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3. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part III: Pharmacological treatment

Author

Roessner, V, Eichele, H, Stern, J, Skov, L, Rizzo, R, Debes, N, Nagy, P, Cavanna, A, Termine, C, Ganos, C, Münchau, A, Szejko, N, Cath, D, Müller-Vahl, K, Verdellen, C, Hartmann, A, Rothenberger, A, Hoekstra, P, Plessen, K, Roessner V, Eichele H, Stern JS, Skov L, Rizzo R, Debes NM, Nagy P, Cavanna A, Termine C, Ganos C, Münchau A, Szejko N, Cath D, Müller-Vahl KR, Verdellen C, Hartmann A, Rothenberger A, Hoekstra PJ, Plessen KJ, Roessner, V, Eichele, H, Stern, J, Skov, L, Rizzo, R, Debes, N, Nagy, P, Cavanna, A, Termine, C, Ganos, C, Münchau, A, Szejko, N, Cath, D, Müller-Vahl, K, Verdellen, C, Hartmann, A, Rothenberger, A, Hoekstra, P, Plessen, K, Roessner V, Eichele H, Stern JS, Skov L, Rizzo R, Debes NM, Nagy P, Cavanna A, Termine C, Ganos C, Münchau A, Szejko N, Cath D, Müller-Vahl KR, Verdellen C, Hartmann A, Rothenberger A, Hoekstra PJ, and Plessen KJ

Abstract

In 2011, the European Society for the Study of Tourette Syndrome (ESSTS) published the first European guidelines for Tourette Syndrome (TS). We now present an update of the part on pharmacological treatment, based on a review of new literature with special attention to other evidence-based guidelines, meta-analyses, and randomized double-blinded studies. Moreover, our revision took into consideration results of a recent survey on treatment preferences conducted among ESSTS experts. The first preference should be given to psychoeducation and to behavioral approaches, as it strengthens the patients’ self-regulatory control and thus his/her autonomy. Because behavioral approaches are not effective, available, or feasible in all patients, in a substantial number of patients pharmacological treatment is indicated, alone or in combination with behavioral therapy. The largest amount of evidence supports the use of dopamine blocking agents, preferably aripiprazole because of a more favorable profile of adverse events than first- and second-generation antipsychotics. Other agents that can be considered include tiapride, risperidone, and especially in case of co-existing attention deficit hyperactivity disorder (ADHD), clonidine and guanfacine. This view is supported by the results of our survey on medication preference among members of ESSTS, in which aripiprazole was indicated as the drug of first choice both in children and adults. In treatment resistant cases, treatment with agents with either a limited evidence base or risk of extrapyramidal adverse effects might be considered, including pimozide, haloperidol, topiramate, cannabis-based agents, and botulinum toxin injections. Overall, treatment of TS should be individualized, and decisions based on the patient’s needs and preferences, presence of co-existing conditions, latest scientific findings as well as on the physician’s preferences, experience, and local regulatory requirements.

Published
2022

5. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part III: pharmacological treatment

Author

Roessner, V., Eichele, H., Stern, J.S., Skov, L., Rizzo, R., Debes, N.M., Nagy, P., Cavanna, A.E., Termine, C., Ganos, C., Münchau, A., Szejko, N., Cath, D., Müller-Vahl, K.R., Verdellen, C., Hartmann, A., Rothenberger, A., Hoekstra, P.J., and Plessen, K.J.

Subjects
Adult, Attention Deficit Disorder with Hyperactivity/drug therapy, Child, Female, Guanfacine/therapeutic use, Humans, Male, Risperidone/therapeutic use, Tic Disorders/complications, Tic Disorders/drug therapy, Tourette Syndrome/complications, Tourette Syndrome/drug therapy, Medication, Pharmacotherapy, Tics, Tourette syndrome, Treatment
Abstract

In 2011, the European Society for the Study of Tourette Syndrome (ESSTS) published the first European guidelines for Tourette Syndrome (TS). We now present an update of the part on pharmacological treatment, based on a review of new literature with special attention to other evidence-based guidelines, meta-analyses, and randomized double-blinded studies. Moreover, our revision took into consideration results of a recent survey on treatment preferences conducted among ESSTS experts. The first preference should be given to psychoeducation and to behavioral approaches, as it strengthens the patients' self-regulatory control and thus his/her autonomy. Because behavioral approaches are not effective, available, or feasible in all patients, in a substantial number of patients pharmacological treatment is indicated, alone or in combination with behavioral therapy. The largest amount of evidence supports the use of dopamine blocking agents, preferably aripiprazole because of a more favorable profile of adverse events than first- and second-generation antipsychotics. Other agents that can be considered include tiapride, risperidone, and especially in case of co-existing attention deficit hyperactivity disorder (ADHD), clonidine and guanfacine. This view is supported by the results of our survey on medication preference among members of ESSTS, in which aripiprazole was indicated as the drug of first choice both in children and adults. In treatment resistant cases, treatment with agents with either a limited evidence base or risk of extrapyramidal adverse effects might be considered, including pimozide, haloperidol, topiramate, cannabis-based agents, and botulinum toxin injections. Overall, treatment of TS should be individualized, and decisions based on the patient's needs and preferences, presence of co-existing conditions, latest scientific findings as well as on the physician's preferences, experience, and local regulatory requirements.

Published
2022

6. Tackle your Tics:pilot findings of a brief, intensive group-based exposure therapy program for children with tic disorders

Author

Heijerman-Holtgrefe, A. P., Verdellen, C. W.J., van de Griendt, J. M.T.M., Beljaars, L. P.L., Kan, K. J., Cath, D., Hoekstra, P. J., Huyser, C., Utens, E. M.W.J., Heijerman-Holtgrefe, A. P., Verdellen, C. W.J., van de Griendt, J. M.T.M., Beljaars, L. P.L., Kan, K. J., Cath, D., Hoekstra, P. J., Huyser, C., and Utens, E. M.W.J.

Abstract

Tourette syndrome (TS) and other chronic tic disorders (CTD) are prevalent neurodevelopmental disorders, which can have a huge burden on families and society. Behavioral treatment is a first-line intervention for tic disorders. Despite demonstrated efficacy, tic reduction and utilization rates of behavioral treatment remain relatively low. Patient associations point to an urgent need for easy-to-undergo treatments that focus both on tic reduction and improvement of quality of life. To enhance treatment outcome and overcome treatment barriers, this pilot study’s aim was to investigate the feasibility and preliminary results of a brief, intensive group-based treatment. Tackle your Tics is a 4-day intensive and comprehensive group-based program for children and adolescents (9–17 years) with a tic disorder, consisting of exposure and response prevention (ERP) treatment and additional supporting components, such as coping strategies, relaxing activities and parent support. Assessments were performed pre- and post-treatment and at 2 months follow-up, to test outcomes on tic severity and quality of life, and explore premonitory urges, emotional and behavioral functioning and treatment satisfaction (N = 14, of whom 13 completed the treatment). Parents and children rated this treatment positive on a treatment satisfaction questionnaire. On tic severity (Yale Global Tic Severity Scale) and quality of life (Gilles de la Tourette Syndrome Quality of Life Scale for children and adolescents), improvements between pre-treatment and follow-up were found. Intensive ERP in group format is promising as a feasible treatment to improve both tic severity as well as quality of life. Larger controlled trials are needed to establish its effectiveness.

