Research Progress on Integrated Chinese and Western Medicine Treatment of Tourette Syndrome in Children

Tourette syndrome is a common neuropsychiatric disorder that affects the physical and mental health of children.Early detection,diagnosis,and treatment are crucial to prevent serious impacts on the affected children,their families,and society.In recent years,there has been an increasing trend towards using a combination of methods in the clinical treatment of children with Tourette syndrome.This approach has achieved remarkable results,leading to a reduction in the rate of Tourette syndrome symptoms in children.In recent years,a combination of clinical methods has been used to treat children with Tourette syndrome,resulting in significant improvement in control rates.This article reviews the etiology of infantile Tourette syndrome and the progress made in Chinese and Western medicine treatments,providing a reference for further treatment of the condition.

Clinical characteristics of pediatric patients with treatment-refractory Tourette syndrome:An evidence-based survey in a Chinese population

BACKGROUND Tourette syndrome(TS)is a complex neurodevelopmental condition marked by tics,as well as a variety of psychiatric comorbidities,such as obsessivecompulsive disorders(OCDs),attention deficit hyperactivity disorder(ADHD),anxiety,and self-injurious behavior.TS might progress to treatment-refractory Tourette syndrome(TRTS)in some patients.However,there is no confirmed evidence in pediatric patients with TRTS.AIM To investigate the clinical characteristics of TRTS in a Chinese pediatric sample.METHODS A total of 126 pediatric patients aged 6-12 years with TS were identified,including 64 TRTS and 62 non-TRTS patients.The Yale Global Tic Severity Scale(YGTSS),Premonitory Urge for Tics Scale(PUTS),and Child Behavior Checklist(CBCL)were used to assess these two groups and compared the difference between the TRTS and non-TRTS patients.RESULTS When compared with the non-TRTS group,we found that the age of onset for TRTS was younger(P<0.001),and the duration of illness was longer(P<0.001).TRTS was more often caused by psychosocial(P<0.001)than physiological factors,and coprolalia and inappropriate parenting style were more often present in the TRTS group(P<0.001).The TRTS group showed a higher level of premonitory urge(P<0.001),a lower intelligence quotient(IQ)(P<0.001),and a higher percentage of family history of TS.The TRTS patients demonstrated more problems(P<0.01)in the“Uncommunicative”,“Obsessive-Compulsive”,“Social-Withdrawal”,“Hyperactive”,“Aggressive”,and“Delinquent”subscales in the boys group,and“Social-Withdrawal”(P=0.02)subscale in the girls group.CONCLUSION Pediatric TRTS might show an earlier age of onset age,longer duration of illness,lower IQ,higher premonitory urge,and higher comorbidities with ADHD-related symptoms and OCD-related symptoms.We need to pay more attention to the social communication deficits of TRTS.

Fecal transplantation can alleviate tic severity in a Tourette syndrome mouse model by modulating intestinal flora and promoting serotonin secretion

Background:Tourette syndrome(TS)is a neuropsychiatric disorder with onset in childhood that warrants effective therapies.Gut microbiota can affect central physiology and function via the microbiota-gut-brain axis.Therefore,the gut microbiota plays an important role in some mental illnesses.A small clinical trial showed that fecal microbiota transplantation(FMT)may alleviate TS symptoms in children.Herein,FMT effects and mechanisms were explored in a TS mouse model.Methods:TS mice model(TSMO)(n=80)were established with 3,3'-iminodipropionitrile,and 80 mice were used as controls.Mice were grouped into eight groups and were subjected to FMT with feces from children or mice with or without TS,or were given probiotics.Fecal specimens were collected 3 weeks after FMT.16S rRNA sequencing,behavioral observation,and serum serotonin(5-HT)assay were performed.Differences between groups were analyzed using Mann-Whitney U test and Kolmogorov-Smirnov(KS)tests.Results:A total of 18 discriminative microbial signatures(linear discriminant analysis score>3)that varied significantly between TS and healthy mice(CONH)were identified.A significant increase in Turicibacteraceae and Ruminococcaceae in TSMO after FMT was observed(P<0.05).Compared with non-transplanted TSMO,the symptoms of those transplanted with feces from CONH were alleviated(W=336,P=0.046).In the probiotic and FMT experiments,the serum 5-HT levels significantly increased in TSMO that received probiotics(KS=1.423,P=0.035)and in those transplanted with feces from CONH(W=336.5,P=0.046)compared with TSMO without transplantation.Conclusions:This study suggests that FMT may ameliorate TS by promoting 5-HT secretion,and it provides new insights into the underlying mechanisms of FMT as a treatment for TS.

