盐酸托莫西汀治疗共患抽动障碍的注意缺陷多动障碍的临床疗效

目的 探讨盐酸托莫西汀治疗共患抽动障碍的注意缺陷多动障碍(ADHD)的临床疗效.方法 对符合美国<精神障碍诊断与统计手册>中ADHD和抽动障碍诊断标准的儿童予系统的盐酸托莫西汀治疗,逐渐滴定至最适剂量.盐酸托莫西汀胶囊每日晨单次服用.以家长填写的ADHD评定量表为主要疗效评价指标评定注意缺陷多动症状;以耶鲁综合抽动严重程度量表评定抽动症状.结果 本研究完成系统盐酸托莫西汀滴定的ADHD患儿20例,注意缺陷型10例,混合型9例,多动冲动型1例.男17例,女3例;年龄(7.58～17.0)(10.55±2.58)岁.完成剂量滴定患儿的最后剂量为(1.19±0.21) mg/(kg*d).ADHD总分治疗前为(31.10±8.52)分,治疗后为(12.65±9.08)分;注意缺陷评分治疗前为(17.60±3.09)分,治疗后为(7.45±4.75)分;多动冲动评分:治疗前为13.0分,治疗后为3.0分.治疗后家长ADHD症状评定量表总分及分量表分较治疗前均显著下降(P＜0.001).治疗后抽动总分9.0分,运动抽动分(8.15±5.29)分,发声抽动分0分;治疗前抽动总分32.5分,运动抽动分(30.0±16.93)分,发声抽动分7.0分.治疗后运动抽动及发声抽动的数量、频度、强度和复杂性均较治疗前显著减少(Pa＜0.05).结论 盐酸托莫西汀治疗共患抽动障碍的ADHD患儿的多动冲动、注意力缺陷、运动抽动、发声抽动均有明显疗效.     

不同剂量托莫西汀治疗注意缺陷多动障碍44例临床分析

目的探讨不同剂量托莫西汀治疗注意缺陷多动障碍(ADHD)的疗效和安全性。方法将2008年11月至2009年10月广州医学院荔湾医院心理门诊及住院的44例7～16岁ADHD患儿分为大剂量组21例[剂量由0.5mg(/kg·d)增至1.2mg(/kg·d)];小剂量组23例[0.5mg(/kg·d)];均每日晨顿服,共8周。在治疗前和治疗8周末,以中文版SNAP-Ⅳ家长评定量表进行疗效评定,采用治疗副反应量表(TESS)评估其治疗过程中的副反应。结果治疗后两组SNAP-Ⅳ家长评定量表总分均较治疗前下降(P0.01)。治疗8周后,大、小剂量组有效率分别为76.1%和60.3%,差异有统计学意义(P0.05);完全缓解率分别为47.6%和26.1%,差异有统计学意义(P0.01)。两组均未见严重副反应,大、小剂量组常见的副反应为食欲减退(28.6%、13.0%,P0.01),恶心(9.5%、8.7%,P0.05),瞌睡/疲倦(19.0%、8.7%,P0.05),头晕(4.8%、4.3%,P0.05),腹痛(9.6%、4.3%,P0.05)和体重下降(23.8%、8.7%,P0.01)。结论大剂量组托莫西汀治疗儿童ADHD的疗效优于小剂量组,且安全性均较好,未出现严重副反应。     

治疗注意缺陷障碍的新药--托莫西汀

盐酸托莫西汀(简称托莫西汀)是获美国食品药品管理局批准不久的新药,用于治疗儿童、青少年和成人注意缺陷障碍(ADHD).其可能的作用机制是阻断突触前膜去甲肾上腺素转运体.迄今为止,托莫西汀已经在2500多名ADHD儿童和青少年以及350多名ADHD成人患者中进行了安慰剂对照研究和开放性研究,其在缓解ADHD症状方面均明显优于安慰剂,并且有很好的安全性和耐受性.     