Published
2021

10. European clinical guidelines for Tourette Syndrome and other tic disorders. Part I

Author

Cath, Danielle C., Tammy, Hedderly, Ludolph, Andrea G., Stern, Jeremy S., Tara, Murphy, Andreas, Hartmann, Virginie, Czernecki, Mary May Robertson, Davide, Martino, Munchau, A., Rizzo, R., Essts Guidelines Group Androutsos, C., Aschauer, H., Baird, G., Bos Veneman, N., Brambilla, A., Cardona, Francesco Carmelo Giovanni, Cath, D. c., Cavanna, A., Czernecki, V., Dehning, S., Eapter, A., Farkas, L., Gadaros, J., Hartmann, A., Hauser, E., Heyman, I., Hedderly, T., Hoekstra, P. j., Korsgaard, A., Jackson, G. m., Larsson, L., Ludolph, A. g., Martino, D., Menghetti, C., Mol Debes, N., Muller, N., Muller Vahl, K., Murphy, T., Musil, R., Nagy, P., Nurnberger, J., Oostra, B., Paschou, P., Pasquini, M., Plessen, K. j., Porta, M., Rickards, H., Robertson, M. m., Roessner, V., Rothenberger, A., Servello, D., Skov, L., Stern, J. s., Strand, G., Tarnok, Z., Termine, C., Van Der Griendt, J., Verdellen, C., Visser Vandewalle, V., Wannag, E., Wolanczyck, T., Department of Clinical and Health Psychology, Utrecht University/Altrecht Academic Anxiety Outpatient Services, Tourettes Clinic-Evelina Childrens Hospital at Guys and St. Thomas', Kings Health Partners AHSC, Department of Child and Adolescent Psychiatry, Universität Ulm - Ulm University [Ulm, Allemagne], UK Tourette SyndromeAssociation, Department of Neurology, St George's Hospital, Tourette SyndromeClinic, Great Ormond Street Hospital for Children [London] (GOSH), Centre De Référence National 'Syndrome Gilles de la Tourette', Pôle des Maladies du Système Nerveux [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (CRICM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Department of Mental Health Sciences, UCL, Department of Neurological and Psychiatric Sciences, Università degli studi di Bari Aldo Moro (UNIBA), Department of Neurology, University Hospital Medical Centre, Department of Child and Adolescent Neurology and Psychiatry, Catania University, Cath, D, Hedderly, T, Ludolph, A, Stern, J, Murphy, T, Hartmann, A, Czernecki, V, Robertson, M, Martino, D, Munchau, A, Rizzo, R, Androutsos, C, Aschauer, H, Baird, G, Bos-Veneman, N, Brambilla, A, Cardona, F, Cavanna, A, Dehning, S, Eapter, A, Farkas, L, Gadaros, J, Hauser, E, Heyman, I, Hoekstra, P, Korsgaard, A, Jackson, G, Larsson, L, Menghetti, C, Debes, N, Muller, N, Muller-Vahl, K, Musil, R, Nagy, P, Nurnberger, J, Oostra, B, Paschou, P, Pasquini, M, Plessen, K, Porta, M, Rickards, H, Roessner, V, Rothenberger, A, Servello, D, Skov, L, Strand, G, Tarnok, Z, Termine, C, Van Der Griendt, J, Verdellen, C, Visser-Vandewalle, V, Wannag, E, Wolanczyck, T, Neurochirurgie, RS: MHeNs School for Mental Health and Neuroscience, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Università degli studi di Bari Aldo Moro = University of Bari Aldo Moro (UNIBA), Università degli studi di Catania = University of Catania (Unict), and University of Groningen

Subjects
YOUNG-PEOPLE, Comorbidity, Neuropsychological Tests, Guideline, Severity of Illness Index, Tourette syndrome, 0302 clinical medicine, DEFICIT-HYPERACTIVITY DISORDER, QUALITY-OF-LIFE, Developmental and Educational Psychology, Child and adolescent psychiatry, Tic, Tourette, Assessment, Guidelines, medicine.diagnostic_test, ATTENTION-DEFICIT/HYPERACTIVITY DISORDER, Neuropsychology, General Medicine, 3. Good health, Europe, Psychiatry and Mental health, assessment, guidelines, tics, tourette, Tics, TEST-RETEST RELIABILITY, Psychology, medicine.medical_specialty, Tourette, Physical examination, Article, SELF-REPORT, Diagnosis, Differential, 03 medical and health sciences, VERSION DISC-R, Quality of life (healthcare), medicine, Humans, Attention deficit hyperactivity disorder, Pediatrics, Perinatology, and Child Health, Psychiatry, Physical Examination, DIAGNOSTIC INTERVIEW SCHEDULE, Tic, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, OBSESSIVE-COMPULSIVE DISORDER, medicine.disease, 030227 psychiatry, PSYCHOMETRIC PROPERTIES, Tic Disorders, Pediatrics, Perinatology and Child Health, 030217 neurology & neurosurgery, Tourette Syndrome
Abstract

International audience; A working group of the European Society for the Study of Tourette Syndrome (ESSTS) has developed the first European assessment guidelines of Tourette Syndrome (TS). The available literature including national guidelines was thoroughly screened and extensively discussed in the expert group of ESSTS members. Detailed clinical assessment guidelines of tic disorders and their comorbidities in both children and adults are presented. Screening methods that might be helpful and necessary for specialists' differential diagnosis process are suggested in order to further analyse cognitive abilities, emotional functions and motor skills. Besides clinical interviews and physical examination, additional specific tools (questionnaires, checklists and neuropsychological tests) are recommended.

