The Causes Analysis And Treatment For Chlidren’s Refractory Tourette Syndrome

Objective:Through the retrospective study of refractory and commonTourette syndrome(TS) cases’ clinical datas，probe etiologies of theformation of refractory TS， research the clinical curative effect ofTopiramate (TPM) for it at the same time, then expect to provide the basisesfor the standardized treatment of TS.Methods:44children were enrolled in this study. Among them,22casescollected in June2012to February2013in the neurology clinic of Children’shospital of Chongqing medical university were refractory TS (refractorygroup), and another22cases selected randomly conventional effective drugtreatment were common group. Field investigation ways to collect children’sage, gender, onset age and symptoms, treatment condition,Electroencephalogram (EEG), brain Magnetic resonance imaging (brainMRI), The Yale Global Tic sevefi-Scale (YGTSS) grade, children’spsychological situation after onset, families’ emotions, surroundings’attitude, previous history, situation during perinatal stage and pregnancy，family history etc. Method retrospective materials research to carry out the comparative study on the refractory group and common group in clinicaldatas, and analysis and research of the treatment in the exposed group at thesame time.Results:(1)The differences were statistically significant in onset age,abnormal EEG early in the illness, drawing drugs optionally, the vulnerableaffected by various factors, local diseases histories associated withsymptoms, negative emotions and attitude from families and surroundings inrefractory group and common group.(2) The differences were not statistically significant in YGTSS grade inearly illness，onset symptoms, children’s psychological situation after onset,hypoxia during perinatal stage.(3) Brain MRI, family history, history of smoking during pregnancy，beat and scold satiation of family members were normal.(4)After using TPM, the rate of symptoms cure effective andimprovement of EEG were86.4%and100%respectively in refractory group;The average of TPM working time is10.5±7.6d，4~30d; in refractory group;the differences between using TPM separately and combination with otherconventional drugs were not statistically significant.Conclusions:(1)Those children with earlier onset age, abnormal EEGearly in the illness, drawing drugs repeatedly, more vulnerable in condition,local diseases histories associated with symptoms have more probabilities toform refractory TS in the future. Therapy in the treatment process should be regular; families should give children with psychological support, findcomorbid mental disorders timely and take active treatments when necessaryat the same time; in daily life, families and people around should givechildren with positive treatment method and attitude.(2)Those cases with abnormal EEG early in the illness should use TPMas the preferred drug; those refractory TS cases should switch to TPMregimens after conventional drugs were invalid.(3) Psychological behavior treatment become more and more importantin treatment of TS. those diagnosed TS for the first time with small age，short duration，light symptoms could take psychological behavior treatmentas the preferred treatment; other methods of treatment can also becombined with psychological behavioral therapy at the same time for bettercurative effects and less relapses, even continue behavioral therapy afterstopping other treatments regularly to consolidate curative effect.(4) We should make personalized management therapy for childrenwith TS based on their clinical characteristics, then promote children’sconditions continue to improve and steady eventually.