托吡酯对抽动-秽语综合征患儿血浆谷氨酸和门冬氨酸含量的影响

目的：观察托吡酯（TPM）对抽动-秽语综合征（TS）患儿血浆兴奋性氨基酸中谷氨酸（Clu）和门冬氨酸（Asp）含量的影响。方法：选择40例TS患儿（治疗组）,予以TPM治疗至少12周。分别在治疗前及治疗12周后检测TS患儿血浆Glu和Asp的含量,并评估其治疗效果。选择我院体检正常儿童30例作对照（对照组）。结果：治疗组TS患儿治疗前血浆Glu和Asp含量较对照组明显增加（P〈0．01）。应用TPM治疗12周后,患儿血浆Glu和Asp含量较治疗前明显下降（P〈0．01）;同时患儿耶鲁综合抽动严重度量表（YGTSS）评分指标运动性抽动分数、发声性抽动分数和综合损害分数均显著降低（P〈0．01）。结论：兴奋性氨基酸可能参与佟的发病过程。TPM治疗TS患儿的临床疗效确切,能明显降低患儿YGTSS评分,作用机制可能通过降低血浆兴奋性氨基酸的含量。     

托吡酯治疗抽动-秽语综合征的疗效

<正>抽动-秽语综合征是儿童神经精神系统的常见疾病,以学龄前期至青少年期儿童多见,患病率高达1%-2%[1]。其症状迁延治疗困难,部分甚至迁延至成人,严重影响学业、工作和生活质量。氟哌啶醇一直是治疗抽动-秽语综合征的首选药物,但由于该药的不良反应常致使患者不能耐受而终止治疗。为此,笔者自2002年开始采用托吡酯治疗抽动-秽语综合征患者64例,现将结果报告如下。     

抽动—秽语综合征的治疗体会

抽动-秽语综合征（deleTrouetle’s综合征、TS）。其治疗多首选经典抗精神病药物。我们认为TS的治疗必须是综合性的药物治疗、行为矫正和心理治疗三者联合。现将一典型病例报道如下。患儿男性，14岁，中学生，从4岁开始无明显诱因出现全身各处油动，每天数次至数十次，早轻夜重，同时伴随污秽语言或喉呜。患者出生时曾发生窒息，其原因末明。家族中无类似患者。体格检查与同龄儿童无区别，智力发育一般，各科成绩均在60分左右。情绪不稳定时，有冲动行为。经适应性行为评定为中度不良。在检查过程中经常发现头颈、手足、躯体历时1～2秒的…     

托吡酯与硫必利治疗儿童多发性抽动症的对比分析

目的对比分析托吡酯治疗儿童多发性抽动症（TS）的临床疗效及安全性。方法选择符合DSM—IV-TR诊断标准的多发性抽动症70例,随机分为托吡酯组、硫必利组。托吡酯组采用托吡酯剂量每日2-3mg／kg;硫必利组采用硫必利剂量50～150mg／次,每日2次,维持剂量50～150mg／d。以抽动发作减少次数作为评定疗效,对比分析两组不良反应发生率。结果托吡酯组有效率为85．7％（36／42）,硫必利组有效率为82．1％（23／28）。两组疗效比较差异无显著性（x^2=0．0045,P=0．9466）。托吡酯组总的不良反应发生率35．7％,轻度不良反应（33.3％）,中度不良反应发生率2．4％;硫必利组总的不良反应发生率60．7％,轻度不良反应（35．7％）中重度不良反应发生率25％。两组不良反应比较有显著差异（x^2=4．2311,P=0．0397）。结论托吡酯与硫必利治疗TS同样有效,不良反应托吡酯与硫必利相比明显少而轻。     

托吡酯对抽动-秽语综合征患儿血浆多巴胺和兴奋性氨基酸含量的影响

抽动-秽语综合征（TS）是一种儿童期起病的遗传性神经精神疾病,以多发性、运动性抽动伴发声性抽动为特征.目前发病机理不十分明确,多数学者认为TS患儿存在神经递质功能紊乱和兴奋性氨基酸含量改变[1-2].托吡酯（TPM）是一种结构独特的具有多重药理作用的新型抗癫癎药物,近年来研究发现其治疗TS患儿的疗效确切[3-4],但具体的作用机制尚不完全明确.     

