Clinical and electroencephalographic characteristics of chronic tic disorders in children and adolescents

Chronic tic disorders (CTDs) are one of the relevant problems of pediatric neurology, the higher prevalence of which is associated with undifferentiated therapy without considering comorbidity.
Objective: to enhance the efficiency of diagnosis and therapy of tic disorders in children and adolescents in terms of video-electroencephalography (EEG) monitoring data.
Patients and methods. The investigation enrolled 116 patients, including 83 (71.6%) boys and 33 (28.4%) girls at the age of 3 to 15 years (mean age, 9.0±3.0 years), diagnosed with CTD who had been examined at the Specialized Neurology Department, Voronezh Regional Children's Clinical Hospital One, in the period 2010–2014. The investigation consisted of two steps: 1) clinical, laboratory, and neurophysiologic  examination; 2) differentiated therapy. The Yaele Global Tic Severity Scale (YGTSS) was used. The diagnosis was established in accordance with the draft classification of epileptic seizures and epilepsy syndromes by the Intern ational League Against Epilepsy. Video-EEG monitoring was carried out in an awake state and during daytime and/or nighttime sleep.
Results and discussion. EEC epileptiform activity was recorded in 46.6% of the patients; a concurrence of CTDs and epilepsy was ascertained in 16.4% of cases. The risk factors of epilepsy in children with CTDs and EEG epileptiform activity are isolated motor tics in the facial region (p=0.0023), MRI epileptogenic changes (p = 0.01), a remitting course (p=0.02), and an early age at the full-scaled picture of tic disorder (p=0.02). CTD therapy with antiepileptic drugs (extended-release valproic acid) was effective and safe in both epileptic seizures (remission in 85.7% of cases) and tics with an improvement in 81.5% of cases with retention in therapy during 2–3 years. Therapy with dopamine transmissionlowering drugs was effective against tics; however, their intake for more than 6 months increased a risk for added epileptic seizures in patients with EEG epileptiform activity (the secondary bilateral synchronization phenomenon and epileptic seizures were recorded in 42.9 and 14.3% of the patients, respectively).

chronic tic disorders, diagnosis, electroencephalography, therapy, antiepileptic seizures, adverse events

1. Зыков ВП. Диагностика и лечение наследственных заболеваний нервной системы у детей: руководство для врачей. Москва: Триада-Х; 2008. С. 187-212 [Zykov VP. Diagnostika i lechenie nasledstvennykh zabolevanii nervnoi sistemy u detei: Rukovodstvo dlya vrachei [Diagnosis and treatment of hereditary diseases of the nervous system in children: Guide for physicians]. Moscow: Triada-X; 2008. P. 187-212].

2. Swain JE. Tourette syndrome and tic disorders: a decade of progress. J Am Acad Child Adolesc Psychiatry. 2007;46(8):947-68. doi: 10.1097/chi.0b013e318068fbcc

3. Scharf JM. Prevalence of Tourette syndrome and chronic tics in the population-based Avon longitudinal study of parents and children cohort. J Am Acad Child Adolesc Psychiatry. 2012;51(2):192-201. doi: 10.1016/j.jaac.2011.11.004

4. Fernandez-Alvarez E. Movement disorders in children: recent advances in management. Indian J Pediatr. 2009;76(5):531-6. doi: 10.1007/s12098-009-0138-6

5. Plessen KJ. Tic disorders and Tourette’s syndrome. Eur Child Adolesc Psychiatry. 2013;22(1):55-60. doi: 10.1007/s00787-012-0362-x

6. Bitsko RH, Holbrook JR, Visser SN, et al. A National Profile of Tourette Syndrome, 2011-2012. J Dev Behav Pediatr. 2014;35(5): 317-22. doi: 10.1097/DBP.0000000000000065

7. Бегашева ОИ. Когнитивные нарушения у больных тикозными гиперкинезами и синдромом Туретта детского возраста: Дисс. ... канд. мед. наук. Москва; 2003. 120 с. [Begasheva OI. Kognitivnye narusheniya u bol’nykh tikoznymi giperkinezami i sindromom Turetta detskogo vozrasta: Diss. ... kand. med. nauk [Cognitive impairment in patients with tic hyperkinesis and Tourette syndrome of childhood: Diss. ... Cand. Med. Sci.]. Moscow; 2003. 120 p.].