Association between Tourette Syndrome and the Dopamine D3 Receptor Gene Rs6280

Background：Tourette syndrome （TS） is a complex,heterozygous genetic disorder.The number of molecular genetic studies have investigated several candidate genes,particularly those implicated in the dopamine system.The dopamine D3 receptor （DRD3） gene has been considered as a candidate gene in TS.There was not any report about the association study of TS and DRD3 gene in Han Chinese population.We combined a case-control genetic association analysis and nuclear pedigrees transmission disequilibrium test （TDT） analysis to investigate the association between DRD3 gene rs6280 single nucleotide polymorphisms （SNPs） and TS in a Han Chinese population.Methods：A total of 160 TS patients was diagnosed by the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition.The DRD3 gene rs6280 SNPs were genotyped by TaqMan SNP genotyping assay technique in all subjects.We used a case-control genetic association analysis to compare the difference in genotype and allele frequencies between 160 TS patients and 90 healthy controls.At the same time,we used TDT analysis to identify the DRD3 gene rs6280 transmission disequilibrium among 10l nuclear pedigrees.Results：The genotype and allele frequency of DRD3 gene rs6280 SNPs had no statistical difference between control group （90） and TS group （160） （χ^2 =3.647,P =0.161; χ^2 =0.643,P =0.423） using Chi-squared test.At the basis of the 101 nuclear pedigrees,TDT analysis showed no transmission disequilibrium ofDRD3 gene rs6280 SNPs （χ^2 =0; P =1）.Conclusions：Our findings provide no evidence for an association between DRD3 gene rs6280 and TS in the Han Chinese population.

Deep Brain Stimulation of the Globus Pallidus Internus in Patients with Intractable Tourette Syndrome： A 1-year Follow-up Study

Background： Deep brain stimulation （DBS） has been a promising treatment for patients with refractory Tourette syndrome （TS） for more than a decade. Despite successful DBS treatment of TS in more than 100 patients worldwide, studies with a large patient sample and long-term follow-up assessments are still scarce. Accordingly, we investigated the clinical efficacy and safety of globus pallidus internus （GPi） DBS in the treatment of intractable TS in 24 patients with a 1-year follow-up assessment. Methods： Bilateral/unilateral GPi-DBS was performed in 24 patients with TS. We evaluated symptoms of tics and obsessive-compulsive disorder （OCD） through the Yale Global Tic Severity Scale （YGTSS） and Yale-Brown Obsessive-compulsive Scale （Y-BOCS）. We used the Wechsler Adult Intelligence Scale-Revised in China （WAIS-RC） to evaluate the safety of the treatment. We conducted follow-up assessments of all patients for at least 12 months （12-99 months）. Results： Symptoms of tics and OCD were significantly relieved at a 12-month follow-up assessment. The mean YGTSS score was 74.04 ± 11.52, 49.83 ± 10.91, 32.58 ± 7.97, and 31.21 ± 8.87 at baseline, 3, 6, and 12 months, respectively. The mean YGTSS scores obtained at the follow-up assessments were significantly different from the baseline （P 〈 0.05）. The improvement in motor tics was superior to that in phonic tics. The mean Y-BOCS scores were 21.61 ± 4.97, 18 ± 4.58, 14.39 ± 3.99, and 13.78 ± 4.56 at baseline, 3, 6, and 12 months, respectively （P 〈 0.05）. We observed a remarkable improvement in psychiatric comorbidities, such as OCD and attention-deficit hyperactivity disorder, after the procedure. WAIS-RC scores were comparable before and after the operation. There were no severe postoperative complications. Conclusion： GPi-DBS appears to comprehensively alleviate tic symptoms and psychiatric comorbidities in patients with TS, thus significantly improving patients＇ quality of life.

