Practitioner Review: Behandling av Tourettes syndrom hos barn og unge: Systematisk oversikt

Practitioner Review: Treatments for Tourette syndrome in children and young people - a systematic review

Authors
Whittington, C. Pennant, M. Kendall, T. Glazebrook, C. Trayner, P. Groom, M. Hedderly, T. Heyman, I. Jackso, G. Jackson, S. Murphy, T. Rickards, H. Robertson, M. Stern, J. Hollis, C.
Year
2016
Journal
Journal of Child Psychology and Psychiatry
Volume
57
Pages
988-1004
Background Tourette syndrome (TS) and chronic tic disorder (CTD) affect 1-2% of children and young people, but the most effective treatment is unclear. To establish the current evidence base, we conducted a systematic review of interventions for children and young people. Methods Databases were searched from inception to 1 October 2014 for placebo-controlled trials of pharmacological, behavioural, physical or alternative interventions for tics in children and young people with TS or CTD. Certainty in the evidence was assessed with the GRADE approach. Results Forty trials were included [pharmacological (32), behavioural (5), physical (2), dietary (1)]. For tics/global score there was evidence favouring the intervention from four trials of 2-adrenergic receptor agonists [clonidine and guanfacine, standardised mean difference (SMD)=-0.71; 95% CI -1.03, -0.40; N=164] and two trials of habit reversal training (HRT)/comprehensive behavioural intervention (CBIT) (SMD=-0.64; 95% CI -0.99, -0.29; N=133). Certainty in the effect estimates was moderate. A post hoc analysis combining oral clonidine/guanfacine trials with a clonidine patch trial continued to demonstrate benefit (SMD=-0.54; 95% CI -0.92, -0.16), but statistical heterogeneity was high. Evidence from four trials suggested that antipsychotic drugs improved tic scores (SMD=-0.74; 95% CI -1.08, -0.40; N=76), but certainty in the effect estimate was low. The evidence for other interventions was categorised as low or very low quality, or showed no conclusive benefit. Conclusions When medication is considered appropriate for the treatment of tics, the balance of clinical benefits to harm favours 2-adrenergic receptor agonists (clonidine and guanfacine) as first-line agents. Antipsychotics are likely to be useful but carry the risk of harm and so should be reserved for when 2-adrenergic receptor agonists are either ineffective or poorly tolerated. There is evidence that HRT/CBIT is effective, but there is no evidence for HRT/CBIT alone relative to combining medication and HRT/CBIT. There is currently no evidence to suggest that the physical and dietary interventions reviewed are sufficiently effective and safe to be considered as treatments.

Oversett med Google Translate
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Type of intervention

Treatment and Child Welfare Interventions

Topic

Mental Health Problems and Disorders

Other Problems

Tics and Tourettes

Intervention

Psychological Treatments

Cognitive Behavioral Therapy, Behavioral Therapy and Cognitive Therapy

Psychoeducational Interventions

Pharmacological Treatment

Antipsychotics

Public Health Interventions

Physical Activity

Alternative Treatment

Accupuncture

Nutritional Supplements and Nutrition

Age group

School Aged Children (6-12 years)

Adolescents (13-18 years)

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