Objective To observe curative effect of Ningdong granules on tourette syndrome (TS) concomitant with sleep disorder in children. Methods Eighty-three cases were diagnosed by diagnosis and statistics of mental-disorder (DSM-Ⅳ) TS criterion and diagnostic standard of traditional Chinese medicine, and then were divided into 3 groups: tiapride hydrochloride group (n=25), Ningdong granules group (n=30) and tiapride hydrochloride plus Ningdong granules group (n=28). Yale global tic severity scale (YGTSS) and Athens insomnia scale (Athens) were used for rating the clinical efficacy before and after treatment. The enrolled children were treated for a period of three months. Results The therapeutic effective rate of TS in tiapride hydrochloride group, Ningdong granules group and tiapride hydrochloride plus Ningdong granules group was 92.0%, 90.0% and 96.4%, respectively. The therapeutic effective rate of sleep disorder was 84.0%, 93.3% and 96.4%, respectively. After treatment, YGTSS and Athens scores were significantly changed in all three groups (P<0.05). Athens score was significantly different between tiapride hydrochloride plus Ningdong granules group and tiapride hydrochloride group (P<0.05). The total number of adverse reactions was 16, 1 and 8, with significant difference (P<0.01). Conclusion Curative effect of Ningdong granules is similar to that of tiapride hydrochloride on treating TS, but Ningdong granules is more effective than tiapride hydrochloride on treating sleep disorder with less adverse reactions. Combination therapy of Ningdong granules with tiapride hydrochloride is the better choice for treating TS with sleep disorder, and it can also reduce the incidence of adverse reactions of tiapride hydrochloride.
表1
3组患者临床资料比较
Tab.1
Comparison of the baseline data among three groups of patients ヌ±s
组别
例数
性别 男/例
女/例
年龄/ 岁
病程/ 个月
硫必利组
25
21
4
8.2±1.9
22.9±7.3
宁动颗粒组
30
24
6
7.5±2.1
23.8±6.7
宁动颗粒+硫必利组
28
23
5
7.6±1.5
25.1±5.6
表1
3组患者临床资料比较
Tab.1
Comparison of the baseline data among three groups of patients ヌ±s
1.2 纳入标准
采用美国精神病学会《精神障碍诊断与统计学手册》第4版(diagnosis and statistics of mental-disorder,DSM-Ⅳ)中TS的诊断标准:①具有多种运动性抽动及1种或多种发声性抽动,有时不一定在同一时间出现。所指的抽动为突然的、快速的、反复性的、非节律性、刻板的动作或发声。②抽动每天发作多次,通常为一阵阵发作,病情持续或间断发作已超过1年,其无抽动间歇期连续不超过3个月。③上述症状引起明显的不安,显著影响社交、就业和其他重要领域的活动。④发病于18岁前。⑤上述症状不是直接由某些药物(如兴奋剂)或内科疾病(如亨廷顿舞蹈病或病毒感染后脑炎)引起[10]。中医证候学标准基于前期研究成果[11],并参照《中医儿科学》、《中医内科学》及《中医诊断学》标准制定,心肝亏虚型:眨眼,弄鼻,动嘴,皱额,点头,扭颈,耸肩,四肢抽动,脘腹拘挛,异常发声或秽语,学习能力差,注意力不集中,性情急躁易怒,惊悸少寐、易醒或醒后不易入睡、不寐或多梦,不思饮食,口干舌燥,或舌疮频发,神疲乏力,舌质红,苔黄,脉细弦数,所有患者需具备两个主症和一个兼症,综合临床表现及舌象、脉象,辨为心肝亏虚型[12-14]。
治疗前后TS症状采用耶鲁综合抽动严重程度量表(Yale global tic severity scale,YGTSS)评分并评价疗效[15]。显效:减分率≥60%;好转:30%≤减分率<60%;无效:减分率<30%。减分率(%)=[(治疗前评分-治疗后评分)/治疗前评分]×100%。以显效和好转合计为有效。
表4
3组患者治疗前后YGTSS及Athens量表评分情况比较
Tab.4
Comparison of the scores of YFTSS and Athens scale among three groups of patients before and after treatment 分,ヌ±s
组别与时间
例数
YGTSS评分
Athens评分
硫必利组
25
治疗前
21.4±6.4
12.8±2.6
治疗后
11.5±7.1*1
6.8±3.6*1
宁动颗粒组
30
治疗前
20.3±1.5
13.0±2.0
治疗后
11.2±6.9*1
5.1±2.8*1
宁动颗粒+硫必利组
28
治疗前
22.5±8.8
13.8±3.2
治疗后
7.6±6.3*1
4.6±3.2*1*2
Compared with the same group before treatment,*1P<0.01,Compared with tiapride group ,*2P<0.05
与本组治疗前比较,*1P<0.01;与硫必利组比较,*2P<0.05
表4
3组患者治疗前后YGTSS及Athens量表评分情况比较
Tab.4
Comparison of the scores of YFTSS and Athens scale among three groups of patients before and after treatment 分,ヌ±s
2.4 治疗期间不良反应组间比较
3组在治疗期间不良反应发生情况见表5。
表5
Tab.5
表5
表5
3组治疗期间不良反应发生情况比较
Tab.5
Comparison of adverse reactions among three groups during treatment
组别
例数
全身酸软乏力
头晕
恶心或厌食
便秘
烦躁、不能静坐
