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ABSTRACT
Tourette Syndrome is a familial neurobehavioral disorder characterized by fluctuating involuntary motor and/or vocal tics. The most commonly used medications to treat Tourette's syndrome are haloperidol, pimozide, fluphenazine, and clonidine, all of which may have considerable side effects. We enrolled 450 patients with tics/Tourette's syndrome to be treated with baclofen/botolinum toxin type A for their symptoms. Global severity of tic symptoms was rated by the Yale Global Tic Severity Scale and a quantified videotaped micro-structured analysis of tics. We found that baclofen/botolinum toxin type A are very effective, safe, and reliable in the treatment of tics/Tourette's syndrome. It is worthwhile considering this treatment approach in patients with tics/Tourette's syndrome in order to reduce or avoid the side effects of other medications. Further studies, however, are required. (J Child Neurol 1999; 14:316-319).
Tics are rapid, sudden, unexpected, irresistible, inappropriate, repetitive, stereotypic activity, of brief duration and variable intensity, and occur at irregular intervals.1 They are involuntary muscles contractions, involuntary noises and words, or both. It is not unusual for children to exhibit tics, but when both motor and vocal tics are present for a period of 1 year with no tic-free period of more than 3 consecutive months, the diagnosis of Tourette syndrome should be considered (Diagnostic and Statistical Manual of Mental Disorders-TV). When either vocal or motor tics, but not both, are present for more than 1 year, the diagnosis is chronic motor or chronic tic disorder.2 Tourette syndrome is a familial neurobehavioral disorder characterized by the presence of fluctuating involuntary motor and vocal tics.3 It often cooccurs with attention-deficit hyperactivity disorder (ADHD),4,5 obsessive-compulsive disorder, or obsessivecompulsive symptoms.6,7 In childhood and adolescence especially, the condition is often complicated by learning problems, or other behavioral or psychiatric problems, and is occasionally accompanied by other neuropathologies such as seizures.8,9
Interest in Tourette syndrome has increased over the past 2 decades; it is an everyday disorder seen regularly in child neurology clinics. Once thought to be a rare condition, Tourette syndrome is now estimated to have a prevalence of one case per 1000 boys and one case per 10,000 girls10
The symptoms of Tourette Syndrome were first described by Bouteille in 1810. The first case described, written by Itard (1825), was that of the...