What are the guideline sources, guidelines and references for Tourette_s syndrome ?
Guideline sources The following summarized guidelines for the evaluation and management of Tourette's syndrome are prepared by our editorial team based on guidelines from the American Academy of Neurology (AAN 2019). 1 Guidelines 1. Diagnostic investigations Evaluation of functional impairment: evaluate functional impairment related to tics from the perspective of the patient and, if applicable, the caregiver. A 2. Medical management Alpha-adrenergic agonists: prescribe alpha-2 adrenergic agonists for the treatment of patients with tics when the benefits of treatment outweigh the risks. B Show 4 more https://web.pathway.md/diseases/recTTNGF980AJzSDT 1/3 6/24/23, 4:06 PM Tourette's syndrome Pathway Antipsychotics: consider antipsychotics for the treatment of patients with tics when the benefits of treatment outweigh the risks. C Show 5 more Topiramate: Prescribe topiramate for the treatment of patients with tics when the benefits of treatment outweigh the risks. B Counsel patients regarding common adverse effects of topiramate, including cognitive and language problems, somnolence, weight loss, and an increased risk of renal stones. A Cannabis-based medications: offer patients to direct them to appropriate medical supervision when cannabis is used as self-medication for tics, where regional legislation and resources allow, due to the risks associated with cannabis use and widespread self-medication with cannabis for tics. A Show 5 more 3. Nonpharmacologic interventions Comprehensive behavioral intervention for tics: consider comprehensive behavioral intervention for tics as an initial treatment option relative to watchful waiting for patients with tics who do not experience functional impairment if they are motivated to attempt treatment. C Show 3 more 4. Therapeutic procedures Botulinum toxin injections: consider prescribing botulinum toxin injections for the treatment of adolescent and adult patients with localized and bothersome simple motor tics when the benefits of treatment outweigh the risks. C Show 2 more Deep brain stimulation: use a multidisciplinary evaluation (psychiatrist or neurologist, neurosurgeon, and neuropsychologist) to establish when the benefits of treatment outweigh the risks of prescribing deep brain stimulation for medication-resistant motor and phonic tics. A Show 4 more 5. Specific circumstances Assessment and management of co-occuring mental health conditions: assess for comorbid attention deficit hyperactivity disorder in patients with tics. B Show 7 more 6. Patient education https://web.pathway.md/diseases/recTTNGF980AJzSDT 2/3 6/24/23, 4:06 PM Tourette's syndrome Pathway Patient and caregiver education: Inform patients and their caregivers about the natural history of tic disorders. A Counsel patients that treatments for tics infrequently result in complete cessation of tics. A Psychoeducation for teachers and peers: refer patients with Tourette's syndrome to resources for psychoeducation for teachers and peers, such as the Tourette Association of America. B 7. Follow-up and surveillance Watchful waiting: inform patients and caregivers that watchful waiting is an acceptable approach in people who do not experience functional impairment from their tics. B Follow-up: Periodically reevaluate the need for ongoing medical treatment when prescribing medications for tics. A Consider measure tic severity using a valid scale to assess treatment effects. C References 1. Pringsheim T, Okun MS, M ller-Vahl K et al. Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology. 2019 May 7;92 19 896 906. Open 2. Per Andr n, Ewgeni Jakubovski, Tara L Murphy et al. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part II psychological interventions. Eur Child Adolesc Psychiatry. 2021 Jul 27;1 21. Open https://web.pathway.md/diseases/recTTNGF980AJzSDT 3/3