托吡酯与硫必利治疗Tourette综合征疗效的对照研究

目的 探讨托吡酯与硫必利治疗Tourette综合征（TS）的疗效.方法 将75例TS患儿分为托吡酯组（A组,42例）和硫必利组（B组,33例）.A组给予托吡酯（3～6 mg·kg-1·d-1）治疗;B组给予硫必利（300～600 mg·d-1）治疗,共治疗12周.采用耶鲁抽动症整体严重度量表（YGTSS）于治疗前和治疗12周后对2组进行评估.再将经过硫必利治疗无效的10例（C组）给予托吡酯治疗12周后,采用YGTSS对托吡酯治疗前后评分进行比较.结果 治疗前托吡酯组总抽动得分、综合损伤得分和YGTSS总分与硫必利组比较无明显差异（P＞0.05）.治疗12周后托吡酯组总抽动得分、综合损伤得分和YGTSS总分低于硫必利组（P＜0.05或P＜0.01）,总有效率为90.47%,高于硫必利组（69.69%,P＜0.05）.经硫必利治疗无效者再给予托吡酯治疗,治疗前后总抽动得分、综合损伤得分和YGTSS总分比较有显著性差异（P＜0.01）.结论 托吡酯能有效改善TS的运动抽动、发声抽动和综合损伤,硫必利治疗无效的患者托吡酯治疗亦有效,故可考虑将托吡酯作为TS治疗的首选.

The comparative study of the therapeutic efficacies of topiramate and tiapride in Tourette syndrome

Objective To explore the differences of therapeutic efficacies between topiramate and tiapride in Tourette syndrome （TS）. Methods Seventy - five children with TS were randomized into topiramate group （ group A, n = 42）, treated with topiramate （ 3 - 6 mg· kg^- 1 · d ^- 1 ）, and tiapride group （ group B, n = 33 ）, treated with tiapride （ 300 - 600 mg· d^-1 ）, for a total duration of twelve weeks. The therapeutic efficacies of both groups were assessed by Yale global tic severity scale （YGTSS） before and 12 weeks after treatment. Ten cases failing to respond to tiapride treatment were treated with topiramate; the therapeutic efficacies before and 12 weeks after topiramate treatment were assessed by YGTSS. Results There were no differences in total tic scores, comprehensive impairment scores and total YGTSS scores before treatment between the two groups, while 12 weeks after treatment, all the scores in topiramate group were lower than those in tiapride group （ P 〈 0. 05 or P 〈 0. 01 ）. The total efficacy rate in topiramate group was 90.47% , which was higher than that in tiapride group （69.69% , P 〈 0.05 ）. Ten cases failing to respond to tiapride treatment further underwent topiramate treatment had significant differences in total tic scores, comprehensive impairment scores and total YGTSS scores as compared to those scores prior to topiramate treatment （ P 〈 0.01 ）. Conclusion Topiramate is more effective than tiapride in amending the motor tics, vocal tics and comprehensive impairment, and should be the top priority in the treatment of TS.