Shaoma Zhijing granule for children with tic disorders: A rapid health technology assessment

Objective:To rapidly assess the effectiveness,safety,economy,and applicability of Shaoma Zhijing granule(SZG)for the treatment of children with tic disorders(TD),and provide currently available best evidence for decision-makers of health policies.Methods:We conducted a rapid health technology assessment(RHTA)to explore the value of SZG.A systematic literature search in eight literature databases and on three clinical trial registration platforms was performed.The literature was screened according to eligibility criteria.The screening process and data extraction were conducted by two reviewers,and the quality of the literature was also assessed.The results were summarized,analyzed,and presented in tables or figures.Results:A total of five randomized controlled trials(RCTs)were included in this study,of which one was published in English(in the Journal of Child Psychology and Psychiatry)and four in Chinese journals.The overall risk of bias for the five RCTs was evaluated as“some concerns.”SZG monotherapy or in combi-nation with tiapride was better than tiapride alone in improving traditional Chinese medicine(TCM)syndromes and tic symptoms,with a daily cost of¥67.50e107.22.Adverse events were mainly related to the digestive,respiratory,and neurological systems,but all were mild.Conclusion:Overall,the current RHTA of published,peer-reviewed literature has located a small body of evidence evaluating the use of SZG for the treatment of TD in children.SZG has effects on improving TCM syndromes and tic symptoms;the daily cost is¥67.50e107.22;and all adverse events are mild.High-quality studies with long-term follow-up should be conducted,so as to provide local evidence and consistently guide and improve scientific decision-making.

Clinical Observation on Modified Huan'gan Lipi Decoction Combined with Acupuncture in Treating Spleen Deficiency and Liver Hyperactivity Type Tic Disorders

[Objectives]To observe the clinical efficacy of Modified Huan'gan Lipi Decoction combined with acupuncture in the treatment of spleen deficiency and liver hyperactivity type tic disorders(TD).[Methods]Sixty patients with spleen deficiency and liver hyperactivity type TD were randomly divided into a treatment group of 40 cases and a control group of 20 cases.The treatment group received Modified Huan'gan Lipi Decoction combined with acupuncture,and the control group received Haloperidol Tablets.After 4 weeks of treatment,the Yale Global Tic Severity Scale(YGTSS)score,the total score of TCM syndrome and the clinical efficacy were compared between the two groups before and after treatment.[Results]After treatment,the total effective rate of 87.5%in the treatment group was higher than 80.0%in the control group(P>0.05);the total score of YGTSS and the total score of TCM syndromes in the two groups were compared within groups,P﹤0.01;between groups,P﹤0.01.The recurrence rates of the treatment group and the control group were 11.1%and 71.4%,respectively.The difference between the two groups was statistically significant(P﹤0.01).[Conclusions]Modified Huan'gan Lipi Decoction combined with acupuncture in the treatment of spleen deficiency and liver hyperactivity type TD can significantly improve the patient's tic symptoms,and its long-term efficacy is stable.

Acupuncture:a new method to treat tic disorders in children

Tic disorder is a common pediatric neurological disorder that severely affects children’s quality of life.But in fact,there is still a lack of a very effective treatment for tic disorder.Acupuncture as a flexible treatment time,treatment cycle control,easy to operate treatment method,widely used in the field of neurological disorder,widely praised by clinicians and patients.At the same time,tic disorder belongs to the category of chronic inflammatory convulsion in traditional Chinese medicine,and acupuncture has a good effect of relieving spasticity and fewer adverse reactions,which makes acupuncture have a good application prospect.Now,more and more studies about acupuncture treatment of tic disorder in children have been published.The main methods of treating tic disorder are acupuncture,electroacupuncture,scalp acupuncture and ear acupuncture.The efficacy of acupuncture alone or in combination with other drugs such as tiapride hydrochloride and haloperidol has been shown to be good.The safety of acupuncture is also commendable,and clinical trials showing that the combination of acupuncture and medication can reduce the incidence and severity of adverse drug reactions.According to the existing studies,acupuncture can promote the development and repair of the nervous system,regulate the secretion of neurotransmitters,and reduce the occurrence of local discomfort,which may be the main mechanism of acupuncture treatment of tic disorders.

