TY - JOUR
T1 - Practice guideline recommendations summary
T2 - Treatment of tics in people with Tourette syndrome and chronic tic disorders
AU - Pringsheim, Tamara
AU - Okun, Michael S
AU - Müller-Vahl, Kirsten
AU - Martino, Davide
AU - Jankovic, Joseph
AU - Cavanna, Andrea E
AU - Woods, Douglas W
AU - Robinson, Michael
AU - Jarvie, Elizabeth
AU - Roessner, Veit
AU - Oskoui, Maryam
AU - Holler-Managan, Yolanda
AU - Piacentini, John
N1 - © 2019 American Academy of Neurology.
PY - 2019/5/7
Y1 - 2019/5/7
N2 - OBJECTIVE: To make recommendations on the assessment and management of tics in people with Tourette syndrome and chronic tic disorders.METHODS: A multidisciplinary panel consisting of 9 physicians, 2 psychologists, and 2 patient representatives developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine-compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence.RESULTS: Forty-six recommendations were made regarding the assessment and management of tics in individuals with Tourette syndrome and chronic tic disorders. These include counseling recommendations on the natural history of tic disorders, psychoeducation for teachers and peers, assessment for comorbid disorders, and periodic reassessment of the need for ongoing therapy. Treatment options should be individualized, and the choice should be the result of a collaborative decision among patient, caregiver, and clinician, during which the benefits and harms of individual treatments as well as the presence of comorbid disorders are considered. Treatment options include watchful waiting, the Comprehensive Behavioral Intervention for Tics, and medication; recommendations are provided on how to offer and monitor these therapies. Recommendations on the assessment for and use of deep brain stimulation in adults with severe, treatment-refractory tics are provided as well as suggestions for future research.
AB - OBJECTIVE: To make recommendations on the assessment and management of tics in people with Tourette syndrome and chronic tic disorders.METHODS: A multidisciplinary panel consisting of 9 physicians, 2 psychologists, and 2 patient representatives developed practice recommendations, integrating findings from a systematic review and following an Institute of Medicine-compliant process to ensure transparency and patient engagement. Recommendations were supported by structured rationales, integrating evidence from the systematic review, related evidence, principles of care, and inferences from evidence.RESULTS: Forty-six recommendations were made regarding the assessment and management of tics in individuals with Tourette syndrome and chronic tic disorders. These include counseling recommendations on the natural history of tic disorders, psychoeducation for teachers and peers, assessment for comorbid disorders, and periodic reassessment of the need for ongoing therapy. Treatment options should be individualized, and the choice should be the result of a collaborative decision among patient, caregiver, and clinician, during which the benefits and harms of individual treatments as well as the presence of comorbid disorders are considered. Treatment options include watchful waiting, the Comprehensive Behavioral Intervention for Tics, and medication; recommendations are provided on how to offer and monitor these therapies. Recommendations on the assessment for and use of deep brain stimulation in adults with severe, treatment-refractory tics are provided as well as suggestions for future research.
KW - Behavior Therapy
KW - Counseling
KW - Humans
KW - Tic Disorders/psychology
KW - Tics/psychology
KW - Tourette Syndrome/psychology
U2 - 10.1212/WNL.0000000000007466
DO - 10.1212/WNL.0000000000007466
M3 - Review article
C2 - 31061208
SN - 0028-3878
VL - 92
SP - 896
EP - 906
JO - Neurology
JF - Neurology
IS - 19
ER -