治疗注意缺陷障碍的新药——托莫西汀

盐酸托莫西汀(简称托莫西汀)是获美国食品药品管理局批准不久的新药，用于治疗儿童、青少年和成人注意缺陷障碍(ADHD)。其可能的作用机制是阻断突触前膜去甲。肾上腺素转运体。迄今为止，托莫西汀已经在2500多名ADHD儿童和青少年以及350多名ADHD成人患者中进行了安慰剂对照研究和开放性研究，其在缓解ADHD症状方面均明显优于安慰剂，并且有很好的安全性和耐受性。     

托莫西汀治疗儿童注意缺陷多动障碍对心血管系统的影响

目的 观察托莫西汀治疗注意缺陷多动障碍(ADHD)对患儿心血管系统的影响.方法 采用随机双盲对照方法,将46例门诊ADHD患儿分为托莫西汀治疗组和哌甲酯治疗组各23例.所有患儿均接受8周的治疗,其中托莫西汀剂量为0.8 mg/(kg·d)至1.8 mg/(kg·d),每日1次口服,哌甲酯剂量为0.2mg/(kg·d)至0.6mg/(kg·d),每日2次口服.观察患儿治疗后不良反应、心血管体征和心电图.结果 治疗中患儿无心血管系统症状出现,体检发现心率增快和血压升高,心电图提示RR间期缩短,QT间期均缩短.两组之间差异均无统计学意义,经Fridericia校正后QT间期与基线差异均无统计学意义.结论 托莫西汀治疗ADHD患儿不良反应少,耐受性好,对心血管系统的影响较小.     

抽动障碍患儿的药物治疗进展

抽动障碍（ＴＤ）的发病机制尚不清楚,其根本的防治措施尚未解决,近年来有增多的趋势。对于具有良好社会适应能力的轻症患儿,应尽量避免使用药物,只需进行心理调适;而对于影响到日常生活、学习或社交活动的重症患儿,则需加用药物治疗。本　文从多巴胺受体阻滞剂、多巴胺自身受体激动剂、α受体激动剂和伴随表现的用药等方面综述ＴＤ患儿的药物治疗进展     

抽动障碍患儿的药物治疗进展

抽动障碍（ＴＤ）的发病机制的尚不清楚,其根本的防治措施尚未解决,近年来有增多的趋势。对于具有社会适应能力的轻症患儿,应尽量避免使用药物,只需进行心理调适;而对于以日常生活学习或社交活动的重症患儿,则需加用药物治疗,本文从多巴胺受体阻滞剂、多巴胺自身受体激动剂、α受体激动剂和伴随表现的用药等方面综术饿的药物治疗进展。     

哌醋甲酯和托莫西汀治疗注意缺陷多动障碍的疗效与安全性的系统评价

目的：对中国儿童青少年注意缺陷多动障碍（ADHD）来说, 哌醋甲酯速释片（IR-MPH）、哌醋甲酯控释片（OROS-MPH）和托莫西汀（AHC）等3种药物的疗效、安全性等问题尚存在争议,本研究采用系统综述的方法评价三者治疗中国儿童青少年ADHD的疗效及安全性,为临床用药提供依据。方法：系统检索CNKI、中文科技期刊数据库、CBMDISC网络版、Pubmed、Embase 和 MEDLINE数据库中相关的随机或临床对照研究。由两名评价者独立筛选、摘录文献信息并对纳入文献进行质量评价。结果：共纳入8篇文献。IR-MPH、OROS-MPH和AHC三者对ADHD的疗效确切,OROS-MPH在改善同伴关系、CGI-I评分、母亲满意度、心身问题因子等方面优于IR-MPH。AHC组与IR-MPH组的疗效评分差异无统计学意义。三者不良反应发生率差异无统计学意义,均为轻度不良反应。结论：OROS-MPH可能优于IR-MPH, AHC与IR-MPH 疗效相当。三者的安全性相当,耐受性较好。     

托吡酯快速加量法治疗抽动障碍的临床观察

目的 观察托吡酯快速加量法治疗抽动障碍的疗效及其不良反应,寻找妥泰治疗抽动障碍较有效的方案.方法 将多发性抽动症68例患儿随机分为治疗组和对照组各34例.治疗组以较大剂量及快速加量法治疗,观察组以常规方法用药及加量.治疗期间每周定期门诊复诊和电话联系方式了解病情及指导调整用药方案.结果 治疗组2周内有效率为85.6%.对照组有效率为72.5%.有显著性差异.4～8周内有效率治疗组为87.8%,观察组为85.3%,两组有效率比较差异无显著性(x2=0.061,P＞0.05);两组不良反应相比无显著差异.结论 应用快速加量法治疗抽动障碍早期效果显著,所产生的不良反应无明显差异.     