总不良反应
例
%
例
%
例
%
例
%
例
%
例
%
硫必利组
25
4
16.0
5
20.0
4
16.0
2
8.0
1
4.0
16
64.0
宁动颗粒组
30
0
0.0
0
0.0
1
3.3
0
0.0
0
0.0
1
3.3*1
宁动颗粒+硫必利组
28
2
7.1
3
10.7
2
7.1
1
3.6
0
0.0
8
28.6*1
Compared with tiapride group,*1P<0.01
与硫必利组比较,*1P<0.01
表5
3组治疗期间不良反应发生情况比较
Tab.5
Comparison of adverse reactions among three groups during treatment
BLOCHM,STATEM,PITTENGERC.Recent advances in Tourette syndrome[J].Curr Opin Neurol,2011,24(2): 119-125.
Purpose of review;This review considers the recent literature pertaining to the neurobiology, genetics and treatment of Tourette syndrome.<br/>Recent findings;Over the last several years, both neuropathological and genetic findings have further focused attention on long-standing hypotheses regarding the role of the basal ganglia in causing tics and Tourette syndrome. Moreover, although the field awaits the results the first large-scale genetic studies, recent findings have already mirrored developments in the neuropsychiatric genetics literature more broadly, highlighting the value of the study of rare variation and the overlap of risks among seemingly disparate diagnostic categories. Finally, treatment studies have underscored the importance of cognitive-behavioral as well as pharmacological interventions for the treatment of tic disorders.<br/>Summary;Recent findings have led to novel, testable hypotheses regarding the molecular and cellular mechanisms underlying Tourette syndrome. These, in turn, have begun to provide new avenues to conceptualizing treatment strategies. Although the development of additional medication options is a pressing need, recent data has demonstrated both the safety and efficacy of nonpharmacological approaches.
SINGER HS.Tourette's syndrome: from behavior to biology[J].Lancet Neurol,2005,4(3): 149-159.
Tourette's syndrome (TS) is a chronic neuropsychiatric disorder characterised by motor and vocal tics. Diagnosis is based solely on clinical criteria. The prevalence of this syndrome is estimated to be between one and ten per 1000 children and adolescents and the outcome is generally favourable; most patients improve by their late teens or early adulthood. Affected individuals are at increased risk of various comorbid neurobehavioural problems, the negative effects of which commonly exceed those of tics. Despite evidence that TS is an inherited disorder, the exact genetic abnormality is unknown. Environmental factors might have an important role in the expression of tics, and a poststreptococcal autoimmune cause has been proposed but is unproven. Brain imaging, neurophysiological, and post-mortem studies support involvement of cortical-striatal-thalamocortical pathways, but the definitive pathophysiological mechanism or neurotransmitter abnormality is unknown. Recent evidence, however, suggests a prefrontal dopaminergic abnormality. Traditional neuroleptics are the standard treatment for TS, but there is increasing interest in non-neuroleptic drugs, behavioural therapies, and surgical approaches.
LI JJ,LI ZW,LI AY,et al.Abnormal expression of dopamine and seroton in transport ersassociated with thepathophy siologicme chanism of Tourette's syndrome[J].Neurol Ind,2010,58(4): 523-529.
[本文引用:1]
[5]
TAYLOR JR,MORSHED SA,PARVEENS, et al.An animal model of Tourette's syndrome[J].Am J Psychiatry,2002,159(4):657-660.
[本文引用:2]
[6]
LIUX,WANGY,LID,et al.Transplantation of rat neural stem cells reduces stereotypic behaviors in rats after intrastriatal microinfusion of Tourette's syndrome sera[J].Behav Brain Res,2008,186(1): 84-90.