Published
2011

11. European clinical guidelines for Tourette syndrome and other tic disorders. Part II

Author

Veit, Roessner, Plessen, Kerstin J., Aribert, Rothenberger, Ludolph, Andrea G., Renata, Rizzo, Liselotte, Skov, Gerd, Strand, Stern, Jeremy S., Cristiano, Termine, Hoekstra, Pieter J., Guidelines Group Androutsos, Essts C., Aschauer, H., Baird, G., Bos Veneman, N., Brambilla, A., Cardona, Francesco Carmelo Giovanni, Cath, D. c., Cavanna, A. e., Czernecki, V., Dehning, S., Eapter, A., Farkas, L., Gadaros, J., Hartmann, A., Hauser, E., Heyman, I., Hedderly, T., Hoekstra, P. j., Korsgaard, A., Jackson, G. m., Larsson, L., Ludolph, A. g., Martino, D., Menghetti, C., Mol Debes, N., Muller, N., Muller Vahl, K., Munchau, A., Murphy, T., Musil, R., Nagy, P., Nurnberger, J., Oostra, B., Paschou, P., Pasquini, M., Plessen, K. j., Porta, M., Rickards, H., Rizzo, R., Robertson, M. m., Roessner, V., Rothenberger, A., Servello, D., Skov, L., Stern, J. s., Strand, G., Tarnok, Z., Termine, C., Van Der Griendt, J., Verdellen, C., Visser Vandewalle, V., Wannag, E., Wolanczyck, T., Department of Child and Adolescent Psychiatry, University of Dresden Medical School, Centre for Child and Adolescent Psychiatry at Bispebjerg, Capital Region Psychiatry, Department of Neurology, Psychiatry and Sensory Sciences, Faculty of Health and Medical Sciences, University of Copenhagen = Københavns Universitet (KU)-University of Copenhagen = Københavns Universitet (KU), University of Göttingen - Georg-August-Universität Göttingen, Universität Ulm - Ulm University [Ulm, Allemagne], Renata Rizzo Child and Adolescent Neurology and Psichiatry, Maternal Infantile and Radiological Sciences Department, Catania University, Department of Pediatrics, Glostrup University Hospital, Norwegian Resource Center for AD/HD, Tourette Syndrome and Narcolepsy, Ullevål University Hospital, St George's Hospital Neurology, Child Neuropsychiatry Unit, Department of Experimental Medicine, Universitá degli Studi dell’Insubria, Department of Psychiatry, University Medical Center Groningen [Groningen] (UMCG), Roessner, V, Plessen, K, Rothenberger, A, Ludolph, A, Rizzo, R, Skov, L, Strand, G, Stern, J, Termine, C, Hoekstra, P, Androutsos, C, Aschauer, H, Baird, G, Bos-Veneman, N, Brambilla, A, Cardona, F, Cath, D, Cavanna, A, Czernecki, V, Dehning, S, Eapter, A, Farkas, L, Gadaros, J, Hartmann, A, Hauser, E, Heyman, I, Hedderly, T, Korsgaard, A, Jackson, G, Larsson, L, Martino, D, Menghetti, C, Debes, N, Muller, N, Muller-Vahl, K, Munchau, A, Murphy, T, Musil, R, Nagy, P, Nurnberger, J, Oostra, B, Paschou, P, Pasquini, M, Porta, M, Rickards, H, Robertson, M, Servello, D, Tarnok, Z, Van Der Griendt, J, Verdellen, C, Visser-Vandewalle, V, Wannag, E, Wolanczyck, T, Neurochirurgie, and RS: MHeNs School for Mental Health and Neuroscience

Subjects
Placebo-controlled study, Pharmacologic, Guideline, PLACEBO-CONTROLLED TRIAL, Tourette syndrome, Pharmacologic treatment, DOUBLE-BLIND, 0302 clinical medicine, DEFICIT-HYPERACTIVITY DISORDER, Developmental and Educational Psychology, SIMPLE MOTOR TICS, Tic, Tourette, Assessment, ATTENTION-DEFICIT/HYPERACTIVITY DISORDER, LONG-TERM TREATMENT, General Medicine, 3. Good health, Europe, Psychiatry and Mental health, TRANSDERMAL NICOTINE, Tics, BOTULINUM TOXIN INJECTION, Psychology, guidelines, pharmacologic, tics, tourette, treatment, Antipsychotic Agents, medicine.medical_specialty, MEDLINE, Habit reversal training, RETROSPECTIVE CASE-NOTE, Guidelines, Article, 03 medical and health sciences, Tourette, Treatment, medicine, Humans, Medicine & Public Health, Psychiatry, Pediatrics, Perinatology, and Child Health, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, Tic, Evidence-based medicine, OBSESSIVE-COMPULSIVE DISORDER, medicine.disease, 030227 psychiatry, Tic Disorders, Treatment of Tourette syndrome, Pediatrics, Perinatology and Child Health, 030217 neurology & neurosurgery, Tourette Syndrome
Abstract

International audience; To develop a European guideline on pharmacologic treatment of Tourette syndrome (TS) the available literature was thoroughly screened and extensively discussed by a working group of the European Society for the Study of Tourette syndrome (ESSTS). Although there are many more studies on pharmacotherapy of TS than on behavioral treatment options, only a limited number of studies meets rigorous quality criteria. Therefore, we have devised a two-stage approach. First, we present the highest level of evidence by reporting the findings of existing Cochrane reviews in this field. Subsequently, we provide the first comprehensive overview of all reports on pharmacological treatment options for TS through a MEDLINE, PubMed, and EMBASE search for all studies that document the effect of pharmacological treatment of TS and other tic disorders between 1970 and November 2010. We present a summary of the current consensus on pharmacological treatment options for TS in Europe to guide the clinician in daily practice. This summary is, however, rather a status quo of a clinically helpful but merely low evidence guideline, mainly driven by expert experience and opinion, since rigorous experimental studies are scarce.

Published
2011

12. European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment

Author

Roessner, V, Plessen, K, Rothenberger, A, Ludolph, A, Rizzo, R, Skov, L, Strand, G, Stern, J, Termine, C, Hoekstra, P, Androutsos, C, Aschauer, H, Baird, G, Bos-Veneman, N, Brambilla, A, Cardona, F, Cath, D, Cavanna, A, Czernecki, V, Dehning, S, Eapter, A, Farkas, L, Gadaros, J, Hartmann, A, Hauser, E, Heyman, I, Hedderly, T, Korsgaard, A, Jackson, G, Larsson, L, Martino, D, Menghetti, C, Debes, N, Muller, N, Muller-Vahl, K, Munchau, A, Murphy, T, Musil, R, Nagy, P, Nurnberger, J, Oostra, B, Paschou, P, Pasquini, M, Porta, M, Rickards, H, Robertson, M, Servello, D, Tarnok, Z, Van Der Griendt, J, Verdellen, C, Visser-Vandewalle, V, Wannag, E, Wolanczyck, T, Roessner V, Plessen KJ, Rothenberger A, Ludolph AG, Rizzo R, Skov L, Strand G, Stern JS, Termine C, Hoekstra PJ, Androutsos C, Aschauer H, Baird G, Bos-Veneman N, Brambilla A, Cardona F, Cath DC, Cavanna A, Czernecki V, Dehning S, Eapter A, Farkas L, Gadaros J, Hartmann A, Hauser E, Heyman I, Hedderly T, Korsgaard A, Jackson GM, Larsson L, Martino D, Menghetti C, Debes NM, Muller N, Muller-Vahl K, Munchau A, Murphy T, Musil R, Nagy P, Nurnberger J, Oostra B, Paschou P, Pasquini M, Porta M, Rickards H, Robertson MM, Servello D, Tarnok Z, Van Der Griendt J, Verdellen C, Visser-Vandewalle V, Wannag E, Wolanczyck T, Roessner, V, Plessen, K, Rothenberger, A, Ludolph, A, Rizzo, R, Skov, L, Strand, G, Stern, J, Termine, C, Hoekstra, P, Androutsos, C, Aschauer, H, Baird, G, Bos-Veneman, N, Brambilla, A, Cardona, F, Cath, D, Cavanna, A, Czernecki, V, Dehning, S, Eapter, A, Farkas, L, Gadaros, J, Hartmann, A, Hauser, E, Heyman, I, Hedderly, T, Korsgaard, A, Jackson, G, Larsson, L, Martino, D, Menghetti, C, Debes, N, Muller, N, Muller-Vahl, K, Munchau, A, Murphy, T, Musil, R, Nagy, P, Nurnberger, J, Oostra, B, Paschou, P, Pasquini, M, Porta, M, Rickards, H, Robertson, M, Servello, D, Tarnok, Z, Van Der Griendt, J, Verdellen, C, Visser-Vandewalle, V, Wannag, E, Wolanczyck, T, Roessner V, Plessen KJ, Rothenberger A, Ludolph AG, Rizzo R, Skov L, Strand G, Stern JS, Termine C, Hoekstra PJ, Androutsos C, Aschauer H, Baird G, Bos-Veneman N, Brambilla A, Cardona F, Cath DC, Cavanna A, Czernecki V, Dehning S, Eapter A, Farkas L, Gadaros J, Hartmann A, Hauser E, Heyman I, Hedderly T, Korsgaard A, Jackson GM, Larsson L, Martino D, Menghetti C, Debes NM, Muller N, Muller-Vahl K, Munchau A, Murphy T, Musil R, Nagy P, Nurnberger J, Oostra B, Paschou P, Pasquini M, Porta M, Rickards H, Robertson MM, Servello D, Tarnok Z, Van Der Griendt J, Verdellen C, Visser-Vandewalle V, Wannag E, and Wolanczyck T

