儿童抽动障碍的非药物治疗

Non- drug therapy for tic disorders in children

儿童抽动障碍（TD）的治疗除药物治疗外，心理治疗、行为干预、神经调控治疗等非药物治疗方法正日益受到关注，在减轻抽动症状、干预共病和改善生命质量方面发挥重要作用。心理治疗包括支持性心理治疗、家庭干预和学校干预等，是非药物治疗的重要内容。行为干预包括正性强化、消退法、密集练习、放松训练、自我监督、习惯逆转训练、情景管理、效应预防的暴露、认知行为治疗、自信训练和减压技术等，其中习惯逆转训练是研究最深入、应用最广泛且有效的行为矫正方法；效应预防暴露和自我监督也是有效的，但综合行为干预的疗效更显著，更持久，可促进患者异常的皮质-纹状体-丘脑-皮质关联和运动通路正常化，是TD的一线治疗方法。近年来对于药物难治性TD儿童患者，脑电生物反馈、深部脑刺激、经颅磁刺激等神经调控治疗方法也是常用的非药物治疗手段。

For tic disorders（TD）, non-drug therapy including psychotherapy, behavioral intervention, neural regulation have demonstrated efficacy in reducing tic severity, managing co-occurring psychiatric symptoms and improving life quality in addition to pharmacotherapy.Psychotherapy such as supportive psychotherapy, family intervention, school intervention can be major contributors to the development of evidence-based non-drug treatments.Different behavioural therapies that were used included positive reinforcement, extinction, massed negative practice, relaxation therapy, habit reversal training（HRT）, exposure with response prevention, self-monitoring, contingency management, cognitive-behavioural therapy, assertiveness training, tension-reduction technique.Overall, HRT is the best-studied and most widely-used technique and there is sufficient experimental evidence to suggest that it is an effective treatment.Evidence suggests that exposure with response prevention and self-monitoring are effective, but comprehensive behavioral intervention for tics （CBIT） show more effective and durability of benefit over time.CBIT may promote normalization of aberrant cortico-striato-thalamo-cortical associative and motor pathways in individuals with tourette′s syndrome.Based on available evidence, recent published guidelines suggest that CBIT can be considered a first-line treatment for persons with TD.Neural regulation included electroencephalogram biofeedback, deep brain stimulation, transcranial magnetic stimulation are increasingly considered when tics become troublesome or even disabling or self-injurious despite optimal medical therapy.