Abstract This study evaluated the prevalence of tic disorders. MEDLINE and EMBASE databases were searched, using terms specific to Tourette syndrome and tic disorders, for studies of incidence, ...prevalence, and epidemiology. Thirty-five studies reporting data from 1985-2011 on the incidence or prevalence of tic disorders in a defined population were included. One reported incidence, and 34 reported prevalence. Meta-analysis of 13 studies of children yielded a prevalence of Tourette syndrome at 0.77% (95% confidence interval, 0.39-1.51%). Prevalence is higher in boys: 1.06% of boys were affected (95% confidence interval, 0.54-2.09%) vs 0.25% of girls (95% confidence interval, 0.05-1.20%). Transient tic disorder comprised the most common tic disorder in children, affecting 2.99% (95% confidence interval, 1.60-5.61%). Meta-analysis of two studies assessing adults for Tourette syndrome revealed a prevalence of 0.05% (95% confidence interval, 0.03-0.08%). The prevalence of tic disorders was higher in all studies performed in special education populations. Tic disorders are more common in children than adults, in boys than girls, and in special education populations. Parents, educators, healthcare professionals, and administrators should be aware of the frequency with which tic disorders occur, and ensure proper access to appropriate care.
BACKGROUND Several pharmacologic and nonpharmacologic therapeutic options have been used to treat cough that is not associated with a pulmonary or extrapulmonary etiology. METHODS We conducted a ...systematic review to summarize the evidence supporting different cough management options in adults and children with psychogenic, tic, and habit cough. Medline, EMBASE, the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus were searched from the earliest inception of each database to September 2013. Content experts were contacted, and we searched bibliographies of included studies to identify additional references. RESULTS A total of 18 uncontrolled studies were identified, enrolling 223 patients (46% male subjects, 96% children and adolescents). Psychogenic cough was the most common descriptive term used (90% of the studies). Most of the patients (95%) had no cough during sleep; barking or honking quality of cough was described in only eight studies. Hypnosis (three studies), suggestion therapy (four studies), and counseling and reassurance (seven studies) were the most commonly used interventions. Hypnosis was effective in resolving cough in 78% of the patients and improving it in another 5%. Suggestion therapy resolved cough successfully in 96% of the patients. The greatest majority of improvements noted with these forms of therapy occurred in the pediatric age group. The quality of evidence is low due to the lack of control groups, the retrospective nature of all the studies, heterogeneity of definitions and diagnostic criteria, and the high likelihood of reporting bias. CONCLUSIONS Only low-quality evidence exists to support a particular strategy to define and treat psychogenic, habit, and tic cough. Patient values, preferences, and availability of potential therapies should guide treatment choice.
Abstract Objectives To examine the characteristics of children with coexisting tics and autism spectrum disorder and determine if children with tics have deficits in social behavior. Methods ...Descriptive study of children referred for tics over 18 months. Parents completed the Social Responsiveness Scale and the Social Communications Questionnaire; children screening positive on these measures were evaluated for autism spectrum disorder. Characteristics of children who were diagnosed with both disorders are described. Subscales scores on the Social Responsiveness Scale for children with tics without a comorbid autism spectrum disorder were compared. The relationship between a comorbid diagnosis of attention deficit hyperactivity disorder and autism spectrum disorder symptoms was explored using logistic and linear regression. Results One hundred and fourteen children were evaluated. Children with a tic disorder and autism spectrum disorder had significantly higher rates of comorbid attention deficit hyperactivity disorder ( P = 0.005), rage attacks ( P = 0.006), and oppositional defiant disorder ( P = 0.007) than children without autism spectrum disorder. Mean tic severity and treatment rates did not differ between groups. Mean subscale scores on the Social Responsiveness Scale for children without autism spectrum disorders fell into the clinically significant range for autistic mannerisms only. All Social Responsiveness Scale scores were significantly increased by an attention deficit hyperactivity disorder diagnosis ( P < 0.0001). Conclusion Children referred for assessment of tics should be screened for autism spectrum disorders. There is a subgroup of children with multiple neuropsychiatric comorbidities who suffer from social dysfunction and autistic mannerisms outside of an autism spectrum disorder diagnosis.
