[Multidisciplinary therapy of Tourette syndrome].
The marked fluctuation in symptoms with a spectrum of behavioral problems contribute to misdiagnosis of Tourette syndrome. The authors review the recent progress in diagnosis and management with an emphasis on multidisciplinary approach. Possible associations with various genes have been found in etiology of Tourette syndrome. Development of the disease comes of dopaminerg neurotransmission disorder resulting in cortico-striato-thalamic system dysfunction. Tics are brief movements or sounds that occur intermittently and unpredictably mimicking fragments of normal behavior. Diagnostic criteria are based on the motor and vocal phenomena and their dynamics. The key concept in management are the tic severity scaling correlating with quality of life measurements. Therapeutic interventions indicated at severe alteration in patient's quality of life. Treatment plan combines various drug protocols, psychotherapy and behavioral therapy which should be optimalized for most disabling symptom. Social isolation and self injurious behavior complicates the treatment resistant, severe cases. In these subgroup of patient, an adequate selection of stereotactic intervention could provide an effective control of tic severity or behavioral disorder. Tourette syndrome, as a typical neuropsychiatric disorder, is a striking example for improved efficacy of multidisciplinary approach.
Bábel
B Tamás
BT
Országos Idegsebészeti Tudományos Intézet, Budapest.
Németh
Attila
A
Gádoros
Júlia
J
Bihari
Katalin
K
D001521:Behavior Therapy; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D018492:Dopamine Antagonists / Q000627:therapeutic use; D006801:Humans; D011788:Quality of Life; D011954:Receptors, Dopamine / Q000187:drug effects; D016728:Self-Injurious Behavior / Q000628:therapy; D013238:Stereotaxic Techniques; D013788:Thalamus / Q000601:surgery; D005879:Tourette Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology / Q000601:surgery / Q000628:therapy*
D018492:Dopamine Antagonists; D011954:Receptors, Dopamine