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. 2022 Jul 19;12(7):958-969.
doi: 10.5498/wjp.v12.i7.958.

Clinical characteristics of pediatric patients with treatment-refractory Tourette syndrome: An evidence-based survey in a Chinese population

Ying Li  1 , Jun-Juan Yan  1 , Yong-Hua Cui  2
Affiliations

Clinical characteristics of pediatric patients with treatment-refractory Tourette syndrome: An evidence-based survey in a Chinese population

Ying Li et al. World J Psychiatry. .

Abstract

Background: Tourette syndrome (TS) is a complex neurodevelopmental condition marked by tics, as well as a variety of psychiatric comorbidities, such as obsessive-compulsive disorders (OCDs), attention deficit hyperactivity disorder (ADHD), anxiety, and self-injurious behavior. TS might progress to treatment-refractory Tourette syndrome (TRTS) in some patients. However, there is no confirmed evidence in pediatric patients with TRTS.

Aim: To investigate the clinical characteristics of TRTS in a Chinese pediatric sample.

Methods: A total of 126 pediatric patients aged 6-12 years with TS were identified, including 64 TRTS and 62 non-TRTS patients. The Yale Global Tic Severity Scale (YGTSS), Premonitory Urge for Tics Scale (PUTS), and Child Behavior Checklist (CBCL) were used to assess these two groups and compared the difference between the TRTS and non-TRTS patients.

Results: When compared with the non-TRTS group, we found that the age of onset for TRTS was younger (P < 0.001), and the duration of illness was longer (P < 0.001). TRTS was more often caused by psychosocial (P < 0.001) than physiological factors, and coprolalia and inappropriate parenting style were more often present in the TRTS group (P < 0.001). The TRTS group showed a higher level of premonitory urge (P < 0.001), a lower intelligence quotient (IQ) (P < 0.001), and a higher percentage of family history of TS. The TRTS patients demonstrated more problems (P < 0.01) in the "Uncommunicative", "Obsessive-Compulsive", "Social-Withdrawal", "Hyperactive", "Aggressive", and "Delinquent" subscales in the boys group, and "Social-Withdrawal" (P = 0.02) subscale in the girls group.

Conclusion: Pediatric TRTS might show an earlier age of onset age, longer duration of illness, lower IQ, higher premonitory urge, and higher comorbidities with ADHD-related symptoms and OCD-related symptoms. We need to pay more attention to the social communication deficits of TRTS.

Keywords: Child Behavior Checklist; Obsessive-compulsive disorder; Premonitory Urge for Tics Scale; Social withdrawal; Treatment-refractory Tourette syndrome; Yale Global Tic Severity Scale.

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Conflict of interest statement

Conflict-of-interest statement: All other authors report no conflict of interest for this article.

Figures

Figure 1
Figure 1
Flowchart of identification of included participants. TRTS: Treatment-refractory Tourette syndrome; YGTSS: Yale Global Tic Severity Scale; PUTS: Premonitory Urge for Tics Scale; WISC-IV: Wechsler Intelligence Scale for Children-4th Edition.
Figure 2
Figure 2
Percentage of onset locations of tic symptoms in treatment-refractory Tourette syndrome.
Figure 3
Figure 3
Percentage (top 5) of high frequency motor and vocal tic symptoms in treatment-refractory Tourette syndrome. A: Top 5 high frequency motor tic symptoms in treatment-refractory Tourette syndrome (TRTS); B: Top 5 high frequency vocal tic symptoms in TRTS.
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