Two children with tremor Liu, Helena, BSc; Pringsheim, Tamara, MD; Thompson, Graham C., MD
Canadian Medical Association journal (CMAJ),
04/2015, Letnik:
187, Številka:
7
Journal Article
Recenzirano
Odprti dostop
A right-handed 14-year-old boy was referred to a neurologist for an outpatient evaluation of tremor. The boy was previously healthy and not taking any medications. Developmental milestones were ...achieved within the appropriate norms. There was a family history of tremor in the boy's mother and maternal uncle. The mother reported that her tremor lessened following the consumption of alcohol. The parents first noticed the tremor in their son when he was about six years old. The tremor occurred mainly during voluntary activity, such as writing, eating soup with a spoon, drinking from a cup and using his hands for small skilled movements. The tremor affected both arms and was worse on the right side. His head, voice and legs were unaffected. The tremor was worse when he was physically tired (e.g., after heavy lifting) or nervous (e.g., public speaking). Over the years, the tremor has worsened slightly and has become a source of embarrassment to him. Tremors are classified as rest or action tremors depending on the circumstances under which they occur.3 Rest tremor occurs when a limb is relaxed and supported against gravity (e.g., a hand rested on a table). It is often augmented by mental stress and attenuates with action. Most tremors are action tremors, which occur with voluntary muscle contractions. They can be further subdivided into postural, isometric, kinetic or task-specific tremors. A postural tremor is observed while maintaining a position against gravity. An isometric tremor occurs when muscles contract against rigid stationary objects. A kinetic tremor occurs during voluntary muscle contraction; kinetic tremor is considered "simple" when it occurs during non-target-directed movements (e.g., flexion or extension at wrist) and "intentional" when it is target-directed (e.g., finger-to-nose test). Task-specific tremor occurs only during highly skilled activities (Box 1).1,5 Essential tremor develops insidiously and progresses slowly, presenting as a postural tremor involving both hands and arms in 95% of patients, although asymmetry may be present. It may appear as early as two years of age but often starts in late childhood or adolescence. Children with essential tremor often have a family history of the same.6 The common clinical presentation is the gradual onset of postural tremor over several years that involves both hands and arms and is occasionally associated with tremor of the head or voice. Leg tremor rarely occurs in essential tremor, but it can be a presenting feature of juvenile Parkinson disease. Gait is normal in the early and middle stages of essential tremor, but difficulties with tandem gait can arise in later adulthood.5 The amplitude of essential tremor typically increases with stress, fatigue and medications that stimulate the central nervous system, and with certain voluntary activities, such as holding a cup. Resting or drinking alcohol decreases amplitude. Studies have shown that individuals with essential tremor lack structural or cellular abnormalities but may display cerebellar and cerebellar-pathway dysfunction. One hypothesis is that the condition is due to the central oscillator being enhanced or suppressed by reflex pathways.6,7According to the American Academy of Neurology guidelines, treatment with β-blockers (e.g., propranolol) or anticon-vulsants (e.g., primadone) should be started when the tremor results in functional disability or social embarrassment (Appendix 3 available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj .120496/-/DC1).8,9 Although these guidelines are based on studies involving adults, a paucity of studies involving children necessitates that current practice extrapolate this evidence to tremor in children.
Antipsychotics are effective at suppressing tics in Tourette syndrome, but can cause side effects. At a single center, all children with Tourette syndrome requiring antipsychotics were systematically ...monitored for metabolic and neurologic side effects every 6 months. Seventy-three children were followed for a mean of 39.6 months. Most children were treated primarily with an atypical antipsychotic. Thirty-three of 73 children (45%) developed lipid abnormalities. Compared with population-based mean lipid values for boys, total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglyceride levels were significantly higher in our male sample ( P < 0.0001). Girls had significantly lower high-density lipoprotein concentrations ( P = 0.0033). Thirty-six of 73 (49%) children demonstrated abnormal body mass index percentiles. The odds of having lipid abnormalities were significantly higher in children with abnormal body mass indices (odds ratio, 6.0; 95% confidence interval, 2.15-16.7; P = 0.0004). Three of 73 children developed neurologic complications. Metabolic complications of antipsychotics are common in children. These findings underscore the need to discuss benefits and risks before initiating therapy, and the importance of routinely monitoring growth and lipid profiles. Neurologic complications are uncommon, which is likely attributable to the primary use of atypical antipsychotics in this setting.
Tourette syndrome (TS) and stereotypy in autism spectrum disorders (ASDs) are 2 common movement disorders in childhood. The objective of this review was to summarize randomized controlled trials ...published over the past 5 years as an update of the current pharmacotherapeutic options for the treatment of tics, TS, and motor stereotypies in children with ASD. We searched MEDLINE (2005-May 2010) for randomized controlled trials of medications used for the treatment of these disorders. For the treatment of tics in TS, 2 trials suggest that levetiracetam is not effective, whereas 1 trial found that topiramate was effective. Single clinical trials of metoclopramide, atomoxetine, and ondansetron were of limited quality, preventing conclusions to be made regarding the usefulness of these treatments for tic disorders. For the treatment of stereotypy in children with ASD, risperidone has been shown in both a Cochrane review in 2006 and 2 subsequent randomized control trials to be effective. The addition of pentoxifylline to risperidone may have added benefit. Haloperidol did not improve stereotypy and was poorly tolerated. There is good evidence that aripiprazole is effective in the treatment of sterotypies in children with ASD. A large randomized trial of citalopram did not show any improvement in stereotypy. Single trials of levetiracetam, guanfacine, and atomoxetine suggest they are not useful in the reduction of stereotypy in children with ASD.