Abstract

To develop a European guideline on pharmacologic treatment of Tourette syndrome (TS) the available literature was thoroughly screened and extensively discussed by a working group of the European Society for the Study of Tourette syndrome (ESSTS). Although there are many more studies on pharmacotherapy of TS than on behavioral treatment options, only a limited number of studies meets rigorous quality criteria. Therefore, we have devised a two-stage approach. First, we present the highest level of evidence by reporting the findings of existing Cochrane reviews in this field. Subsequently, we provide the first comprehensive overview of all reports on pharmacological treatment options for TS through a MEDLINE, PubMed, and EMBASE search for all studies that document the effect of pharmacological treatment of TS and other tic disorders between 1970 and November 2010. We present a summary of the current consensus on pharmacological treatment options for TS in Europe to guide the clinician in daily practice. This summary is, however, rather a status quo of a clinically helpful but merely low evidence guideline, mainly driven by expert experience and opinion, since rigorous experimental studies are scarce.

Published
2011

13. European clinical guidelines for Tourette syndrome and other tic disorders. Part I: assessment

Author

Cath, D, Hedderly, T, Ludolph, A, Stern, J, Murphy, T, Hartmann, A, Czernecki, V, Robertson, M, Martino, D, Munchau, A, Rizzo, R, Androutsos, C, Aschauer, H, Baird, G, Bos-Veneman, N, Brambilla, A, Cardona, F, Cavanna, A, Dehning, S, Eapter, A, Farkas, L, Gadaros, J, Hauser, E, Heyman, I, Hoekstra, P, Korsgaard, A, Jackson, G, Larsson, L, Menghetti, C, Debes, N, Muller, N, Muller-Vahl, K, Musil, R, Nagy, P, Nurnberger, J, Oostra, B, Paschou, P, Pasquini, M, Plessen, K, Porta, M, Rickards, H, Roessner, V, Rothenberger, A, Servello, D, Skov, L, Strand, G, Tarnok, Z, Termine, C, Van Der Griendt, J, Verdellen, C, Visser-Vandewalle, V, Wannag, E, Wolanczyck, T, Cath DC, Hedderly T, Ludolph AG, Stern JS, Murphy T, Hartmann A, Czernecki V, Robertson MM, Martino D, Munchau A, Rizzo R, Androutsos C, Aschauer H, Baird G, Bos-Veneman N, Brambilla A, Cardona F, Cavanna A, Dehning S, Eapter A, Farkas L, Gadaros J, Hauser E, Heyman I, Hoekstra PJ, Korsgaard A, Jackson GM, Larsson L, Menghetti C, Debes NM, Muller N, Muller-Vahl K, Musil R, Nagy P, Nurnberger J, Oostra B, Paschou P, Pasquini M, Plessen KJ, Porta M, Rickards H, Roessner V, Rothenberger A, Servello D, Skov L, Strand G, Tarnok Z, Termine C, Van Der Griendt J, Verdellen C, Visser-Vandewalle V, Wannag E, Wolanczyck T, Cath, D, Hedderly, T, Ludolph, A, Stern, J, Murphy, T, Hartmann, A, Czernecki, V, Robertson, M, Martino, D, Munchau, A, Rizzo, R, Androutsos, C, Aschauer, H, Baird, G, Bos-Veneman, N, Brambilla, A, Cardona, F, Cavanna, A, Dehning, S, Eapter, A, Farkas, L, Gadaros, J, Hauser, E, Heyman, I, Hoekstra, P, Korsgaard, A, Jackson, G, Larsson, L, Menghetti, C, Debes, N, Muller, N, Muller-Vahl, K, Musil, R, Nagy, P, Nurnberger, J, Oostra, B, Paschou, P, Pasquini, M, Plessen, K, Porta, M, Rickards, H, Roessner, V, Rothenberger, A, Servello, D, Skov, L, Strand, G, Tarnok, Z, Termine, C, Van Der Griendt, J, Verdellen, C, Visser-Vandewalle, V, Wannag, E, Wolanczyck, T, Cath DC, Hedderly T, Ludolph AG, Stern JS, Murphy T, Hartmann A, Czernecki V, Robertson MM, Martino D, Munchau A, Rizzo R, Androutsos C, Aschauer H, Baird G, Bos-Veneman N, Brambilla A, Cardona F, Cavanna A, Dehning S, Eapter A, Farkas L, Gadaros J, Hauser E, Heyman I, Hoekstra PJ, Korsgaard A, Jackson GM, Larsson L, Menghetti C, Debes NM, Muller N, Muller-Vahl K, Musil R, Nagy P, Nurnberger J, Oostra B, Paschou P, Pasquini M, Plessen KJ, Porta M, Rickards H, Roessner V, Rothenberger A, Servello D, Skov L, Strand G, Tarnok Z, Termine C, Van Der Griendt J, Verdellen C, Visser-Vandewalle V, Wannag E, and Wolanczyck T

Abstract

A working group of the European Society for the Study of Tourette Syndrome (ESSTS) has developed the first European assessment guidelines of Tourette Syndrome (TS). The available literature including national guidelines was thoroughly screened and extensively discussed in the expert group of ESSTS members. Detailed clinical assessment guidelines of tic disorders and their comorbidities in both children and adults are presented. Screening methods that might be helpful and necessary for specialists' differential diagnosis process are suggested in order to further analyse cognitive abilities, emotional functions and motor skills. Besides clinical interviews and physical examination, additional specific tools (questionnaires, checklists and neuropsychological tests) are recommended.