Thirty cases of childhood vocal tic disorders treated with acupoint catgut embedding combined with auricular plaster therapy

Objective:To observe the clinical effect of acupoint catgut embedding combined with auricular plaster therapy in the treatment of children with vocal tic disorders.Methods:Catgut embedding was performed at the acupoints Bǎihuì(百会GV20),Shéntíng(神庭GV24),Dàzhuī(大椎GV14),Shēnzhù(身柱GV12),Fèishū(肺俞BL13),and Wèishū(胃俞BL21),and then auricular plaster sticking was applied to the acupoints Yānhòu(咽喉TG3),Fèi(肺CO14),Wèi(胃CO4),Jiāogǎn(交感AH6 a),Pízhìxià(皮质下AT4).Results:After treatment,the Yale Global Tic Severity Scale(YGTSS)scores of the patients were significantly reduced(P<0.05),5 cases were clinically cured,8 cases remarkably effective,12 cases effective,5 cases ineffective,and the total effective rate was 83.33%.Conclusion:Acupoint catgut embedding combined with auricular plaster therapy for vocal tic disorders was effective,being worthy of clinical popularization.

Clinical observation of tuina manipulations for tic disorders in kids

Objective:To observe the clinical efficacy of tuina manipulations in treating different types of tic disorders(TD).Methods:Eligible TD patients were classified into three types,transient tic disorders(TTD),chronic multiple tic disorders(CMTD)and Tourette syndrome(TS),according to their disease duration and severity.The three types of children were treated with the same tuina manipulations.Changes in the Yale global tic severity scale(YGTSS)score,effective rate for tic,and cervical spine imaging examination results(including asymmetry of the lateral atlanto-dental interval,broadened anterior atlanto-dental interval,C2 spinous process deviation,occipito-atlanto-axial flexion/extension instability)were observed after 1-month and 3-month treatments respectively.Results:The YGTSS score changed significantly after 1-month and 3-month treatments compared with that before treatment(both P<0.01);the effective rate for TD was 46.6%and 86.7%respectively after 1-month and 3-month treatments;there were significant differences comparing the effective rate for tic between different types of TD after 1-month and 3-month treatments(all P<0.05);comparing the effective rate for tic after 1-month treatment with that after 3-month treatment for the same type,the intra-group differences were statistically significant[TTD group(P<0.01),CMTD group(P<0.01),TS group(P<0.05)];the abnormal parameter rates in neck imaging examination after 3-month treatment were significantly different from those before treatment(all P<0.01).Conclusion:Tuina manipulation is effective for TTD,CMTD and TS.It can correct the abnormal alterations of patients'cervical vertebrae,and its efficacy for TTD is most significant.

Review of habit reversal training for tic disorders

Tic disorders(TD)is a neurodevelopmental disorder that is often first recognized in children and adolescents and is characterized mainly by motor and phonic tics.Drug treatment of TD has been criticized because of serious side effects,and TD treatment emphasizes behavioral psychotherapy.This study reviewed the most common behavioral psychotherapy for TD:habit reversal training(HRT).We examined the contents,variation,curative effects,and premonitory urge control of HRT and other behavioral psychotherapies.The findings suggest that current understanding of HRT is insufficient and further studies are needed.First,studies of online guidance training are needed to implement technology that can help more patients.Second,the future integration of HRT and other technologies is important.Third,imaging techniques could be used to further explore the brain mechanisms underlying HRT.Research on HRT for TD in China is insufficient.We call on more Chinese researchers to study,investigate,and develop technology to promote the development of behavioral psychotherapy for TD in China.