8. Колчанова МИ. Клинико-электрофизиологическая и нейропсихологическая характеристика детей с тикозными гиперкинезами, методы комплексной терапии: Дисc. … канд. мед. наук. Пермь; 2008. 159 с. [Kolchanova MI. Kliniko- elektrofiziologicheskaya i neiropsikhologicheskaya kharakteristika detei s tikoznymi giperkinezami, metody kompleksnoi terapii: Diss. … kand. med. nauk [Clinical and electrophysiological and neuropsychological characteristics of children with tic hyperkinesis, methods of complex therapy: Diss. ... Cand. Med. Sci]. Perm’; 2008. 159 p.].

9. Чутко ЛС, Сурушкина СЮ, Никишена ИС и др. Лечение синдрома дефицита внимания с коморбидными тикозными гиперкинезами. Журнал неврологии и психиатрии им. С.С. Корсакова. 2008;(2):45-8 [Chutko LS, Surushkina SYu, Nikishena IS, et al. The treatment of attention deficit disorder with comorbid tic hyperkinesis. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova = S.S. Korsakov Journal of Neurology and Psychiatry. 2008;(2):45-8 (In Russ.)].

10. Айтбеков КА. Клинико-психофизиологическая характеристика детей с различными тиками: Автореф. дисc. ... канд. мед. наук. Санкт-Петербург; 2011. 126 с. [Aitbekov KA. Klinikopsikhofiziologicheskaya kharakteristika detei s razlichnymi tikami: Avtoref. diss. ... kand. med. Nauk [Clinical and psycho-physiological characteristics of children with different types: Authoref. Diss. ... Cand. Med. Sci.]. St. Petersburg; 2011. 126 p.].

11. Фесенко ЮА. Исследование резидуальноневрологических синдромов у детей (новые подходы к диагностике и лечению заикания, гиперактивности, тиков и энуреза): Дисc. …докт. мед. наук. Санкт-Петербург; 2005. 210 с. [Fesenko YuA. Issledovanie rezidual’no-nevrologicheskikh sindromov u detei (novye podkhody k diagnostike i lecheniyu zaikaniya, giperaktivnosti, tikov i enureza): Diss. … dokt. med. nauk [Researchresidual neurological syndromes in children (new approaches to diagnosis and treatment of stuttering, hyperactivity, tics and enuresis): Diss. ... Doct. Med. Sci.]. St. Petersburg; 2005. 210 p.].

12. Шевельчинский СИ. Поведенческие расстройства у детей, связанные с эпилептиформной активностью на ЭЭГ (клинико-электроэнцефалографическое исследование): Дисc. … канд. мед. наук. Москва; 2004. 110 с. [Shevel’chinskii SI. Povedencheskie rasstroistva u detei, svyazannye s epileptiformnoi aktivnost'yu na EEG (kliniko-elektroentsefalograficheskoe issledovanie): Diss. … kand. med. nauk [Behavioral disorders in children associated with epileptiform activity on EEG (electroencephalographic-clinical research): Diss. ... Cand. Med. Sci.]. Moscow; 2004. 110 p.].

13. Карелина ИВ. Тикозное расстройство с затяжным течением у детей и подростков (клиника, патогенез, терапия): Дисc. … канд. мед. наук. Оренбург; 2005. 229 с. [Karelina IV. Tikoznoe rasstroistvo s zatyazhnym techeniem u detei i podrostkov (klinika, patogenez, terapiya): Diss. … kand. med. nauk [Tic disorder with a prolonged course in children and adolescents (clinic, pathogenesis, therapy): Diss. ... Cand. Med. Sci.]. Orenburg; 2005. 229 p.].