针刺治疗抽动秽语综合征

抽动秽语综合征是指儿童的一种突然发生、重复或交替出现的不随意运动,以面部或颈部多组肌肉抽动及不自主发音为特点。笔者5年来采用针刺治疗本病30例,取得较满意疗效。现报告如下。     

托吡酯治疗秽语抽动综合征伴癫痫1例

患者,男,15岁,因发作性奔跑、吼叫伴惊恐1月半,全身强直发作1次入院.1月半前无任何诱因出现发作性奔跑、吼叫伴惊恐,在奔跑时能叫旁人让开,并可躲避途中障碍物;发作后有恶心,偶尔呕吐胃内容物;每次发作持续约20 s,发作间歇期正常;每天最多发作3-4次,昼夜均可发作.     

肌苷治疗抽动秽语综合征46例

<正>抽动-秽语综合征又称多发性抽动症,即Tourette综合征,综合患病率为0.1%¹%,男女患病比例约为4∶1,多数于41%,男女患病比例约为4∶1,多数于4¹2岁起病。该病是一种慢性神经精神障碍性疾病,以多发性抽动、暴发性发声和伴随秽性语言为特征的抽动障碍,病因尚未完全明显。该病还伴发多种多样的行为症状或精神障碍,可不同程度地干扰损害儿童认知功能和发育,影响社会适应能力。目前治疗该病一线药物仍为氟哌啶醇,但不良反     

阿普唑仑治疗抽动秽语综合征98例

目的:观察阿普唑仑治疗抽动秽语综合征的临床疗效.方法:98例抽动秽语综合征患者服用阿普唑仑片0.2～0.8 mg,每晚1次,连服2个月为1个疗程,治疗1或2个疗程判定疗效,同时观察不良反应.结果:本组有效率74.5%,不良反应仅见嗜睡.结论:应用阿普唑仑片治疗抽动秽语综合征,疗效较好,不良反应少.     

小儿抽动秽语综合征86例临床研究

目的 小儿抽动秽语综合征临床特征研究.方法 对2008年1月至2011年1月诊治的小儿抽动秽语综合征86例临床资料进行总结和统计.结果 6例小儿抽动秽语综合征经口服氟哌啶醇、泰必利治疗1～4周后68例临床症状得到基本控制,临床控制率79.06%,11例临床症状减轻未发展.经配合应用硝基安定症状得到显著改善,7例临床症状改善不明显.结论 小儿抽动秽语综合征是儿童中慢性神经精神表现综合征,临床表现多样以头面部为初发的多种形式抽动、可以向颈、肩、躯干发展,常伴有吭吭等不自主发声,正确识别本病临床特征,及早进行诊断避免误诊.     

托吡酯和硫必利治疗儿童多发性抽动症临床疗效及安全性比较

目的:通过比较托吡酯和硫必利治疗儿童多发性抽动症(TS)的临床疗效及安全性,为治疗儿童多发性抽动症提供理论依据。方法:选取我院60例符合DSM-Ⅳ-rIR 诊断标准的儿童多发性抽动症患者,采用随机数表法分为试验组32例和对照组28例。试验组应用托吡酯治疗,每天2~3 mg/kg;对照组应用硫必利治疗,2次/天,每次50~150 mg,以抽动发作减少次数为标准评定临床疗效及安全性,并比较分析两组不良反应发生率。结果:试验组有效率为84.4%,对照组有效率为82.1%,差异无统计学意义(P>0.05)。试验组总的不良反应发生率为28.1%,对照组为46.4%,差异有统计学意义(P<0.05)。结论:托吡酯 与硫必利治疗儿童多发性抽动症同样有效,但托吡酯具有更高的安全性。     