Published
2011

14. European clinical guidelines for Tourette syndrome and other tic disorders. Part III: Behavioural and psychosocial interventions

Author

Verdellen, C, Van De Griendt, J, Hartmann, A, Murphy, T, Androutsos, C, Aschauer, H, Baird, G, Bos-Veneman, N, Brambilla, A, Cardona, F, Cath, D, Cavanna, A, Czernecki, V, Dehning, S, Eapter, A, Farkas, L, Gadaros, J, Hauser, E, Heyman, I, Hedderly, T, Hoekstra, P, Korsgaard, A, Jackson, G, Larsson, L, Ludolph, A, Martino, D, Menghetti, C, Debes, N, Muller, N, Muller-Vahl, K, Munchau, A, Musil, R, Nagy, P, Nurnberger, J, Oostra, B, Paschou, P, Pasquini, M, Plessen, K, Porta, M, Rickards, H, Rizzo, R, Robertson, M, Roessner, V, Rothenberger, A, Servello, D, Skov, L, Stern, J, Strand, G, Tarnok, Z, Termine, C, Visser-Vandewalle, V, Wannag, E, Wolanczyck, T, Verdellen C, Van De Griendt J, Hartmann A, Murphy T, Androutsos C, Aschauer H, Baird G, Bos-Veneman N, Brambilla A, Cardona F, Cath DC, Cavanna A, Czernecki V, Dehning S, Eapter A, Farkas L, Gadaros J, Hauser E, Heyman I, Hedderly T, Hoekstra PJ, Korsgaard A, Jackson GM, Larsson L, Ludolph AG, Martino D, Menghetti C, Debes NM, Muller N, Muller-Vahl K, Munchau A, Musil R, Nagy P, Nurnberger J, Oostra B, Paschou P, Pasquini M, Plessen KJ, Porta M, Rickards H, Rizzo R, Robertson MM, Roessner V, Rothenberger A, Servello D, Skov L, Stern JS, Strand G, Tarnok Z, Termine C, Visser-Vandewalle V, Wannag E, Wolanczyck T, Verdellen, C, Van De Griendt, J, Hartmann, A, Murphy, T, Androutsos, C, Aschauer, H, Baird, G, Bos-Veneman, N, Brambilla, A, Cardona, F, Cath, D, Cavanna, A, Czernecki, V, Dehning, S, Eapter, A, Farkas, L, Gadaros, J, Hauser, E, Heyman, I, Hedderly, T, Hoekstra, P, Korsgaard, A, Jackson, G, Larsson, L, Ludolph, A, Martino, D, Menghetti, C, Debes, N, Muller, N, Muller-Vahl, K, Munchau, A, Musil, R, Nagy, P, Nurnberger, J, Oostra, B, Paschou, P, Pasquini, M, Plessen, K, Porta, M, Rickards, H, Rizzo, R, Robertson, M, Roessner, V, Rothenberger, A, Servello, D, Skov, L, Stern, J, Strand, G, Tarnok, Z, Termine, C, Visser-Vandewalle, V, Wannag, E, Wolanczyck, T, Verdellen C, Van De Griendt J, Hartmann A, Murphy T, Androutsos C, Aschauer H, Baird G, Bos-Veneman N, Brambilla A, Cardona F, Cath DC, Cavanna A, Czernecki V, Dehning S, Eapter A, Farkas L, Gadaros J, Hauser E, Heyman I, Hedderly T, Hoekstra PJ, Korsgaard A, Jackson GM, Larsson L, Ludolph AG, Martino D, Menghetti C, Debes NM, Muller N, Muller-Vahl K, Munchau A, Musil R, Nagy P, Nurnberger J, Oostra B, Paschou P, Pasquini M, Plessen KJ, Porta M, Rickards H, Rizzo R, Robertson MM, Roessner V, Rothenberger A, Servello D, Skov L, Stern JS, Strand G, Tarnok Z, Termine C, Visser-Vandewalle V, Wannag E, and Wolanczyck T

Abstract

https://www.scopus.com/record/display.uri?eid=2-s2.0-79953671767&origin=inward&txGid=f0b1b36d5709f6e790c8e38d3bd219bb#:~:text=This clinical guideline,with drug treatment.

Published
2011

15. European clinical guidelines for Tourette syndrome and other tic disorders. Part III: behavioural and psychosocial interventions

Author

Verdellen, C., Van De Griendt, J., Hartmann, A., Tara, Murphy, Essts Guidelines Group Androutsos, C., Aschauer, H., Baird, G., Bos Veneman, N., Brambilla, A., Cardona, Francesco Carmelo Giovanni, Cath, D. c., Cavanna, A. e., Czernecki, V., Dehning, S., Eapter, A., Farkas, L., Gadaros, J., Hauser, E., Heyman, I., Hedderly, T., Hoekstra, P. j., Korsgaard, A., Jackson, G. m., Larsson, L., Ludolph, A. g., Martino, D., Menghetti, C., Mol Debes, N., Muller, N., Muller Vahl, K., Munchau, A., Murphy, T., Musil, R., Nagy, P., Nurnberger, J., Oostra, B., Paschou, P., Pasquini, M., Plessen, K. j., Porta, M., Rickards, H., Rizzo, R., Robertson, M. m., Roessner, V., Rothenberger, A., Servello, D., Skov, L., Stern, J. s., Strand, G., Tarnok, Z., Termine, C., Van Der Griendt, J., Visser Vandewalle, V., Wannag, E., Wolanczyck, T., Verdellen, C, Van De Griendt, J, Hartmann, A, Murphy, T, Androutsos, C, Aschauer, H, Baird, G, Bos-Veneman, N, Brambilla, A, Cardona, F, Cath, D, Cavanna, A, Czernecki, V, Dehning, S, Eapter, A, Farkas, L, Gadaros, J, Hauser, E, Heyman, I, Hedderly, T, Hoekstra, P, Korsgaard, A, Jackson, G, Larsson, L, Ludolph, A, Martino, D, Menghetti, C, Debes, N, Muller, N, Muller-Vahl, K, Munchau, A, Musil, R, Nagy, P, Nurnberger, J, Oostra, B, Paschou, P, Pasquini, M, Plessen, K, Porta, M, Rickards, H, Rizzo, R, Robertson, M, Roessner, V, Rothenberger, A, Servello, D, Skov, L, Stern, J, Strand, G, Tarnok, Z, Termine, C, Visser-Vandewalle, V, Wannag, E, Wolanczyck, T, HSK Group/Expertise Centre Tics, CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Tourette Syndrome Clinic, Great Ormond Street Hospital for Children [London] (GOSH), Neurochirurgie, RS: MHeNs School for Mental Health and Neuroscience, and University of Groningen

Subjects
literature review, medicine.medical_treatment, Psychological intervention, CHILDREN, Cochrane Library, Guideline, NEUROFEEDBACK, Tourette syndrome, THERAPY, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Behavior Therapy, ADOLESCENTS, Developmental and Educational Psychology, guidelines, behavioural treatment, Tourette, Tic disorders, Behavioural treatment, Psychosocial interventions, SUPPORTIVE PSYCHOTHERAPY, General Medicine, Tic disorder, RANDOMIZED CONTROLLED-TRIAL, 3. Good health, Europe, Psychiatry and Mental health, psychosocial interventions, tic disorders, tourette, Psychology, Psychosocial, medicine.medical_specialty, Tics, Habit reversal training, RELAXATION, HABIT-REVERSAL, 03 medical and health sciences, Psychoeducation, medicine, Humans, Psychosocial intervention, Psychiatry, PEER, SUPPRESSION, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, medicine.disease, 030227 psychiatry, Tic Disorders, Pediatrics, Perinatology and Child Health, 030217 neurology & neurosurgery, Tourette Syndrome
Abstract