Clinical Observation on Treatment of Tourette Syndrome by Integrative Medicine

Objective:To explore the clinical efficacy of integrative Chinese and Western medicine in treating Tourette syndrome(TS).Methods:Ninety children with TS were randomized into two groups by randomizing digital table method:the 60 patients in the treated group were treated by Ningdong Granule(宁动颗粒,NDG) plus haloperidol,and the 30 in the control group treated by haloperidol alone.The course for both groups was 6 months.Conditions of the patients were estimated before and after treatment with Yale Global Tic Sev...

Effects of human mesenchymal stem cell transplantation in the bilateral corpus striatum in a rat model of Tourette's syndrome

Tourette＇s syndrome is treated by behavioral or pharmacological therapy.However,patients with malignant Tourette＇s syndrome also exhibit life-threatening symptoms,which are unresponsive to conservative treatments or neurosurgical procedures,such as deep brain stimulation.In recent years,mesenchymal stem cells（MSCs）have shown therapeutic potential in many neurological diseases.Therefore,the present study proposed to use MSC transplantation as a novel therapy for Tourette＇s syndrome.Stereotypic behaviors in Tourette＇s syndrome rats decreased significantly at21 days after human MSCs transplantation into the striatum.Immunohistochemistry analyses revealed survival of transplanted human MSCs and differentiation into neurons and astrocytes in the rat brain.Results suggest that intrastriatal transplantation of human MSCs could provide therapeutic potential for Tourette＇s syndrome.

Psychosurgery:A History from Prefrontal Lobotomy to Deep Brain Stimulation

Neurosurgical treatment for psychiatric disorders features a long and controversial history.This article explores a“spectrum of psychosurgery”,describing how old-fashioned and controversial prefrontal lobotomy gradually evolved into modern day,mainstream scientific deep brain stimulation(DBS).We focus on the rise,fall and possible re-emergence of psychosurgery as a therapeutic intervention today.We journey through historic indiscriminate use of prefrontal lobotomy,which evoked stern criticism from both public and professionals,through to the development of modern day DBS-performed for patients suffering from severe,treatment resistant symptoms of obsessive-compulsive disorder(OCD),epilepsy and movement disorders.We hope this article will provide a basis for understanding the availability of existing treatment options and potential future opportunities,whilst simultaneously challenging any public/professional preconceptions of psychosurgery,which may indirectly be obstructing patient care.Additionally,we carried out a qualitative survey displayed in WordCloud Format,capturing the intellection of 38 mental health professionals working for North West Boroughs NHS Healthcare Foundation Trust,on“psychosurgery”,“prefrontal lobotomy”and“DBS”,which may well reflect wider public opinion.In summary,the article provides a brief,yet comprehensive overview of the controversial history of psychosurgery,present-day practice,and future trends of neurosurgery for psychiatric disorders.

Correlation between premonitory urges and tic symptoms in a Chinese population with tic disorders

Importance Tics usually start around 4–6 years old and affect about 1%of school‐age children.Premonitory urges(PUs)are sensory phenomena that precede tics and are often described as unpleasant feelings.Recent evidence supports a relationship between PUs and tic severity,but reports are conflicting.In addition,there is no report of PUs in the Chinese population.Objective To investigate the correlation between PUs and tic symptoms in the Chinese population with tic disorders.Methods We recruited 252 Chinese individuals with chronic tic disorders(age 5–16 years).The Yale Global Tic Severity Scale(YGTSS)was used to assess tic symptoms,and the Premonitory Urge for Tics Scale(PUTS)was used to assess PUs.We calculated Spearman correlations between PUTS and YGTSS scores,and constructed a linear regression model to predict the tic symptom severity by PUs.Results There was a significant positive correlation between PU severity(PUTS scores)and motor tic severity,total tic severity,tic‐caused impairment(YGTSS scores)(P<0.05).PU severity was a significant positive predictor of tic symptom severity(standardized beta coefficient=0.174,t=2.786,P=0.006).Interpretation We provide evidence for a correlation between PUs and tic symptoms.PU severity predicts tic symptom severity.Further research on PUs is needed to clarify the shared brain mechanism with tics,and their role in tic expression.A suitable tool to assess PUs in younger children is also needed.