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Tourette syndrome (also Tourette's syndrome or TS) is an inherited neuropsychiatric disorder with onset in childhood, characterized by the presence of motor and phonic tics. Treatment of Tourette syndrome has the goal of managing symptoms to achieve optimum functioning, rather than eliminating symptoms; not all persons with Tourette's require treatment, and there is no cure or universally effective medication.〔Schapiro NA. "Dude, you don't have Tourette's": Tourette's syndrome, beyond the tics. ''Pediatr Nurs.'' 2002 May–Jun;28(3):243–6, 249-53. PMID 12087644〕〔Zinner SH. Tourette disorder. ''Pediatr Rev''. 2000;21(11):372–383. PMID 11077021〕〔 (Tourette Syndrome Fact Sheet ). National Institute of Neurological Disorders and Stroke/National Institutes of Health (NINDS/NIH), February 14, 2007. Retrieved on May 14, 2007.〕 Explanation and reassurance alone are often sufficient treatment;〔 education is an important part of any treatment plan.〔Peterson BS, Cohen DJ. The Treatment of Tourette's Syndrome: Multimodal, Developmental Intervention. ''J Clin Psychiatry.'' 1998;59 Suppl 1:62–72; discussion 73–4. PMID 9448671 (Full text ), archived May 25, 1998. "Because of the understanding and hope that it provides, education is also the single most important treatment modality that we have in TS."〕 Tourette syndrome patients may exhibit symptoms of other comorbid conditions along with their motor and phonic tics. Associated conditions include attention-deficit hyperactivity disorder (ADD or ADHD), obsessive-compulsive disorder (OCD), learning disabilities and sleep disorders.〔 Patients who have ADHD along with Tourette's may also have problems with disruptive behaviors, overall functioning, and cognitive function. Co-occurring OCD can also be a source of impairment, necessitating treatment. Not all persons with tics will also have other conditions and not all persons with tics require treatment, but when comorbid disorders are present, they often require treatment. Stimulants (like Adderall and Ritalin) are underused in the treatment of ADHD when tics are also present because of fears that they increase tics.〔〔 Experimental treatments like deep brain stimulation, nicotine, cannabis and complementary and alternative medicine approaches have widespread appeal but unproven safety and efficacy. ==Treatment priority== Treatment of Tourette syndrome can be divided into treatment of tics, and treatment of co-occurring conditions, which, when present, are often a larger source of functional impairment than the tics themselves.〔Scahill L, Erenberg G, Berlin CM Jr, Budman C, Coffey BJ, Jankovic J, Kiessling L, King RA, Kurlan R, Lang A, Mink J, Murphy T, Zinner S, Walkup J; Tourette Syndrome Association Medical Advisory Board: Practice Committee. (Contemporary assessment and pharmacotherapy of Tourette syndrome ) (PDF). ''NeuroRx.'' 2006 Apr;3(2):192–206. PMID 16554257〕 There is no cure for Tourette's and no medication which works universally for all individuals without significant adverse effects;〔 knowledge and understanding are the best treatments available for tics.〔〔 Management of the symptoms of Tourette's may include pharmacological, behavioral and psychological therapies. While pharmacological treatment is reserved for more severe symptoms, other types of treatments may help avoid or improve symptoms of depression or social isolation, and improve supportive family functioning. Educating the patient, family, and surrounding community (school, church, friends, etc.) is a key part of treatment.〔 The majority of people with TS require no medication, but medication is available to help when symptoms interfere with functioning.〔 Because children with tics often present to physicians when their tics are at their highest severity, and because of the waxing and waning nature of tics, medication is not usually started immediately or changed often. Frequently, the tics subside with understanding of the condition and a supportive environment.〔 When medication is necessary, pharmaceutical intervention should be targeted at the most impairing symptoms, taking into account co-occurring conditions such as ADHD or OCD, which when present, may warrant treatment even when tics are mild.〔 The classes of medication with the most proven efficacy in treating tics—typical and atypical neuroleptics including risperidone (trade name〔Medication trade names may differ between countries. In general, this article uses North American trade names.〕 Risperdal), ziprasidone (Geodon), haloperidol (Haldol), pimozide (Orap) and fluphenazine (Prolixin)—can have long-term and short-term adverse effects.〔Scahill L, Erenberg G, Berlin CM Jr, Budman C, Coffey BJ, Jankovic J, Kiessling L, King RA, Kurlan R, Lang A, Mink J, Murphy T, Zinner S, Walkup J; Tourette Syndrome Association Medical Advisory Board: Practice Committee. Contemporary assessment and pharmacotherapy of Tourette syndrome. ''NeuroRx.'' 2006 Apr;3(2):192–206. PMID 16554257〕 The antihypertensive agents, clonidine (Catapres) and guanfacine (Tenex), are also used to treat tics; studies show variable efficacy, but a lower side effect profile than the neuroleptics.〔Schapiro NA. "Dude, you don't have Tourette's:" Tourette's syndrome, beyond the tics. ''Pediatr Nurs.'' 2002 May-Jun;28(3):243–6, 249-53. PMID 12087644〕 Stimulants and other medications may be useful in treating ADHD when it co-occurs with tic disorders. Drugs from several other classes of medications can be used when stimulant trials fail, including guanfacine (Tenex), atomoxetine (Strattera) and tricyclics. Clomipramine (Anafranil), a tricyclic antidepressant, and SSRIs—a class of antidepressants including fluoxetine (Prozac), sertraline (Zoloft), and fluvoxamine (Luvox)—may be prescribed when a Tourette's patient also has symptoms of obsessive–compulsive disorder.〔 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Treatment of Tourette syndrome」の詳細全文を読む スポンサード リンク
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