Tourette syndrome (TS) is a heterogenous neuropsychiatric disorder. In most cases, tics are self-limited or can be treated by behavioral or pharmacological therapy. However, for some individuals, tics can cause lifelong impairment and life-threatening symptoms, which are intractable to traditional treatment. Neural stem cell (NSC) is a potential tool to treat certain neurological diseases. In this study, we proposed to use neural stem cell transplantation as a novel therapy to treat TS and discussed its efficacy. Wistar rats were microinfused with TS sera into the striatum followed by the transplantation of NSCs or vehicle at the infusion site. The sera of the TS patients were identified to have enriched antineural antibodies. Prior to grafting, rat embryonic NSCs were co-cultured with 5-bromodeoxyuridine (Brdu) for 24h. Stereotypic behaviors were counted at 1, 7, 14 and 21 days after transplantation of NSCs. Morphological analyses revealed that NSCs survived and differentiated into neurons and astrocytes in the striatum 3 weeks after grafting. To sum it up, rat embryonic neural stem cell grafts survived and differentiated in the striatum of TS rat may help relieve stereotypic behaviors of the host. Our results suggest that transplantation of NSCs intrastriatum may have therapeutic potential for TS.
LUH,LIA,MAH,et al.Effects of Ningdong Granule on the dopamine system of Tourette' s syndrome rat models[J].J Ethnopharmacol,2009,124(3): 488-492.
Abstract ETHNOPHARMACOLOGICAL RELEVANCE: Ningdong granula (NDG) is a traditional Chinese medicine (TCM) preparation for the treatment of Tourette's syndrome (TS). AIM OF THE STUDY: To explore the effects of NDG on stereotyped behavior, homovanillic acid (HVA) in sera, dopamine (DA) and dopamine D2 receptor (DRD2) in striatum in TS rats. MATERIALS AND METHODS: Sixty-four rats were randomly divided into control group and three experimental groups. TS rat models were induced by intraperitoneal injection (i.p.) of Apomorphine (Apo, 2 mg/kg) in the experimental groups. After Apo i.p., rats were intragastrically injected (i.g.) with NDG at 370 mg/kg (NDG+Apo group), haloperidol (Hal) at 1.0 mg/kg (Hal+Apo group), and normal saline (0.9%) at 10 ml/kg (control group and Apo group), respectively, once a day for 12 weeks. The behaviors of the rats were observed and recorded each day. After 12 weeks, all rats were sacrificed and sera and striatum were collected. The levels of HVA in sera, DA in striatum were examined by ELISA, and the expression of DRD2 mRNA in striatum was measured by RT-PCR. RESULTS: NDG could increase the HVA content in sera (P<0.05), meanwhile downregulate the expression of DRD2 mRNA in striatum (P<0.05), and inhibit the stereotyped behaviors induced by Apo (P<0.01) in TS rats, the same effects with Hal. NDG could also reduce the DA content in striatum (P<0.01), while Hal could not. CONCLUSIONS: NDG could effectively inhibit the stereotyped behaviors in TS rats, and the mechanisms may be related to the suppression of DA system by increasing the content of HVA in sera, decrease the content of DA and repressing the expression of DRD2 mRNA in striatum.
LECKMAN JF,RIDDLE MA,HARDIN MT,et al.The Yale global tic severity scale:initial testing of a clinician-rated scale of tic severity[J].Am Acad Child Adolesc Psychiatry,1989,28(4): 566-573.
Despite the overt nature of most motor and phonic phenomena, the of valid and reliable scales to rate severity has been an elusive goal. The Yale Global Severity Scale (YGTSS) is a new clinical rating instrument that was designed for use in studies of and other disorders. The YGTSS provides an evaluation of the number, frequency, intensity, complexity, and interference of motor and phonic symptoms. Data from 105 subjects, aged 5 to 51 years, support the construct, convergent, and discriminant validity of the instrument. These results indicate that the YGTSS is a promising instrument for the assessment of severity in children, adolescents and adults.
CHUNG KF,KAN KK,YEUNG WF.Assessing insomnia in adolescents: comparison of insomnia severity index,athens insomnia scale and sleep quality index[J].Sleep Med,2011,12(5): 463-470.