14. Ноговицин ВЮ. Клинико-электроэнцефалографический полиморфизм доброкачественных эпилептиформных нарушений детства: Дисc. … канд. мед. наук. Москва; 2006. 114 с. [Nogovitsin VYu. Kliniko-elektroentsefalograficheskii polimorfizm dobrokachestvennykh epileptiformnykh narushenii detstva: Diss. … kand. med. nauk [Clinical and EEG epileptiform polymorphism benign disorders of childhood: Diss. ... Cand. Med. Sci.]. Moscow; 2006. 114 p.].

15. Томенко ТР. Клинико-электроэнцефалографические и нейропсихологические характеристики детей с доброкачественными эпилептиформными паттернами детства: Дисc. … канд. мед. наук. Москва; 2008. 147 c. [Tomenko TR. Kliniko-elektroentsefalograficheskie i neiropsikhologicheskie kharakteristiki detei s dobrokachestvennymi epileptiformnymi patternami detstva: Diss. … kand. med. nauk [Clinical EEG and neuropsychological characteristics of children with benign epileptiform patterns of childhood: Diss. ... Cand. Med. Sci.]. Moscow; 2008. 147 c.].

16. Vidal 2012. Справочник Видаль. Лекарственные препараты в России. Москва: АстраФармСервис; 2012 [Vidal 2012. Reference Vidal. Drugs in Russia Moscow: AstraFarmServis; 2012].

17. Leckman JF. The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry. 1989;28(4):566-73. doi: 10.1097/00004583-198907000-00015

18. Скворцов ИА. Неврология развития: практическое руководство. Москва: Литтерa; 2008. 544 с. [Skvortsov IA. Nevrologiya razvitiya: Prakticheskoe rukovodstvo [Neurology Development: A Practical Guide]. Moscow: Littera; 2008. 544 p.].

19. Ермоленко НА. Варианты психоневрологического развития в норме и патологии у детей: Автореф. дисc. … докт. мед. наук. Воронеж; 2006. 47 с. [Ermolenko NA. Varianty psikhonevrologicheskogo razvitiya v norme i patologii u detei: Avtoref. diss. … dokt. med. nauk [Options neuropsychiatric development in health and disease in children: Authoref. Diss. ... Cand. Med. Sci.]. Voronezh; 2006. 47 p.].

20. Ахутина ТВ, Пылаева НМ. Нейропсихологическое тестирование: обзор современныхтенденций. К 110-летию со дня рождения А.Р. Лурия. Клиническая и специальная психология. 2012;2. Портал психологических изданий PsyJournals.ru [Электронный ресурс]. Режим доступа http://psyjournals.ru/psyclin/2012/n2/52599_full.s html [Akhutina TV, Pylaeva NM. Neuropsychological testing: an overview of current trends. By the 110th anniversary of the birth of AR Luria. Clinical and special psychology. 2012; 2. Portal psychological publications PsyJournals.ru [electronic resource]. Available from: http://psyjournals.ru/psyclin/2012/n2/52599_full.shtml].

21. Айвазян СО. Дифференциальный диагноз эпилептического и неэпилептического миоклонуса у детей. Российский Вестник перинатологии и педиатрии. 2009;(1):28-36 [Aivazyan SO. The differential diagnosis of epileptic and nonepileptic myoclonus in children. Rossiiskii Vestnik Perinatologii i Pediatrii. 2009;(1):28-36 (In Russ.)].

22. Зыков ВП, Айвазян СО, Ширяев ЮС. Дифференциальная диагностика гиперкинезов с эпилептическими приступами у детей. Русский медицинский журнал. Педиатрия. 2012;(2):41-6 [Zykov VP, Aivazyan SO, Shiryaev YuS. Differential diagnosis of hyperkinetic with epileptic seizures in children. Russkii Meditsinskii Zhurnal. Pediatriya. 2012;(2):41-6 (In Russ.)].