Abstract Background The use of antipsychotic drugs, particularly quetiapine, has increased at an unprecedented rate in the last decade, primarily in relation to nonpsychotic indications. This ...increased use is concerning because of the high rates of metabolic and extrapyramidal side effects and inadequate monitoring of these complications. The purpose of this study was to measure the use of quetiapine and other second-generation antipsychotics by primary care physicians and psychiatrists and the most common diagnoses associated with quetiapine recommendations. Methods We analyzed data on antipsychotic use from the IMS Brogan Canadian CompuScript Database and the Canadian Disease and Treatment Index, with a focus on quetiapine. We looked at the number of dispensed prescriptions for second-generation antipsychotics written by primary care physicians and psychiatrists and the diagnoses associated with recommendations for quetiapine from 2005 to 2012. Results Between 2005 and 2012, there was a 300% increase in dispensed prescriptions for quetiapine ordered by family physicians: from 1.04 million in 2005 to 4.17 million in 2012. In comparison, dispensed prescriptions from family physicians for risperidone increased 37.4%: from 1.39 million in 2005 to 1.91 million in 2012; those for olanzapine increased 37.1%, from 0.97 million in 2005 to 1.33 million in 2012. Dispensed prescriptions for quetiapine ordered by psychiatrists increased 141.6%: from 0.87 million in 2005 to 2.11 million in 2012. The top 4 diagnoses associated with quetiapine in 2012 were mood disorders, psychotic disorders, anxiety disorders and sleep disturbances. A 10-fold increase in quetiapine recommendations for sleep disturbances was seen over the study period, with almost all coming from family physicians. Interprétation These findings indicate a preferential increase in the use of quetiapine over other antipsychotic drugs and show that most of the increased use is a result of off-label prescribing by family physicians.
BACKGROUND We conducted a systematic review on the management of psychogenic cough, habit cough, and tic cough to update the recommendations and suggestions of the 2006 guideline on this topic. ...METHODS We followed the American College of Chest Physicians (CHEST) methodologic guidelines and the Grading of Recommendations, Assessment, Development, and Evaluation framework. The Expert Cough Panel based their recommendations on data from the systematic review, patients' values and preferences, and the clinical context. Final grading was reached by consensus according to Delphi methodology. RESULTS The results of the systematic review revealed only low-quality evidence to support how to define or diagnose psychogenic or habit cough with no validated diagnostic criteria. With respect to treatment, low-quality evidence allowed the committee to only suggest therapy for children believed to have psychogenic cough. Such therapy might consist of nonpharmacologic trials of hypnosis or suggestion therapy, or combinations of reassurance, counseling, and referral to a psychologist, psychotherapy, and appropriate psychotropic medications. Based on multiple resources and contemporary psychologic, psychiatric, and neurologic criteria ( Diagnostic and Statistical Manual of Mental Disorders , 5th edition and tic disorder guidelines), the committee suggests that the terms psychogenic and habit cough are out of date and inaccurate. CONCLUSIONS Compared with the 2006 CHEST Cough Guidelines, the major change in suggestions is that the terms psychogenic and habit cough be abandoned in favor of somatic cough syndrome and tic cough, respectively, even though the evidence to do so at this time is of low quality.
•With population aging, the burden of neurological disease is increasing worldwide.•Understanding the factors affecting the onset and progression of neurological disease through systematic review is ...essential for the development of strategies to reduce the burden of these diseases.•Systematic review identified biological, demographic, environmental, genetic, lifestyle and pharmacological risk factors for specific neurological conditions.•Several risk factors were associated with the onset of multiple conditions. Pesticides, for example, were associated with an increased risk of Alzheimer’s disease, amyotrophic lateral sclerosis, primary brain tumours, and Parkinson’s disease.•Helmet use was associated with a reduction in onset of neurotrauma, as well as all neurologic conditions for which head injury was a risk factor.•The findings presented here should be viewed as provisional, pending a more in-depth evaluation of the weight of evidence.•Further research will also serve to fill current data gaps, particularly regarding risk factors for the progression of neurological disease.•In the interim, the modifiable risk factors may be considered as potential candidates for the development of targeted interventions to reduce the burden of neurological disease in Canada and internationally.
Systematic reviews were conducted to identify risk factors associated with the onset and progression of 14 neurological conditions, prioritized as a component of the National Population Health Study of Neurological Conditions. These systematic reviews provided a basis for evaluating the weight of evidence of evidence for risk factors for the onset and progression of the 14 individual neurological conditions considered. A number of risk factors associated with an increased risk of onset for more than one condition, including exposure to pesticides (associated with an increased risk of AD, amyotrophic lateral sclerosis, brain tumours, and PD; smoking (AD, MS); and infection (MS, Tourette syndrome). Coffee and tea intake was associated with a decreased risk of onset of both dystonia and PD. Further understanding of the etiology of priority neurological conditions will be helpful in focusing future research initiatives and in the development of interventions to reduce the burden associated with neurological conditions in Canada and internationally.
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