International audience; This clinical guideline provides recommendations for the behavioural and psychosocial interventions (BPI) of children and adolescents with tic disorders prepared by a working group of the European Society for the Study of Tourette Syndrome (ESSTS). A systematic literature search was conducted to obtain an update on the efficacy of BPI for tics. Relevant studies were identified using computerised searches of the Medline and PsycINFO databases and the Cochrane Library for the years 1950-2010. The search identified no meta-analyses, yet twelve (systematic) reviews and eight randomised controlled trials provided evidence for the current review. Most evidence was found for habit reversal training (HRT) and the available but smaller evidence also supports the efficacy of exposure with response prevention (ERP). Both interventions are considered first line behavioural treatments for tics for both children and adults and should be offered to a patient, taking into account his preference. Treatments that are considered second line or add-on behavioural treatments are contingency management, function based interventions and relaxation training. Neurofeedback is still experimental. Almost no research was identified that examined the efficacy of psychosocial interventions, e.g., psychoeducation and group work. Based on clinical practice, this guideline recommends behavioural treatment as first line offer to patients in most cases. It should be embedded within a psychoeducational and supportive context and can be combined with drug treatment.

Published
2011

16. European clinical guidelines for Tourette syndrome and other tic disorders. Part IV: Deep brain stimulation

Author

Muller Vahl, K. r., Cath, Danielle C., Cavanna, Andrea E., Sandra, Dehning, Mauro, Porta, Robertson, Mary M., Veerle Visser Vandewalle, Essts Guidelines Group Androutsos, C., Aschauer, H., Baird, G., Bos Veneman, N., Brambilla, A., Cardona, Francesco Carmelo Giovanni, Cath, D. c., Cavanna, A. e., Czernecki, V., Dehning, S., Eapter, A., Farkas, L., Gadaros, J., Hartmann, A., Hauser, E., Heyman, I., Hedderly, T., Hoekstra, P. j., Korsgaard, A., Jackson, G. m., Larsson, L., Ludolph, A. g., Martino, D., Menghetti, C., Mol Debes, N., Muller, N., Muller Vahl, K., Munchau, A., Murphy, T., Musil, R., Nagy, P., Nurnberger, J., Oostra, B., Paschou, P., Pasquini, M., Plessen, K. j., Porta, M., Rickards, H., Rizzo, R., Robertson, M. m., Roessner, V., Rothenberger, A., Servello, D., Skov, L., Stern, J. s., Strand, G., Tarnok, Z., Termine, C., Van Der Griendt, J., Verdellen, C., Visser Vandewalle, V., Wannag, E., Wolanczyck, T., University of Groningen, Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School [Hannover] (MHH), Department of Clinical and Health Psychology, Utrecht University/Altrecht Academic Anxiety Outpatient Services, Department of Neuropsychiatry, Birmingham and Solihull Mental Health NHS Foundation, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München (LMU), Movement Disorders and Tourette Centre, Department of Mental Health Sciences, UCL, Department of Neurosurgery, University Hospital Maastricht, Neurochirurgie, RS: MHeNs School for Mental Health and Neuroscience, Muller-Vahl, K, Cath, D, Cavanna, A, Dehning, S, Porta, M, Robertson, M, Visser-Vandewalle, V, and the ESSTS Guidelines, G

Subjects
Pediatrics, Tic, Tourette, Deep Brain Stimulation, Treatment, ASSESSMENT RECOMMENDATIONS, SURGERY, medicine.medical_treatment, DBS, Guideline, Tourette syndrome, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Developmental and Educational Psychology, Deep brain stimulation, THALAMIC-STIMULATION, General Medicine, 3. Good health, Europe, Psychiatry and Mental health, Tics, Anxiety, medicine.symptom, Psychology, medicine.medical_specialty, NUCLEUS-ACCUMBENS, Context (language use), IMPROVEMENT, Guidelines, PATIENT SELECTION, 03 medical and health sciences, medicine, Humans, Tourette, Psychiatry, GLOBUS-PALLIDUS INTERNUS, Tic, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, medicine.disease, 030227 psychiatry, GPI, Supportive psychotherapy, Tic Disorders, Pediatrics, Perinatology and Child Health, 030217 neurology & neurosurgery, Tourette Syndrome
Abstract

International audience; Ten years ago deep brain stimulation (DBS) has been introduced as an alternative and promising treatment option for patients suffering from severe Tourette syndrome (TS). It seemed timely to develop a European guideline on DBS by a working group of the European Society for the Study of Tourette Syndrome (ESSTS). For a narrative review a systematic literature search was conducted and expert opinions of the guidelines group contributed also to the suggestions. Of 63 patients reported so far in the literature 59 had a beneficial outcome following DBS with moderate to marked tic improvement. However, randomized controlled studies including a larger number of patients are still lacking. Although persistent serious adverse effects (AEs) have hardly been reported, surgery-related (e.g., bleeding, infection) as well as stimulation-related AEs (e.g., sedation, anxiety, altered mood, changes in sexual function) may occur. At present time, DBS in TS is still in its infancy. Due to both different legality and practical facilities in different European countries these guidelines, therefore, have to be understood as recommendations of experts. However, among the ESSTS working group on DBS in TS there is general agreement that, at present time, DBS should only be used in adult, treatment resistant, and severely affected patients. It is highly recommended to perform DBS in the context of controlled trials.

Published
2011

19. European clinical guidelines for Tourette syndrome and other tic disorders—version 2.0. Part III: pharmacological treatment

Author

Kerstin J. Plessen, Peter Nagy, Christos Ganos, Renata Rizzo, Danielle C. Cath, Andreas Hartmann, Cristiano Termine, Andrea E. Cavanna, Natalia Szejko, Kirsten R. Müller-Vahl, Aribert Rothenberger, Alexander Münchau, Cara Verdellen, Liselotte Skov, Nanette Mol Debes, Heike Eichele, Pieter J. Hoekstra, Veit Roessner, Jeremy S. Stern, Technische Universität Dresden = Dresden University of Technology (TU Dresden), University of Birmingham [Birmingham], Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Centre De Référence National 'Syndrome Gilles de la Tourette', Pôle des Maladies du Système Nerveux [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Roessner, V, Eichele, H, Stern, J, Skov, L, Rizzo, R, Debes, N, Nagy, P, Cavanna, A, Termine, C, Ganos, C, Münchau, A, Szejko, N, Cath, D, Müller-Vahl, K, Verdellen, C, Hartmann, A, Rothenberger, A, Hoekstra, P, and Plessen, K