Serum ferritin levels in children with attention deficit hyperactivity disorder and tic disorder

BACKGROUND Iron plays an important role in neurodevelopmental functions in the brain.Serum ferritin levels are different in children with attention deficit hyperactivity disorder and tic disorder than in healthy children.AIM To explore the current status of iron deficiency in children with neurodevelopmental disorders and its sex and age effects.METHODS A total of 1565 children with attention deficit hyperactivity disorder(ADHD),1694 children with tic disorder(TD),93 children with ASD and 1997 healthy control children were included between January 1,2020,and December 31,2021 at Beijing Children's Hospital.We describe the differences in age levels and ferritin levels between different disease groups and their sex differences.The differences between the sexes in each disease were analyzed using the t test.The incidence rate of low serum ferritin was used to describe the differences between different diseases and different age groups.A chi-square test was used to analyze the difference in the incidence of low serum ferritin between the disease group and the control group.Analysis of variance was used for comparisons between subgroups,and regression analysis was used for confounding factor control.RESULTS A total of 1565 ADHD patients aged 5-12 years were included in this study,and the average serum ferritin levels of male and female children were 36.82±20.64μg/L and 35.64±18.56μg/L,respectively.A total of 1694 TD patients aged 5-12 years were included in this study,and the average serum ferritin levels of male and female children were 35.72±20.15μg/L and 34.54±22.12μg/L,respectively.As age increased,the incidence of low serum ferritin in ADHD and TD first decreased and then increased,and 10 years old was the turning point of rising levels.The incidence of ADHD with low serum ferritin was 8.37%,the incidence of TD with low serum ferritin was 11.04%,and the incidence of the healthy control group with low serum ferritin was 8.61%,among which male children with TD accounted for 9.25%and female children with TD accounted for 11.62%.There was a significant difference among the three groups(P<0.05).In addition,there were 93 children with ASD with an average serum ferritin level of 30.99±18.11μg/L and a serum ferritin incidence of 15.05%.CONCLUSION In conclusion,low serum ferritin is not a risk factor for ADHD or TD.The incidence of low serum ferritin levels in children with ADHD and TD between 5 and 12 years old decreases first and then increases with age.

Research progress of Chinese and Western Medicine on tic disorder in children

Tic disorder is one of the common neuropsychiatric disorders that affect children’s physical and mental health.If it is not tested,diagnosed and treated early,it will have a serious impact on children themselves,their families,and even the whole society.Simple western medicine treatment methods include drugs,nerve regulation,psychological and behavioral therapy,but the results are not ideal.Traditional Chinese medicine takes systematic treatment based on syndrome differentiation and it uses methods of traditional Chinese medicine,massage and acupuncture to regulate five viscera and six bowels in order to harmonized Yin and Yang.These methods make up for the deficiencies of western treatment.In recent years,the clinical treatment of children with Tic disorders involving a variety of combined therapy has achieved significant results.As a result,the rehabilitation of children with Tic disorders has been significantly improved.By consulting the available literature at home and abroad in recent years,the author elaborates the etiology,pathogenesis and treatment of tic disorder in children,in order to further guide the clinical diagnosis and treatment.

Cross‑sectional Exploration of the Relationship Between Glutamate Abnormalities and Tic Disorder Severity Using Proton Magnetic Resonance Spectroscopy

Glutamate(Glu)has been reported to be closely related to the pathophysiology of Tic Disorders(TD).By using proton mag-netic resonance spectroscopy(1H-MRS),we aimed to investigate the relationship between in vivo Glu levels and the severity of TD.We performed a cross-sectional study in medication-free patients with TD and healthy controls aged between 5 and 13 years using 1H-MRS at 3 T.First,we measured the Glu levels in both patients and controls and observed the difference in subgroups,including mild TD patients and moderate TD patients.We then examined the correlations between the Glu levels and clinical features of the patients.Finally,we assessed the diagnostic value of 1H-MRS and the influencing factors.Our results show that the Glu levels in the striatum of all patients with TD were not significantly different from those of the healthy controls.Subgroup analysis revealed that the Glu levels in the moderate TD group were higher than those in the mild TD group and healthy controls.The correlation analysis showed that Glu levels are strongly positive correlated with TD severity.The optimal cutoff value of Glu levels to differentiate mild tics from moderate tics was 1.244,with a sensitivity of 88.2%and a specificity of 94.7%.Multiple linear regression models revealed that the severity of TD is one of the important factors that affect Glu levels.We conclude that Glu levels are mainly associated with the severity of tics,thus it could serve as a key biomarker for TD classification.

