Behawioralne, farmakologiczne i neurochirurgiczne leczenie tików — aktualny stan wiedzy
Streszczenie
Zespół Gilles’a de la Tourette’a (GTS, Gilles de la Tourette syndrome) jest zaburzeniem neuropsychiatrycznym o nieustalonej przyczynie, stwierdzanym u dzieci i dorosłych, rozpoczynającym się przed 18. rokiem życia, którego głównym objawem są tiki ruchowe i głosowe utrzymujące się dłużej niż 12 miesięcy. Tiki występują u wszystkich chorych z GTS, u większości współistnieją także inne schorzenia: zespół nadpobudliwości psychoruchowej (ADHD, attention deficit hyperactivity disorder), zaburzenie obsesyjno-kompulsyjne (OCD, obsessive-compulsive symptoms), depresja, zespoły lękowe, agresja. Leczenie jest objawowe i nie ma dowodów, że wpływa na naturalny przebieg choroby, rokowanie czy proces dojrzewania mózgu u dzieci i młodzieży. Wielu chorych nie wymaga leczenia z powodu niewielkiego nasilenia tików. Podejmuje się je wyłącznie wtedy, gdy tiki wpływają na codzienne funkcjonowanie. Terapia tików obejmuje interwencje behawioralne (np. terapia z odwracaniem nawyku/kompleksowa behawioralna interwencja w tikach oraz terapia ekspozycyjna z powstrzymaniem reakcji) oraz leczenie farmakologiczne. Najczęściej stosowanymi lekami są neuroleptyki: klasyczne (haloperydol, pimozyd) i atypowe (rysperydon, arypiprazol, sulpiryd) oraz agoniści receptora adrenergicznego alfa2 (klonidyna). Inne dostępne w Polsce leki redukujące tiki to topiramat, toksyna botulinowa, tetrabenazyna, benzodiazepiny. Głęboka stymulacja mózgu (DBS, deep brain stimulation) jest zarezerwowana dla chorych z ciężkimi, niepoddającymi się żadnemu leczeniu tikami, pozwala na redukcję tików o około połowę, ale wciąż pozostaje terapią o nieudokumentowanej ostatecznie skuteczności. Najczęściej wybieraną strukturą anatomiczną, do której implantuje się elektrody, jest przyśrodkowa część wzgórza oraz część wewnętrzna gałki
bladej. Obecna praca poglądowa podsumowuje aktualne sposoby leczenia tików i opisuje nowe metody.
Słowa kluczowe: tikizespół Gilles’a de la Tourette’ainterwencje behawioralneleczenie farmakologicznegłęboka stymulacja mózgu
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