抽动-秽语综合征患者应用脑电超慢涨落技术与脑电图仪进行诊断的比较

目的探讨抽动-秽语综合征患者脑电超慢涨落（ET）的变化特点.方法对30例抽动-秽语综合征患者进行脑电超慢涨落分析仪和脑电图检查与分析.结果 30例患者中仅5例出现脑电图异常,表现为后头部波幅弥漫降低,而所有病例ET检测均有异常,表现为脑功能欠佳,记忆力指标下降;多巴胺、乙酰胆碱、强兴奋介质谷氨酸类显著增高,同时伴有弥散性缺血、缺氧指标,提示脑状态偏向缺血、兴奋以及应激水平增高.结论抽动-秽语综合征患者脑ET均存在明显异常,与传统脑电图比较,ET对该综合征的诊断敏感性更高.     

托吡酯治疗320例癫痫病人的不良反应

目的：了解托吡酯治疗癫痫病人的不良反应。方法：对托吡酯单用或作为添加治疗的320例癫痫病人进行不良反应的前瞻性研究。结果：320例病人的用药时间为(30±s 7)wk,16 wk～36 mo。有98例出现不同程度的不良反应,占全部病人的30．6%,其中13例(13．2%)因不良反应停药。单用托吡酯的142例病人中有68例(48．0%)出现不同程度的不良反应,添加治疗的178例病人有30例(17．0%)出现不良反应,两者间差异有非常显著意义(P＜0．01)。最常见的是体重减轻、手足麻木、头痛头晕,12例病人用药后述有记忆力或学习成绩下降,简易韦氏智能测定9例异常。结论：托吡酯是较为安全的新抗癫痫药,虽然不良反应发生率高,但多数很轻微。     

文静汤治疗小儿多发性抽动症30例临床疗效观察

目的观察中药文静汤治疗儿童多发性抽动症的临床疗效及不良反应。方法对2009年7月至2009年12月诊治的60例多发性抽动症患儿,采用随机、对照方法分成治疗组与对照组各30例。治疗组应用文静汤治疗,对照组应用西药泰必利治疗。结果治疗组总有效率为90.0%,对照组总有效率为76.7%,治疗组疗效优于对照组。结论中药文静汤治疗儿童多发性抽动症疗效优于西药泰必利,且无明显副作用,值得在临床推广应用。     

Serial pharmacological prescribing practices for tic management in Tourette syndrome

Pharmacological treatments for Tourette syndrome (TS) vary in efficacy between different patients. The evidence base is limited as even high quality controlled studies tend to be of relatively short duration which may lose relevance in clinical usage. Patients are frequently treated with serial agents in the search for efficacy and tolerability. The success of this strategy has not been previously documented. We examined 400 consecutive TS patients seen over a 10‐year period, some with a longer prior history in other clinics; 255/400 (64%) were prescribed medication. We present this heterogeneous cohort in terms of the number of drugs they had tried, and as a proxy measure of some benefit of the last drug used, whether it had been prescribed under our supervision for ≥5 months. The most commonly prescribed medications were aripiprazole (64%), clonidine (40%), risperidone (30%) and sulpiride (29%) with changes in prescribing practises over the period examined. The number of different drugs tried were one (n = 155), two (n = 69), three (n = 36), four (n = 14), five (n = 15), six (n = 5), seven (n = 2) and eight (n = 1). The data illustrate the difficulty in drug treatment of tics and suggest that even after trials of several agents there is potential benefit in trying further options. Copyright © 2015 John Wiley & Sons, Ltd.     