Correlation Analysis of Personality Characteristics of Children with TIC Disorder with Family Factors

Objective To explore the personality characteristics of children with tic disorders and their relationship with family factors. Methods Sixty cases of children with tic disorders diagnosed in our hospital were selected as the case group and 65 cases of normal children were selected as the control group. The children of two groups were assessed using Eysenck Personality Questionnaire(EPQ), Family Environment Scale(FES-CV) and general situation questionnaire of family(GSQ), respectively. The scores of EPQ personality characteristics, FES-CV and GSQ scores were compared for the children in the two groups. The Person correlation analysis method was used to analyze the correlation between personality scores of children in case group and family environment factors. Results The general situation questionnaire results showed that there was significant statistically difference in parenting style, parental education level and family types of the children between case group and control group(P<0.05); EPQ results showed that the neuroticism and psychoticism scores of children in the case group were significantly higher than those in the control group(P<0.05) and the lying degree scores in the control group were significantly higher than those in the case group(P<0.05); FES-CV results showed that the family cohesion scores of the case group were significantly lower than those of the control group(P<0.05), and the family conflict scores in the case group were significantly higher than those in the control group(P<0.05). The Person correlation analysis results indicated that the psychoticism score was negatively correlated with the score of family cohesion(P<0.05), and positively correlated with family conflict(P<0.05), while the neuroticism score was positively correlated with family conflict score(P<0.05). Conclusion The children with tic disorders have significant personality deviation compared to the normal children, and the personality deviation degree is correlated to family contradiction, and family cohesion.

Multicenter Clinical Study on the Treatment of Children's Tic Disorder with Qufeng Zhidong Recipe(祛风止动方)

Objective:To assess the effect and adverse reaction of Qufeng Zhidong Recipe(袪风止动方, QZR)in treating children's tic disorder(TD).Methods:With multicenter randomized parallel open-controlled method adopted,the patients enrolled were assigned to two groups,41 cases in the Chinese medicine (CM)group and 40 in the Western medicine(WM)group.They were treated by QZR and haloperidol plus trihexyphenidyl respectively for 12 weeks as one course.In total,two courses of treatment were given.The curative effect and adve...

Clinical Research into Qufeng Zhidong Recipe Used to Treat 31 Children with Tic Disorder

Objective: To assess the therapeutic effect and adverse reaction of Qufeng Zhidong Recipe (a recipe for dispelling wind to stop abnormal movement) used to treat children with tic disorder (TD). Methods: The enrolled patients were randomized into a TCM group (31 cases) treated with Qufeng Zhidong Recipe and a Western medicine group (30 cases) treated with haloperidol and trihexyphenidyl. Two courses of treatment were observed with 12 weeks as one course. The therapeutic effect and adverse reaction were assessed with Yale Global Tic Severity Scale (YGTSS), Tic Symptom Score Scale (TSSS), TCM Syndrome Score Scale (TCMSSS), Treatment Emergent Symptom Scale (TESS) and laboratory examinations. Results: The total effective rate was 100% in the TCM group and 60% in the Western medicine group with statistical significance in difference (P<0.05). All the scores in the TCM group were better than those in the Western medicine group (P<0.05). Conclusion: Qufeng Zhidong Recipe can obviously relieve the symptoms and signs of TD children without toxic side-effects.