小剂量单药托吡酯治疗抽动障碍的效果

目的探讨小剂量单药托吡酯治疗抽动障碍的临床效果。方法随机选择在儿科门诊就诊、明确诊断抽动障碍、未曾用药53例（第一组）和经治疗药物效果不佳者32例（第二组）患儿,采用小剂量托吡酯单药治疗,初始剂量1.0mg/（kg·d）,1周后症状无好转可每周递增0.5mg/（kg·d）,症状控制后,有效剂量巩固维持观察3个月无复发,再减量停药。结果第一组38例服药至第2周1.5mg/（kg·d）时,抽动消失;15例服至第3周2.0mg/（kg·d）时,抽动消失。第二组19例托吡酯服至第2周1.5mg/（kg·d）时,抽动完全控制;13例托吡酯服至2.0mg/（kg·d）,第3周抽动完全控制。85例患儿有效剂量巩固维持治疗,观察3个月均无复发。3例服至2mg/（kg·d）时有食欲不振和少汗,余82例未发现不良反应。结论小剂量单药托吡酯治疗抽动障碍患儿效果好,有效控制量只需1.5～2.0mg/（kg·d）,不良反应少。     

儿童和青少年Tourette综合征治疗现状

Tourette综合征(TS)是一种儿童期发病的神经发育障碍性疾病,主要临床表现为多种运动和至少1种发声抽动。TS发病可能由多种遗传和环境因素引起,大多共患其他精神障碍性疾病,如注意力缺陷多动障碍、强迫症等。TS的治疗方式包括行为干预、药物干预、外科手术、经颅磁刺激等。文章综述儿童和青少年TS治疗的研究进展。     

Homogeneous clinical subgroups in children with Tourette syndrome

The existence of two clinically homogeneous subgroups in Tourette syndrome, depending upon the presence or absence of migraine or a family history of migraine, is suggested. Patients with Tourette syndrome who have migraine (n = 18) were found to have a significantly higher prevalence of disorders of arousal--particularly sleepwalking and night terrors--as well as a higher prevalence of motion sickness than patients without migraine (n = 27). They were also significantly more likely to exhibit a co-occurrence of associated features (two or more) than the patients without migraine. Patients with Tourette syndrome who have not had migraine headaches but in whom there is a family history for migraine (n = 20) were shown to have an intermediate prevalence of associated symptoms. It is suggested that the differential association for these symptoms in patients with Tourette syndrome may reflect an underlying abnormality in function of two different neurotransmitter systems.     

Tourette syndrome in children: an updated review

Tourette syndrome (TS) is a common neuropsychiatric disorder in children characterized by multiple motor and vocal tics that fluctuate in severity and lasting for at least 1 year. Boys are more commonly affected than girls. Symptoms usually begin with simple motor or vocal tics which then evolve into more complex motor and vocal tics over time. Premonitory sensory urges are common in children over the age of 8 years, and these urges help distinguish tics from symptoms of other movement disorders. Common comorbidities of TS include attention deficit hyperactivity disorder, obsessive-compulsive disorder and learning difficulties. Several genes have been assessed as candidate genes for TS; environmental factors such as stress and streptococcal infections might also contribute to its etiology. The pathophysiology of TS mainly involves dysfunction of basal ganglia-related circuits and hyperactive dopaminergic innervations. A thorough history assessment and neurological examination are important for the correct diagnosis and differentiation from other movement disorders. Treatment for TS should focus on improving the patient's social functioning, minimizing the impairment from cormobid disorders, and controlling tics, if they are severe. Commonly used medications for TS include a2-adrenergic agonists and atypical neuroleptics. Habit reversal therapy is an effective option for TS, and repetitive transcranial magnetic stimulation may be a promising approach for severe cases.     

