Tics und Tourette-Störung für die Praxis

ZUSAMMENFASSUNG

Primäre Tic-Störungen und das Tourette-Syndrom (TS) sind häufige neuropsychiatrische Erkrankungen, die sich im frühen Lebensalter manifestieren und durch motorische und/oder vokale Tics gekennzeichnet sind. Oftmals bestehen bei den Betroffenen psychiatrische Komorbiditäten wie Zwangsstörungen, Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung, Angst- und affektive Störungen. Differenzialdiagnostisch stellen neben anderen Bewegungsstörungen wie zum Beispiel Chorea oder Stereotypien, die funktionellen Tic-ähnlichen Störungen eine besondere Herausforderung dar. Tiermodelle, Post-mortem-Studien, behaviorale und bildgebende Studienbefunde weisen auf Veränderungen im kortiko-striato-thalamo-kortikalen Regelkreis in der primären Tic-Störung und dem TS hin, wobei in der Genese dieser Erkrankungen das dopaminerge System eine wichtige Rolle zu spielen scheint. Therapeutisch werden spezifische verhaltenstherapeutische Strategien wie das Habit Reversal Learning oder das Exposure and Response Prevention in erster Linie empfohlen. Pharmakotherapien beinhalten antipsychotische Medikation, Botulinumtoxin-Injektionen sowie cannabisbasierte Medikamente. In therapieresistent verlaufenden Fällen kann die tiefe Hirnstimulation erwogen werden.

ABSTRACT

Primary tic disorders, including Tourette syndrome (TS) are neuropsychiatric disorders characterized by childhood onset motor and/or vocal tics. Beyond the defining feature of repetitive tic movements or sounds, the large majority of affected individuals also fulfil diagnostic criteria for other psychiatric disorders, most commonly obsessive-compulsive disorder, attention deficit hyperactivity disorder AD(H)D, anxiety, and affective disorders. Primary tics should be distinguished from other hyperkinesias, as for example chorea or myoclonus, and also functional neurological disorders presenting with tic-like movements. Although the exact pathophysiology of tic disorders still remains elusive, studies on animal models, post-mortem findings and results from behavioral and neuroimaging investigations point towards specific alterations of the cortico-striato-thalamo-cortical loops. Behavioral interventions, particularly habit reversal therapy and exposure and response prevention are first line treatments. Pharmacological approaches include antipsychotic medication, botulinum toxin injections as well as cannabis-based therapies. In severe, treatment refractory cases, the application of deep brain stimulation can be considered.

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