Practitioner Review: Treatments for Tourette syndrome in children and young people – a systematic review / Craig WHITTINGTON in Journal of Child Psychology and Psychiatry, 57-9 (September 2016)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 57-9 (September 2016) . - p.988-1004 Titre : Practitioner Review: Treatments for Tourette syndrome in children and young people – a systematic review Type de document : Texte imprimé et/ou numérique Auteurs : Craig WHITTINGTON, Auteur ; Mary PENNANT, Auteur ; Tim KENDALL, Auteur ; Cristine GLAZEBROOK, Auteur ; Penny TRAYNER, Auteur ; Madeleine GROOM, Auteur ; Tammy HEDDERLY, Auteur ; Isobel HEYMAN, Auteur ; Georgina JACKSON, Auteur ; Stephen JACKSON, Auteur ; Tara MURPHY, Auteur ; Hugh RICKARDS, Auteur ; Mary ROBERTSON, Auteur ; Jeremy STERN, Auteur ; Chris HOLLIS, Auteur Article en page(s) : p.988-1004 Langues : Anglais (eng) Mots-clés : Paediatrics  Tourette syndrome  therapy  tics Index. décimale : PER Périodiques Résumé : Background Tourette syndrome (TS) and chronic tic disorder (CTD) affect 1–2% of children and young people, but the most effective treatment is unclear. To establish the current evidence base, we conducted a systematic review of interventions for children and young people. Methods Databases were searched from inception to 1 October 2014 for placebo-controlled trials of pharmacological, behavioural, physical or alternative interventions for tics in children and young people with TS or CTD. Certainty in the evidence was assessed with the GRADE approach. Results Forty trials were included [pharmacological (32), behavioural (5), physical (2), dietary (1)]. For tics/global score there was evidence favouring the intervention from four trials of ?2-adrenergic receptor agonists [clonidine and guanfacine, standardised mean difference (SMD) = ?0.71; 95% CI ?1.03, ?0.40; N = 164] and two trials of habit reversal training (HRT)/comprehensive behavioural intervention (CBIT) (SMD = ?0.64; 95% CI ?0.99, ?0.29; N = 133). Certainty in the effect estimates was moderate. A post hoc analysis combining oral clonidine/guanfacine trials with a clonidine patch trial continued to demonstrate benefit (SMD = ?0.54; 95% CI ?0.92, ?0.16), but statistical heterogeneity was high. Evidence from four trials suggested that antipsychotic drugs improved tic scores (SMD = ?0.74; 95% CI ?1.08, ?0.40; N = 76), but certainty in the effect estimate was low. The evidence for other interventions was categorised as low or very low quality, or showed no conclusive benefit. Conclusions When medication is considered appropriate for the treatment of tics, the balance of clinical benefits to harm favours ?2-adrenergic receptor agonists (clonidine and guanfacine) as first-line agents. Antipsychotics are likely to be useful but carry the risk of harm and so should be reserved for when ?2-adrenergic receptor agonists are either ineffective or poorly tolerated. There is evidence that HRT/CBIT is effective, but there is no evidence for HRT/CBIT alone relative to combining medication and HRT/CBIT. There is currently no evidence to suggest that the physical and dietary interventions reviewed are sufficiently effective and safe to be considered as treatments. En ligne : http://dx.doi.org/10.1111/jcpp.12556 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=292 [article] Practitioner Review: Treatments for Tourette syndrome in children and young people – a systematic review [Texte imprimé et/ou numérique] / Craig WHITTINGTON, Auteur ; Mary PENNANT, Auteur ; Tim KENDALL, Auteur ; Cristine GLAZEBROOK, Auteur ; Penny TRAYNER, Auteur ; Madeleine GROOM, Auteur ; Tammy HEDDERLY, Auteur ; Isobel HEYMAN, Auteur ; Georgina JACKSON, Auteur ; Stephen JACKSON, Auteur ; Tara MURPHY, Auteur ; Hugh RICKARDS, Auteur ; Mary ROBERTSON, Auteur ; Jeremy STERN, Auteur ; Chris HOLLIS, Auteur . - p.988-1004. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 57-9 (September 2016) . - p.988-1004 Mots-clés : Paediatrics  Tourette syndrome  therapy  tics Index. décimale : PER Périodiques Résumé : Background Tourette syndrome (TS) and chronic tic disorder (CTD) affect 1–2% of children and young people, but the most effective treatment is unclear. To establish the current evidence base, we conducted a systematic review of interventions for children and young people. Methods Databases were searched from inception to 1 October 2014 for placebo-controlled trials of pharmacological, behavioural, physical or alternative interventions for tics in children and young people with TS or CTD. Certainty in the evidence was assessed with the GRADE approach. Results Forty trials were included [pharmacological (32), behavioural (5), physical (2), dietary (1)]. For tics/global score there was evidence favouring the intervention from four trials of ?2-adrenergic receptor agonists [clonidine and guanfacine, standardised mean difference (SMD) = ?0.71; 95% CI ?1.03, ?0.40; N = 164] and two trials of habit reversal training (HRT)/comprehensive behavioural intervention (CBIT) (SMD = ?0.64; 95% CI ?0.99, ?0.29; N = 133). Certainty in the effect estimates was moderate. A post hoc analysis combining oral clonidine/guanfacine trials with a clonidine patch trial continued to demonstrate benefit (SMD = ?0.54; 95% CI ?0.92, ?0.16), but statistical heterogeneity was high. Evidence from four trials suggested that antipsychotic drugs improved tic scores (SMD = ?0.74; 95% CI ?1.08, ?0.40; N = 76), but certainty in the effect estimate was low. The evidence for other interventions was categorised as low or very low quality, or showed no conclusive benefit. Conclusions When medication is considered appropriate for the treatment of tics, the balance of clinical benefits to harm favours ?2-adrenergic receptor agonists (clonidine and guanfacine) as first-line agents. Antipsychotics are likely to be useful but carry the risk of harm and so should be reserved for when ?2-adrenergic receptor agonists are either ineffective or poorly tolerated. There is evidence that HRT/CBIT is effective, but there is no evidence for HRT/CBIT alone relative to combining medication and HRT/CBIT. There is currently no evidence to suggest that the physical and dietary interventions reviewed are sufficiently effective and safe to be considered as treatments. En ligne : http://dx.doi.org/10.1111/jcpp.12556 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=292

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