: 573-575
- 9 Demartini B, Ricciardi L. et al A positive diagnosis of functional (psychogenic) tics. Eur J Neurol 2015; 22: 527-e536
- 10 Ganos C, Edwards MJ, Muller-Vahl K. “I swear it is Tourette’s!”: On functional coprolalia and other tic-like vocalizations. Psychiatry Res 2016; 246: 821-826
- 11 Ganos C, Martino D, Espay AJ. et al Tics and functional tic-like movements: Can we tell them apart?. Neurology 2019; 93: 750-758
- 12 Ganos C, Roessner V, Munchau A. The functional anatomy of Gilles de la Tourette syndrome. Neurosci Biobehav Rev 2013; 37: 1050-1062
- 13 Palminteri S, Lebreton M, Worbe Y. et al Dopamine-dependent reinforcement of motor skill learning: evidence from Gilles de la Tourette syndrome. Brain 2011; 134: 2287-2301
- 14 Delorme C, Salvador A, Valabregue R. et al Enhanced habit formation in Gilles de la de la Tourette syndrome. Brain 2016; 139: 605-615
- 15 Beste C, Tubing J. et al Altered perceptual binding in Gilles de la Tourette syndrome. Cortex 2016; 83: 160-166
- 16 Ganos C, Martino D, Pringsheim T. Tics in the Pediatric Population: Pragmatic Management. Mov Disord Clin Pract 2016; 4: 160-172
- 17 Fründt O, Woods D, Ganos C. Behavioral therapy for Tourette syndrome and chronic tic disorders. Neurology Clinical practice 2017; 7: 148-156
- 18 Verdellen C, van de Griendt J, Hartmann A. et al European clinical guidelines for Tourette syndrome and other tic disorders. Part III: behavioural and psychosocial interventions. Eur Child Adolesc Psychiatry 2011; 20: 197-207
- 19 Pringsheim T, Okun MS, Muller-Vahl K. et al Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology 2019; 92: 896-906