Tic-Erkrankungen bei Kindern und Jugendlichen

Abstract

Tics are very common in children in primary school age. The typical age of onset is between six and eight years. In the beginning in most cases tics are mild. In the course tics are waxing and waning and characterized by fluctuations in number, frequency, intensity, complexity, and interference. In most children who suffer from transient tics (duration <1 year), tics are mild and, therefore, there is no need for special treatment. Chronic tic disorders are characterized by a tic duration of more than one year. They can be divided into chronic motor or vocal tic disorders and the Tourette syndrome, a combined chronic motor and vocal tic disorder. The majority of those patients who suffer from chronic tic disorders have mild to moderate tics. Treatment of tics should be considered in those patients who suffer from severe tics or who are significantly impaired by their tics. In all children with tics detailed information about the nature, the underlying cause, and the typical course of the disease should be given to the parents and the teachers. With increasing tic severity, an increasing number of comorbidities occurs, most often attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), anxiety disorder, and self injurious behaviour. In most of those children who suffer from both tics and comorbidities, quality of life is considerably more impaired by symptoms related to ADHD and OCD than by tics. Available treatment for tics is a symptomatic therapy and does not influence the underlying pathology or the course of the disorder. First choice treatment are dopamine receptor antagonists such as tiapride, risperidone, sulpiride, and aripiprazole. The aim of the treatment is a tic reduction but not a complete remission. Apart from rare and severe cases, the prognosis of both transient and chronic tic disorders is good. After a tic maximum at the age of 10 to 12 years, in most cases tics improve spontaneously without any treatment with increasing age.