Subjects
Male, medicine.medical_treatment, Medication, PLACEBO-CONTROLLED TRIAL, Tourette syndrome, Tiapride, chemistry.chemical_compound, DOUBLE-BLIND, 0302 clinical medicine, Pharmacotherapy, Tics, Treatment, DEFICIT-HYPERACTIVITY DISORDER, DELTA(9)-TETRAHYDROCANNABINOL THC, Developmental and Educational Psychology, Medicine, Child, ATTENTION-DEFICIT/HYPERACTIVITY DISORDER, PSYCHIATRIC-DISORDERS, General Medicine, Risperidone, 3. Good health, Clonidine, Psychiatry and Mental health, Aripiprazole, Female, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], medicine.drug, Adult, medicine.medical_specialty, 03 medical and health sciences, BOTULINUM TOXIN, Psychoeducation, Attention deficit hyperactivity disorder, Humans, Psychiatry, ARIPIPRAZOLE OPC-14597, Tic, [SDV.MHEP.PED]Life Sciences [q-bio]/Human health and pathology/Pediatrics, business.industry, OBSESSIVE-COMPULSIVE DISORDER, medicine.disease, 030227 psychiatry, Guanfacine, chemistry, Attention Deficit Disorder with Hyperactivity, Tic Disorders, Pediatrics, Perinatology and Child Health, ANTIPSYCHOTIC AUGMENTATION, business, 030217 neurology & neurosurgery
Abstract

In 2011, the European Society for the Study of Tourette Syndrome (ESSTS) published the first European guidelines for Tourette Syndrome (TS). We now present an update of the part on pharmacological treatment, based on a review of new literature with special attention to other evidence-based guidelines, meta-analyses, and randomized double-blinded studies. Moreover, our revision took into consideration results of a recent survey on treatment preferences conducted among ESSTS experts. The first preference should be given to psychoeducation and to behavioral approaches, as it strengthens the patients’ self-regulatory control and thus his/her autonomy. Because behavioral approaches are not effective, available, or feasible in all patients, in a substantial number of patients pharmacological treatment is indicated, alone or in combination with behavioral therapy. The largest amount of evidence supports the use of dopamine blocking agents, preferably aripiprazole because of a more favorable profile of adverse events than first- and second-generation antipsychotics. Other agents that can be considered include tiapride, risperidone, and especially in case of co-existing attention deficit hyperactivity disorder (ADHD), clonidine and guanfacine. This view is supported by the results of our survey on medication preference among members of ESSTS, in which aripiprazole was indicated as the drug of first choice both in children and adults. In treatment resistant cases, treatment with agents with either a limited evidence base or risk of extrapyramidal adverse effects might be considered, including pimozide, haloperidol, topiramate, cannabis-based agents, and botulinum toxin injections. Overall, treatment of TS should be individualized, and decisions based on the patient’s needs and preferences, presence of co-existing conditions, latest scientific findings as well as on the physician’s preferences, experience, and local regulatory requirements.

Published
2021

20. Addressing co-occurring conditions in behavioural therapy for tic disorders: a review and guideline.

Author

Sanderson C, Verdellen C, Debes N, Tárnok Z, van de Griendt J, Zimmerman-Brenner S, and Murphy T

Subjects
Humans, Child, Attention Deficit Disorder with Hyperactivity therapy, Attention Deficit Disorder with Hyperactivity complications, Autism Spectrum Disorder therapy, Autism Spectrum Disorder complications, Obsessive-Compulsive Disorder therapy, Practice Guidelines as Topic, Adult, Tourette Syndrome therapy, Adolescent, Tic Disorders therapy, Behavior Therapy methods, Comorbidity
Abstract

Co-occurring psychiatric conditions are very common in tic disorders and Tourette syndrome. These additional symptoms are often detrimental to quality of life and may impact upon the implementation and efficacy of evidence-based behavioural therapies (BT) for tics. Combining a review of the available literature, relevant theory, and expert clinical practice, we present a guideline for implementing behavioural and psychosocial interventions when common comorbidities are present. These include attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, disruptive behaviour, autism spectrum disorder (ASD) and depression. Practical recommendations are provided for assessment, formulation and management of specific and multiple comorbidities in BT for both children and adults. Despite comorbidities being common in tic disorders, few studies have comprehensively addressed how they may influence the efficacy or implementation of existing therapies or how such treatments may need to be modified or sequenced. We outline recommendations for future research, including randomised control trials of BT for those with specific or multiple comorbidities, as well as adequately powered sub-group analyses within larger scale trials or naturalistic study designs. Transdiagnostic models of psychiatric disorders and treatment, including modular cross-diagnostic therapies, which recognise the dimensionality of psychiatric disorders are also highlighted as an important focus in treatment development in tic disorders., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Published
2024
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21. Effectiveness of 'Tackle Your Tics', a brief, intensive group-based exposure therapy programme for children with tic disorders: study protocol of a randomised controlled trial.

Author

Heijerman-Holtgrefe A, Huyser C, Verdellen C, van de Griendt J, Beljaars L, Kan KJ, Lindauer R, Cath D, Hoekstra P, and Utens L

Subjects
Adolescent, Child, Humans, Quality of Life, Randomized Controlled Trials as Topic, Implosive Therapy, Tic Disorders therapy, Tics therapy, Tourette Syndrome psychology, Tourette Syndrome therapy
Abstract

Introduction: This paper outlines the study protocol for the Dutch Tackle Your Tics study in youth with tic disorders. Tourette syndrome and chronic tic disorders are prevalent neurodevelopmental disorders, placing considerable burden on youth and their families. Behavioural treatment is the first-line, evidence-based intervention for tic disorders, but tic reduction and availability remain relatively low. Patient associations stress the need for more accessible high-quality treatments, also focusing on improving quality of life. Therefore, the brief, intensive group-based treatment Tackle Your Tics was developed., Methods and Analysis: Tackle Your Tics is a 4-day intensive and comprehensive group-based intervention for children and adolescents (9-17 years) with Tourette syndrome or a chronic tic disorder. The programme encompasses exposure and response prevention treatment and additional supporting components (coping strategies, relaxation exercises and parent support). To study the effectiveness of Tackle Your Tics and identify predictors/moderators at baseline, a single-blinded randomised controlled trial (n=104) is conducted, comparing Tackle Your Tics (n=52) with a waiting list condition lasting 3 months (n=52). Assessments are performed at similar time points for both groups: at baseline, after 4 weeks, and at 3 and 6 months of follow-up, on tic severity, quality of life and other psychosocial variables., Ethics and Dissemination: Ethics approval has been obtained from the medical ethical committee of the Amsterdam Medical Centre (METC nr NL66340.018.18, v3 June 2020). Findings will be presented on national and international conferences, peer-reviewed scientific journals, patient organisation meetings and public media. Patient representatives are fully integrated as part of the research team. If Tackle Your Tics proves to be effective, it can expand evidence-based treatment possibilities for children and adolescents with tic disorders. Identifying the psychosocial predictors/moderators for the effectiveness of this intervention can provide personalised treatment advice in the future., Trial Registration Number: NL8052., Competing Interests: Competing interests: CV and JMTMG developed and published the manual ‘Tics’ and the training app BT-Coach (BT-Tics Foundation), which are both being used in the programme. On behalf of all authors, the corresponding author states that there are no other conflicts of interest., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2022
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22. European clinical guidelines for Tourette syndrome and other tic disorders: summary statement.