Abstract OBJECTIVES: To compare the psychometric properties of the Chinese versions of Insomnia Severity Index (ISI), Athens Insomnia Scale (AIS) and Sleep Quality Index (SQI) for assessment and screening of insomnia in adolescents. METHODS: This is a school-based survey of 1516 adolescents aged 12-19 years. Sleep-wake habit questionnaire, ISI, AIS, SQI, Epworth Sleepiness Scale (ESS) and 12-item General Health Questionnaire (GHQ-12) were administered. Insomnia Interview Schedule was used to assess the severity of insomnia symptoms and DSM-IV-TR diagnosis of insomnia. RESULTS: The Cronbach's alpha of ISI, AIS and SQI were 0.83, 0.81 and 0.65, respectively, and the 2-week test-retest reliability were 0.79, 0.80 and 0.72. All three scales had a 2-factor structure, and their scores were significantly correlated with sleep-wake variables, ESS and GHQ-12 scores, smoking and drinking habits, and academic performance. The areas under curve of ISI, AIS and SQI for detecting clinical insomnia were 0.85, 0.80 and 0.85, respectively. The optimal cut-offs for ISI, AIS and SQI were a total score of nine (sensitivity/specificity: 0.87/0.75), seven (sensitivity/specificity: 0.78/0.74) and five (sensitivity/specificity: 0.83/0.79), respectively. CONCLUSION: The Chinese versions of ISI, AIS and SQI are reliable and valid instruments. The ISI and AIS appear to have better psychometric properties than the SQI. Copyright 2011 Elsevier B.V. All rights reserved.
MOGWITZS,BUSEJ,EHRLICHS,et al.Clinical pharmacology of dopamine-modulating agents in Tourette's syndrome[J].Int Rev Neurobiol,2013,112:281-349.
ABSTRACT Forty years of research and clinical practice have proved dopamine (DA) receptor antagonists to be effective agents in the treatment of Tourette's syndrome (TS), allowing a significant tic reduction of about 70%. Their main effect seems to be mediated by the blockade of the striatal DA-D2 receptors. Various typical and atypical agents are available and there is still discord between experts about which of them should be considered as first choice. In addition, there are suggestions to use DA receptor agonists such as pergolide or non-DA-modulating agents. The present chapter is focusing on the clinical pharmacology of DA-modulating agents in the treatment of TS. The introduction outlines their clinical relevance and touches on the hypotheses of the role of DA in the pathophysiology of TS. Subsequently, general information about the mechanisms of action and adverse effects are provided. The central part of the chapter forms a systematic review of all DA-modulating agents used in the treatment of TS, including an overview of studies on their effectiveness, and a critical discussion of their specific adverse effects. The present chapter closes with a summary of the body of evidence and a description of the resulting recommendations for the pharmacological treatment of TS.
... 采用美国精神病学会《精神障碍诊断与统计学手册》第4版(diagnosis and statistics of mental-disorder,DSM-Ⅳ)中TS的诊断标准:①具有多种运动性抽动及1种或多种发声性抽动,有时不一定在同一时间出现.所指的抽动为突然的、快速的、反复性的、非节律性、刻板的动作或发声.②抽动每天发作多次,通常为一阵阵发作,病情持续或间断发作已超过1年,其无抽动间歇期连续不超过3个月.③上述症状引起明显的不安,显著影响社交、就业和其他重要领域的活动.④发病于18岁前.⑤上述症状不是直接由某些药物(如兴奋剂)或内科疾病(如亨廷顿舞蹈病或病毒感染后脑炎)引起[10].中医证候学标准基于前期研究成果[11],并参照《中医儿科学》、《中医内科学》及《中医诊断学》标准制定,心肝亏虚型:眨眼,弄鼻,动嘴,皱额,点头,扭颈,耸肩,四肢抽动,脘腹拘挛,异常发声或秽语,学习能力差,注意力不集中,性情急躁易怒,惊悸少寐、易醒或醒后不易入睡、不寐或多梦,不思饮食,口干舌燥,或舌疮频发,神疲乏力,舌质红,苔黄,脉细弦数,所有患者需具备两个主症和一个兼症,综合临床表现及舌象、脉象,辨为心肝亏虚型[12-14]. ...