泻青丸治疗多发性抽动秽语综合征的药效学研究

目的：探讨泻青丸治疗多发性抽动秽语综合征在运动性抽动及学习记忆方面的作用,为临床从肝辨治提供依据。方法：观察泻肝法的代表方剂泻青丸对小鼠自主活动的影响,对抗戊四唑致小鼠惊厥的作用以及对东莨菪碱致小鼠记忆获得障碍的影响。结果：泻青丸Ⅰ,Ⅱ组均可延长小鼠惊厥潜伏期及死亡时间,减少3 min内小鼠跳台的错误次数;泻青丸Ⅱ组可减少小鼠的自主活动次数,延长小鼠触电潜伏期。结论：泻青丸具有镇静、对抗抽动、促进学习记忆的作用,提示泻肝法可能有助于多发性抽动秽语综合征的治疗。     

托吡酯治疗小儿癫痫

目的 :评价托吡酯治疗小儿癫痫的疗效和安全性。方法 :3 1例癫痫病儿 (男性 2 1例 ,女性 10例 ,年龄 6a±s 4a)口服托吡酯 ,起始剂量为 1～ 2mg·kg- 1·d- 1,qd ;目标剂量为 4～ 10mg·kg- 1·d- 1,bid。随访时间为 3～ 8mo。结果 :托吡酯总有效率为 69% ,单药治疗与添加治疗的疗效比较差异无显著意义 (P >0 .0 5 ) ,其不良反应较轻。结论 :托吡酯对于小儿癫痫有较好的疗效 ,单药与添加治疗的疗效近似 ,病儿对其有较好的耐受性。     

Emerging drugs in Tourette syndrome

Proper education of the patient is the first step in the treatment of Tourette syndrome (TS). Before deciding how to treat the patient, it is important to decide whether to treat the TS-related symptoms. Counselling and behavioural modification may be sufficient for those with mild symptoms. Medications, however, may be considered when symptoms begin to interfere with peer relationships, social interactions, academic or job performance, or with activities of daily living. Therapy must be individualised and the most troublesome symptoms should be targeted first. Antidopaminergic agents are clearly the most effective drugs in the treatment of tics. Although haloperidol and pimozide are the only drugs currently approved by the FDA for the treatment of TS, other dopamine receptor-blocking drugs and tetrabenazine, a dopamine depleting drug, as well as botulinum toxin injections, have been used to treat tics associated with TS. Carefully designed, comparative, longitudinal trials assessing the efficacy and adverse-effect profiles of these drugs, including tardive dyskinesia, are lacking. Selective serotonin reuptake inhibitors are recommended for the treatment of obsessive-compulsive behaviour: a common comorbidity. Psychostimulants, such as methylphenidate, are the treatment of choice for attention deficit hyperactivity disorder. Even though these drugs may transiently increase tics, this does not necessarily constitute a definite contraindication to the use of these drugs in patients with TS. Here, existing and emerging medical treatments in patients with tics and comorbid behavioural disorders associated with TS are reviewed.     

Dopaminergic activity in Tourette syndrome and obsessive-compulsive disorder

Tourette syndrome (TS) and obsessive-compulsive disorder (OCD) both are neuropsychiatric disorders associated with abnormalities in dopamine neurotransmission. Aims of this study were to quantify striatal D_2/3 receptor availability in TS and OCD, and to examine dopamine release and symptom severity changes in both disorders following amphetamine challenge.Changes in [¹¹C]raclopride binding potential (BP_ND) were assessed using positron emission tomography before and after administration of d-amphetamine (0.3 mg kg^?1) in 12 TS patients without comorbid OCD, 12 OCD patients without comorbid tics, and 12 healthy controls. Main outcome measures were baseline striatal D_2/3 receptor BP_ND and change in BP_ND following amphetamine as a measure of dopamine release.Voxel-based analysis revealed significantly decreased baseline [¹¹C]raclopride BP_ND in bilateral putamen of both patient groups vs. healthy controls, differences being more pronounced in the TS than in the OCD group. Changes in BP_ND following amphetamine were not significantly different between groups. Following amphetamine administration, tic severity increased in the TS group, which correlated with BP_ND changes in right ventral striatum. Symptom severity in the OCD group did not change significantly following amphetamine challenge and was not associated with changes in BP_ND.This study provides evidence for decreased striatal D_2/3 receptor availability in TS and OCD, presumably reflecting higher endogenous dopamine levels in both disorders. In addition, it provides the first direct evidence that ventral striatal dopamine release is related to the pathophysiology of tics.