Author

Müller-Vahl KR, Szejko N, Verdellen C, Roessner V, Hoekstra PJ, Hartmann A, and Cath DC

Subjects
Humans, Tic Disorders diagnosis, Tic Disorders therapy, Tics diagnosis, Tics therapy, Tourette Syndrome diagnosis, Tourette Syndrome psychology, Tourette Syndrome therapy
Abstract

In 2011 a working group of the European Society for the Study of Tourette syndrome (ESSTS) developed the first European Guidelines for Tourette syndrome (TS) published in the ECAP journal. After a decade ESSTS now presents updated guidelines, divided into four sections: Part I: assessment, Part II: psychological interventions, Part III: pharmacological treatment and Part IV: deep brain stimulation (DBS). In this paper, we summarise new developments described in the guidelines with respect to assessment and treatment of tics. Further, summary findings from a recent survey conducted amongst TS experts on these same topics are presented, as well as the first European patient representative statement on research. Finally, an updated decision tree is introduced providing a practical algorithm for the treatment of patients with TS. Interestingly, in the last decade there has been a significant shift in assessment and treatment of tics, with more emphasis on non-pharmacological treatments., (© 2021. The Author(s).)

Published
2022
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23. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part II: psychological interventions.

Author

Andrén P, Jakubovski E, Murphy TL, Woitecki K, Tarnok Z, Zimmerman-Brenner S, van de Griendt J, Debes NM, Viefhaus P, Robinson S, Roessner V, Ganos C, Szejko N, Müller-Vahl KR, Cath D, Hartmann A, and Verdellen C

Subjects
Behavior Therapy, Humans, Psychosocial Intervention, Tic Disorders, Tics therapy, Tourette Syndrome psychology, Tourette Syndrome therapy
Abstract

Part II of the European clinical guidelines for Tourette syndrome and other tic disorders (ECAP journal, 2011) provides updated information and recommendations for psychological interventions for individuals with tic disorders, created by a working group of the European Society for the Study of Tourette Syndrome (ESSTS). A systematic literature search was conducted to obtain original studies of psychological interventions for tic disorders, published since the initial European clinical guidelines were issued. Relevant studies were identified using computerized searches of the MEDLINE and PsycINFO databases for the years 2011-2019 and a manual search for the years 2019-2021. Based on clinical consensus, psychoeducation is recommended as an initial intervention regardless of symptom severity. According to a systematic literature search, most evidence was found for Habit Reversal Training (HRT), primarily the expanded package Comprehensive Behavioral Intervention for Tics (CBIT). Evidence was also found for Exposure and Response Prevention (ERP), but to a lesser degree of certainty than HRT/CBIT due to fewer studies. Currently, cognitive interventions and third-wave interventions are not recommended as stand-alone treatments for tic disorders. Several novel treatment delivery formats are currently being evaluated, of which videoconference delivery of HRT/CBIT has the most evidence to date. To summarize, when psychoeducation alone is insufficient, both HRT/CBIT and ERP are recommended as first-line interventions for tic disorders. As part of the development of the clinical guidelines, a survey is reported from ESSTS members and other tic disorder experts on preference, use and availability of psychological interventions for tic disorders., (© 2021. The Author(s).)

Published
2022
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24. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part III: pharmacological treatment.

Author

Roessner V, Eichele H, Stern JS, Skov L, Rizzo R, Debes NM, Nagy P, Cavanna AE, Termine C, Ganos C, Münchau A, Szejko N, Cath D, Müller-Vahl KR, Verdellen C, Hartmann A, Rothenberger A, Hoekstra PJ, and Plessen KJ

Subjects
Adult, Child, Female, Guanfacine therapeutic use, Humans, Male, Risperidone therapeutic use, Attention Deficit Disorder with Hyperactivity drug therapy, Tic Disorders complications, Tic Disorders drug therapy, Tourette Syndrome complications, Tourette Syndrome drug therapy
Abstract

In 2011, the European Society for the Study of Tourette Syndrome (ESSTS) published the first European guidelines for Tourette Syndrome (TS). We now present an update of the part on pharmacological treatment, based on a review of new literature with special attention to other evidence-based guidelines, meta-analyses, and randomized double-blinded studies. Moreover, our revision took into consideration results of a recent survey on treatment preferences conducted among ESSTS experts. The first preference should be given to psychoeducation and to behavioral approaches, as it strengthens the patients' self-regulatory control and thus his/her autonomy. Because behavioral approaches are not effective, available, or feasible in all patients, in a substantial number of patients pharmacological treatment is indicated, alone or in combination with behavioral therapy. The largest amount of evidence supports the use of dopamine blocking agents, preferably aripiprazole because of a more favorable profile of adverse events than first- and second-generation antipsychotics. Other agents that can be considered include tiapride, risperidone, and especially in case of co-existing attention deficit hyperactivity disorder (ADHD), clonidine and guanfacine. This view is supported by the results of our survey on medication preference among members of ESSTS, in which aripiprazole was indicated as the drug of first choice both in children and adults. In treatment resistant cases, treatment with agents with either a limited evidence base or risk of extrapyramidal adverse effects might be considered, including pimozide, haloperidol, topiramate, cannabis-based agents, and botulinum toxin injections. Overall, treatment of TS should be individualized, and decisions based on the patient's needs and preferences, presence of co-existing conditions, latest scientific findings as well as on the physician's preferences, experience, and local regulatory requirements., (© 2021. The Author(s).)

Published
2022
Full Text
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25. European clinical guidelines for Tourette syndrome and other tic disorders. Part III: behavioural and psychosocial interventions.

Author

Verdellen C, van de Griendt J, Hartmann A, and Murphy T

Subjects
Europe, Humans, Behavior Therapy, Tic Disorders therapy, Tourette Syndrome therapy
Abstract

This clinical guideline provides recommendations for the behavioural and psychosocial interventions (BPI) of children and adolescents with tic disorders prepared by a working group of the European Society for the Study of Tourette Syndrome (ESSTS). A systematic literature search was conducted to obtain an update on the efficacy of BPI for tics. Relevant studies were identified using computerised searches of the Medline and PsycINFO databases and the Cochrane Library for the years 1950-2010. The search identified no meta-analyses, yet twelve (systematic) reviews and eight randomised controlled trials provided evidence for the current review. Most evidence was found for habit reversal training (HRT) and the available but smaller evidence also supports the efficacy of exposure with response prevention (ERP). Both interventions are considered first line behavioural treatments for tics for both children and adults and should be offered to a patient, taking into account his preference. Treatments that are considered second line or add-on behavioural treatments are contingency management, function based interventions and relaxation training. Neurofeedback is still experimental. Almost no research was identified that examined the efficacy of psychosocial interventions, e.g., psychoeducation and group work. Based on clinical practice, this guideline recommends behavioural treatment as first line offer to patients in most cases. It should be embedded within a psychoeducational and supportive context and can be combined with drug treatment.

Published
2011
Full Text
View/download PDF

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