Tourette综合征儿童主观生活质量研究

目的：探讨Tourette综合征（TS）儿童的主观生活质量状况,为其综合干预提供理论依据。方法：选取儿童保健科就诊的174例TS患儿（≥8岁）作为病例组,选取儿童保健科门诊的正常体检儿童186例(≥8岁)为对照组。采用病例对照研究的方法探讨TS儿童的主观生活质量状况。结果：TS儿童主观生活质量总分（156.6±21.1）低于对照组（164.2±21.2）（P<0.01）,家庭生活、学校生活、认知成分、抑郁体验和焦虑体验得分（19.1±3.5,24.1±4.4,90.6±13.3,24.0±4.6,23.8±4.4）亦低于对照组（20.7±3.0,26.6±3.2,97.9±15.3,25.1±3.1,24.7±3.5）（P<0.05）。相关分析发现TS儿童主观生活质量总分与患儿年龄、病程、症状严重程度、儿童行为总分及家庭矛盾性呈负相关 (r=-0.432,-0.213,-0.869,-0.137, -0.257;均P＜0.01),而与家庭娱乐性呈正相关(r=0.084,P＜0.01)。多元逐步回归分析显示TS儿童主观生活质量的影响因素是症状严重程度、患儿年龄、家庭矛盾性和娱乐性(β′=-0.787,-0.171,-0.109,0.106;P<0.01)。结论：TS儿童主观生活质量不佳;为提高患儿主观生活质量,尽早控制临床症状与改善家庭环境是必要的。     

Treatment practices in Tourette syndrome: the European perspective

AimsNational differences in licensing laws suggest that the use of medications for the treatment of Tourette syndrome differs between European countries. However, variability in prescribing practices has never been investigated. This study aims to systematically examine European prescribing practices in Tourette syndrome.MethodsAll members of the European Society for the Study of Tourette syndrome actively prescribing for paediatric and/or adult Tourette syndrome populations were invited to complete an online questionnaire covering pharmacological treatment of the five main symptom domains of Tourette syndrome: tics, attention-deficit hyperactivity symptoms, obsessive-compulsive symptoms, anxiety and depression.ResultsResponse rates were good, with 44/57 (77%) members returning the questionnaire. Risperidone (n = 13), methylphenidate (n = 21) and sertraline (n = 17) were the most commonly prescribed medications for the treatment of tics, attention-deficit hyperactivity symptoms and obsessive-compulsive symptoms, respectively. However, there was a large variability in both the medication choices and the dosages used for each of these symptom domains.ConclusionsThis is the first large-scale survey on prescribing habits for the pharmacological management of Tourette syndrome in Europe. In general, dopamine blockers were widely used for tics, selective serotonin reuptake inhibitors for depression, obsessive-compulsive symptoms and anxiety, and stimulants for attention-deficit hyperactivity symptoms, but there was high variation within these choices. Future studies need to target specific patient groups.     

Factors influencing diagnosis delay in children with Tourette syndrome.

BACKGROUND: Tourette syndrome (TS) is a chronic disorder characterized by motor and vocal tics. Previous studies reported a substantial lag period between disease onset and diagnosis ranging from 3 to 11.9 years. AIMS: To determine the lag period and factors associated with diagnosis delay of TS. METHODS: All files of 185 children with TS attending one neuropediatric unit in Jerusalem were reviewed. Lag time between disease onset, according to DSM criteria, and diagnosis was determined and the contributions of the disease course, comorbidities and epidemiological factors were assessed. RESULTS: A relatively short lag to diagnosis following the onset of diagnosable TS was documented (mean 13.2+/-15.9 months, median 6 months). A relatively longer gap was associated with older age at TS onset (r=0.161, p<0.05) and vocal tics as the first manifestation rather than motor or combined motor and vocal tics (mean=20.3+16.3 months vs 11.9+16.5 and 12.6+15.2, respectively, p<0.05). A relatively shorter gap was associated with tic severity (r=0.13, p<0.05) and presence of comorbid obsessive-compulsive disorder (OCD) (9.5+14.7 months vs. 14.1+16 without OCD, p<0.05). CONCLUSIONS: Lag time to diagnosis is relatively short in our population. Factors associated with a shorter lag (early age of TS onset, motor tics as the first manifestation, greater tics severity and the presence of OCD) may be perceived as disruptive, prompting patient and families to seek medical care. Conversely, vocal tics as the first manifestation, associated with a longer lag, may be misdiagnosed as features of common pediatric conditions, thus delaying diagnosis.     

儿童抽动秽语综合征中免疫紊乱的新证据

近年来抽动秽语综合征(Tourette syndrome,TS)患病率逐渐增高,但发病机制仍不清楚.一些研究提示TS患儿存在非特异和特异性免疫的异常,如辅助性T细胞亚群Th1和Th2紊乱,以及所分泌的细胞因子水平的变化、自然杀伤细胞和自身抗体表达的改变等.免疫系统的动态平衡和适度的免疫应答对维持机体正常生理功能发挥重要作用.该文对TS患儿免疫特点进行综述,探讨免疫功能紊乱对TS患儿发病的影响,为临床诊断及治疗提供理论依据.