126例抽动-秽语综合征患儿的中医证候学特点
1
2010
... 采用美国精神病学会《精神障碍诊断与统计学手册》第4版(diagnosis and statistics of mental-disorder,DSM-Ⅳ)中TS的诊断标准:①具有多种运动性抽动及1种或多种发声性抽动,有时不一定在同一时间出现.所指的抽动为突然的、快速的、反复性的、非节律性、刻板的动作或发声.②抽动每天发作多次,通常为一阵阵发作,病情持续或间断发作已超过1年,其无抽动间歇期连续不超过3个月.③上述症状引起明显的不安,显著影响社交、就业和其他重要领域的活动.④发病于18岁前.⑤上述症状不是直接由某些药物(如兴奋剂)或内科疾病(如亨廷顿舞蹈病或病毒感染后脑炎)引起[10].中医证候学标准基于前期研究成果[11],并参照《中医儿科学》、《中医内科学》及《中医诊断学》标准制定,心肝亏虚型:眨眼,弄鼻,动嘴,皱额,点头,扭颈,耸肩,四肢抽动,脘腹拘挛,异常发声或秽语,学习能力差,注意力不集中,性情急躁易怒,惊悸少寐、易醒或醒后不易入睡、不寐或多梦,不思饮食,口干舌燥,或舌疮频发,神疲乏力,舌质红,苔黄,脉细弦数,所有患者需具备两个主症和一个兼症,综合临床表现及舌象、脉象,辨为心肝亏虚型[12-14]. ...
1
1995
... 采用美国精神病学会《精神障碍诊断与统计学手册》第4版(diagnosis and statistics of mental-disorder,DSM-Ⅳ)中TS的诊断标准:①具有多种运动性抽动及1种或多种发声性抽动,有时不一定在同一时间出现.所指的抽动为突然的、快速的、反复性的、非节律性、刻板的动作或发声.②抽动每天发作多次,通常为一阵阵发作,病情持续或间断发作已超过1年,其无抽动间歇期连续不超过3个月.③上述症状引起明显的不安,显著影响社交、就业和其他重要领域的活动.④发病于18岁前.⑤上述症状不是直接由某些药物(如兴奋剂)或内科疾病(如亨廷顿舞蹈病或病毒感染后脑炎)引起[10].中医证候学标准基于前期研究成果[11],并参照《中医儿科学》、《中医内科学》及《中医诊断学》标准制定,心肝亏虚型:眨眼,弄鼻,动嘴,皱额,点头,扭颈,耸肩,四肢抽动,脘腹拘挛,异常发声或秽语,学习能力差,注意力不集中,性情急躁易怒,惊悸少寐、易醒或醒后不易入睡、不寐或多梦,不思饮食,口干舌燥,或舌疮频发,神疲乏力,舌质红,苔黄,脉细弦数,所有患者需具备两个主症和一个兼症,综合临床表现及舌象、脉象,辨为心肝亏虚型[12-14]. ...
2002
1
2002
... 采用美国精神病学会《精神障碍诊断与统计学手册》第4版(diagnosis and statistics of mental-disorder,DSM-Ⅳ)中TS的诊断标准:①具有多种运动性抽动及1种或多种发声性抽动,有时不一定在同一时间出现.所指的抽动为突然的、快速的、反复性的、非节律性、刻板的动作或发声.②抽动每天发作多次,通常为一阵阵发作,病情持续或间断发作已超过1年,其无抽动间歇期连续不超过3个月.③上述症状引起明显的不安,显著影响社交、就业和其他重要领域的活动.④发病于18岁前.⑤上述症状不是直接由某些药物(如兴奋剂)或内科疾病(如亨廷顿舞蹈病或病毒感染后脑炎)引起[10].中医证候学标准基于前期研究成果[11],并参照《中医儿科学》、《中医内科学》及《中医诊断学》标准制定,心肝亏虚型:眨眼,弄鼻,动嘴,皱额,点头,扭颈,耸肩,四肢抽动,脘腹拘挛,异常发声或秽语,学习能力差,注意力不集中,性情急躁易怒,惊悸少寐、易醒或醒后不易入睡、不寐或多梦,不思饮食,口干舌燥,或舌疮频发,神疲乏力,舌质红,苔黄,脉细弦数,所有患者需具备两个主症和一个兼症,综合临床表现及舌象、脉象,辨为心肝亏虚型[12-14]. ...
The Yale global tic severity scale:initial testing of a clinician-rated scale of tic severity
1
1989
... 治疗前后TS症状采用耶鲁综合抽动严重程度量表(Yale global tic severity scale,YGTSS)评分并评价疗效[15].显效:减分率≥60%;好转:30%≤减分率<60%;无效:减分率<30%.减分率(%)=[(治疗前评分-治疗后评分)/治疗前评分]×100%.以显效和好转合计为有效. ...
Assessing insomnia in adolescents: comparison of insomnia severity index,athens insomnia scale and sleep quality index
, 牛笛
