Tic-Störungen und Tourette-Syndrom in der Lebensspanne

ZusammenfassungTreten chronisch motorische und phonetische (vokale) Tics länger als ein Jahr auf, spricht man vom Gilles-de-la-Tourette-Syndrom (TS). Die Tic-Störung manifestiert sich meist vor dem 11. Lebensjahr, Jungen sind ca. 3-mal häufiger als Mädchen betroffen. Oft zeigt die Tic-Symptomatik um das 14. Lebensjahr ihre schwerste Ausprägung, bei ca. der Hälfte der Betroffenen ist sie dann deutlich rückläufig. Schwer Betroffene leiden sehr häufig unter Komorbiditäten. Die häufigste Begleiterkrankung im Kindes- und Jugendalter ist die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS). Zwangsstörungen, Angsterkrankungen und affektive Störungen kommen im weiteren Verlauf dazu. Ursächlich scheint eine Dysregulation in der dopaminergen Neurotransmission der kortiko-striato-thalamo-kortikalen Bahnen zugrunde zu liegen. Die Psychopharmaka, die zum Einsatz kommen, wirken größtenteils auf das dopaminerge System. Die gebräuchlichsten atypischen Neuroleptika werden sowohl im Kindes- und Jugendalter als auch im Erwachsenenalter „off label“ eingesetzt. Atomoxetin scheint bei komorbider ADHS auch die Tics zu mildern, erste Erfolg versprechende Fallserien liegen für den partiellen Dopaminagonisten Aripiprazol vor. SummaryChronic motor and vocal tics lasting longer than a year are classified as Tourette’s syndrome (TS). Tics mostly manifest before the age of 11 years. Boys are affected at a threefold higher rate than girls. Tics are often worst at the age of 14; in 50% of the cases the tic symptoms will remit nearly completely. Severely affected patients often suffer from comorbidities. In childhood and adolescence the most common comorbid condition is attention deficit hyperactivity disorder (ADHD). Obsessive-compulsive behaviour, anxiety and affective disorder might occur in the course of TS. A dysregulation in the dopaminergic neurotransmission in the cortico-striatal-thalamic-cortical circuits (CSTC) might be the underlying neurobiological basis. The psychotropic substances administered for TS treatment largely affect the dopaminergic system. The most commonly used atypical neuroleptics are not approved for TS treatment and are used „off label“. Atomoxetine might also improve tics in comorbid ADHD. First results of some case series with the partial dopamine agonist aripiprazole are encouraging.

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