There are multiple treatment options for people with Tourette Syndrome, although there is no definitive cure. The two most common treatments are medication and behavioral therapy. Unfortunately, medication is often used unnecessarily and can cause more problems than it creates. There are no prescription drugs that are approved by the Food and Drug Administration to treat T.S., so a variety of other medications are often prescribed for related issues including ADHD. However, these drugs are often ineffective and bring with them a host of negative side effects that can cause patients to experience a downward spiral after starting on medication. For this reason, natural treatment options and therapy-based practices are much more appealing.
Natural Treatments for Tics and Tourette's: A Patient and Family Guide book pdf
In the natural history of TS, motor tics often begin between the age of 3 and 8, several years before the appearance of vocal tics. Tic severity usually peaks during the second decade of life with many patients showing a marked reduction in severity by young adulthood.3,5,6 A recent report on 50 youths with TS indicated that the majority experienced a persistence of tic severity over two years, although impairment due to tics decreased over this time.7 In contrast to childhood and youth-onset TS, adult-onset tic disorders are associated with more severe symptoms, greater social morbidity, poorer response to neuroleptic medication, and a potential trigger event.8
Indeed, eliciting a thorough tic inventory, including timing, severity, and exacerbating and ameliorating factors, is extremely important in order to make treatment decisions and follow the course of illness. The Yale Children's Global Stress Index (YCGSI) is a standard tool for such evaluations. In addition, obtaining a thorough perinatal, personal, and family history as well as screening for possible comorbidities including ADHD, OCD, and learning difficulties, are essential. Although childhood tic severity is only modestly predictive of adult tic severity, tic-related obsessive-compulsive symptoms, which are likely to develop about two years later than tics, are more likely to persist into adulthood.5 A complete review of stressors is also in order as stress is a key determinant of outcome.15 It is important to review the strengths and abilities of a patient, along with an exploration of how these may be fully explored. Children with TS are often observed to be particularly attuned to the concerns and well being of others, possibly because their own experience of illness. Assessment of community issues and possible support are also important. As with any psychiatric illness, adequate pediatric medical care, including physical examination and laboratory work-up to rule out any medical conditions (e.g., infections or neurological conditions), should be included in the plan of care. Psychological testing is often also useful to assess and manage possible learning difficulties.
Lifestyle and diet. Acute and chronic stress can exacerbate tics, so an attempt to reduce the stress of patients with TS is reasonable. Psychotherapy sessions may be useful to improve self-esteem, social coping, family strain, and school adjustment, but it is unclear if they directly affect tic severity. Regular appointments with the same clinical team, who can help the patient deal with the changing manifestations of the disorder through the years, are highly recommended. Regular contact via telephone or e-mail may also be helpful. Participation in regular school and extracurricular activities is encouraged.
This welcome guide explains how to treat tics and Tourette syndrome using natural and alternative therapies, with a focus on environmental medicine and nutritional and dietary therapy. The status of behavioral and counseling therapies, EEG biofeedback, homeopathy, bodywork, energy medicine, and Chinese medicine as approaches are explored.
In this second edition to Tics and Tourette's: Breakthrough Discoveries in Natural Treatments, DeMare offers a detailed natural treatment plan. No more will patients have to rely on traditional, drug-based treatments that often carry multiple side effects.
"With this book we are competently and comprehensively ushered into a new era of treatment for children. It is a triumph and an indispensable guide for any parent of a child with a neurological disorder - ADHD, obsessive-compulsive disorder, autism, and mood disorders.... Nowhere else can parents find such a well-organized and scientifically documented presentation of promising alternative medical treatments. Countless families will find this book a comfort, an intelligent, easy-to-read reference, and a lifeline for bringing their child back to health." (Tamar Chansky, PhD, author of Freeing Your Child from OCD; Freeing Your Child from Anxiety)
Pimozide is a dopamine D2 receptor antagonist which also blocks calcium channels. In the past, it has been one of the most frequently used medications in the treatment of tics [115] despite only a limited number of trials comparing its effectiveness to placebo or other agents [122]. Since 2011, no new English-language RCTs have been published in TS. Although several reviews give some support that pimozide is effective as treatment of tics, a recent meta-analysis (including also Chinese-language RCTs) did not find that pimozide is significantly better than placebo [6]. Moreover, due to its prominent adverse effects including drowsiness and risk of extrapyramidal symptoms (EPS), although to a lesser extent as compared to haloperidol [9, 122], weight gain (less than risperidone, but more than aripiprazole), sedation [9, 122,123,124], and the risk of QTc prolongation [9, 122], its application has declined noticeably [125]. Similar to haloperidol, in current guidelines it is recommended only in severely affected and otherwise treatment resistant patients [10, 12].