23. Ретюнский КЮ. Системные расстройства детского и подросткового возраста с затяжным неблагоприятным течением (клиника, патогенез, терапия): Дисc. … докт. мед. наук. Томск; 2003. 387 с. [Retyunskii KYu. Sistemnye rasstroistva detskogo i podrostkovogo vozrasta s zatyazhnym neblagopriyatnym techeniem (klinika, patogenez, terapiya): Diss. … dokt. med. nauk [Systemic disorders of childhood and adolescence with lingering unfavorable course (clinic, pathogenesis, therapy): Diss. ... Doct. Med. Sci.]. Tomsk; 2003. 387 p.].

24. Sowell ER. Thinning of sensorimotor cortices in children with Tourette syndrome. Nat Neurosci. 2008;11:637-9. doi: 10.1038/nn.2121

25. Bohlhalter S, Goldfine A, Matteson S, et al. Neural correlates of tic generation in Tourette syndrome: an event-related functional MRI study. Brain. 2006;129(8):2029-37. doi: 10.1093/brain/awl050

26. Зыков ВП. Тик и синдром Туретта у детей. Лечебное дело. 2009;(1):13-8 [Zykov VP. Tics of Tourette’s syndrome in children. Lechebnoe Delo. 2009;(1):13-8 (In Russ.)].

27. Bloch MH, Panza KE, Landeros-Weisenberger A, Leckman JF. Meta-analysis: treatment of attentiondeficit/hyperactivity disorder in children with comorbid tic disorders. J Am Acad Child Adolesc Psychiatry. 2009;48(9):884-93. doi: 10.1097/CHI.0b013e3181b26e9f

28. Джанумова ГМ, Будкевич АВ, Пилина ГС. Терапия тикозных гиперкинезов с коморбидным синдромом гиперактивности с дефицитом внимания у детей. Лечащий врач. 2013;(9):111 [Dzhanumova GM, Budkevich AV, Pilina GS. Therapy with comorbid tic hyperkinetic syndrome, attention deficit hyperactivity disorder in children. Lechashchii Vrach. 2013;(9):111 (In Russ.)].

29. Cohen SC, Leckman JF, Bloch MH. Clinical assessment of Tourette syndrome and tic disorders. Neurosci Biobehav Rev. 2013;37(6):997-1007. doi: 10.1016/j.neubiorev.2012.11.013

30. Зыков ВП, Бегашева ОИ. Ламиктал в лечении синдрома Туретта у детей. В кн.: Тезисы докладов XII Российского национального конгресса «Человек и лекарство». Москва; 2005. C. 390 [Zykov VP, Begasheva OI. Lamictal to treat Tourette's syndrome in children. In: Tezisy dokladov XII Rossiiskogo natsional'nogo kongressa «Chelovek i lekarstvo» [Abstracts XIV Russian National Congress «Man and medicine»]. Moscow; 2005. P. 390].

31. Hedderick EF, Morris CM, Singer HS. Double-blind, crossover study of clonidine and levetiracetam in Tourette syndrome. Pediatr Neurol. 2009;40(6):420-5. doi: 10.1016/j.pediatrneurol. 2008.12.014

32. Jankovic J, Jimenez-Shahed J, Brown LW. A randomised, double-blind, placeboontrolled study of topiramate in the treatment of Tourette syndrome. J Neurol Neurosurg Psychiatry. 2010;81(1):70-3. doi: 10.1136/jnnp.2009.185348

33. Martinez-Granero MA, Garcia-Perez A, Montanes F. Levetiracetam as an alternative therapy for Tourette syndrome. Neuropsychiatr Dis Treat. 2010;6:309-16. doi: 10.2147/NDT.S6371

34. Cavanna AF, Nani A. Antiepileptic drugs and Tourette syndromeт. Int Rev Neurobiol. 2013;112:373-89. doi: 10.1016/B978-0-12-411546-0.00012-3