In addition to the use of pharmacological agents with systemic effects, there is some evidence for the efficacy of botulinum toxin injections to treat persistent well-localized motor and, sometimes, vocal tics by temporarily weakening the associated muscles, through the inhibition of acetylcholine release from peripheral motor nerve terminals. In European practice this approach is limited to older adolescents and adults in patients with insufficient response to other treatments. According to the AAN guidelines on TS [3] botulinum toxin as local application is probably more likely than placebo to reduce tics. This judgement as well as several reviews after 2011 on botulinum toxin in TS [74,75,76,77,78,79,80,81,82,83,84,85] are based on the only published randomized crossover trial of botulinum toxin injection versus placebo for the treatment of simple motor tics from 2001 conducted in 20 adolescents and adults [162]. Adverse reactions associated with botulinum toxin may include temporary soreness and mild muscle weakness including hypophonia when used in the throat region to treat disturbing vocal tics [163].
Depending on its individual receptor binding profile, each agent bears the risk of specific adverse effects. Therefore, not only effectiveness but also potential adverse effects of each agent should be taken into consideration when deciding about the most suitable agent for a patient with TS. Most pharmacological treatments discussed in these guidelines have well known adverse effects, including weight gain, drug-induced movement disorders, elevated prolactin levels, sedation, and effects on heart rate, blood pressure, and electrocardiograms. Therefore, careful monitoring of adverse events is recommended (see Table 2). In case of treatment discontinuation, gradual tapering off antipsychotic medications is recommended to avoid withdrawal dyskinesias [3].
In the light of the limited existing evidence several questions remain unanswered: most importantly, the effectiveness of combinations of behavioral therapy with pharmacological treatment and of different agents needs further trials. Studies directly comparing different agents or combinations of agents in TS are rare, and there is currently only one study [192] available that compared pharmacological treatment with behavior therapy, yielding equal effects within a study period of 10 weeks. Moreover, the study periods of published trials on pharmacological treatment of TS were quite short, e.g., in view of the natural waxing and waning course of tics in TS. In addition, research should be conducted on treatment sequencing and decision-making and for whom particular sequences of treatment are most effective [3]. Another area in need of further evidence is the treatment of patients with co-existing conditions. Moreover, questions around how to deal with treatment refractoriness remain unanswered [193]. The risk of adverse events when using specific agents needs further exploration, e.g., sudden death due to QTc prolongation [116], hyperprolactinemia and its consequences [109], and weight gain [128]. In addition, the questions of optimal treatment duration, as well as long-term outcome after discontinuation of a pharmacological treatment of tics remain unanswered. These important points for the pharmacotherapy of TS are still open to discussion due to a non-existent or too small base of evidence and are important areas for future research. Unfortunately, the number of new agents that might be effective as treatment of TS is limited. Perhaps most promising are the Chinese herbal medicine products 5-ling granule and Ningdong granule, which were classified as compounds showing moderate confidence in evidence of treatment effects according to the AAN guidelines, based on well-powered RCTs conducted in China. However, these products are currently not available to clinicians on the European market. One final future step to improve pharmacological treatment of TS would be precision medicine as well as personalized medicine [194] by prior genetic testing or the use of other neurobiological markers [195]. This approach, however, is still an aspiration for neuropsychiatric disorders, such as TS. 2ff7e9595c
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