Application of Delphi Method-Based Definition of Treatment-Refractory Tourette Disorder in a Large Italian Clinical Cohort of Children and Adolescents - 04/12/25
, Rita Barone, MD, PhD a : Professor, Maria Chiara Milana, MD a, Lara Cirnigliaro, MD a : PhD Student, Davide Martino, MD, PhD b : Professor, Renata Rizzo, MD, PhD a : ProfessorAbstract |
Background |
Tourette syndrome (TS) is characterized by the presence of tics and possible associated neuropsychiatric comorbidities. A subset of patients with TS present with severe and “treatment-refractory” tics, requiring multiple therapeutic interventions.
Methods |
In 2023, a group of international specialist clinicians with specific expertise in tics used a multistep Delphi approach to propose an expert consensus-based definition of treatment failure for tics. In this study, we applied this recently published algorithm to establish treatment-refractory TS patients in a large Italian cohort of 614 pediatric patients.
Results |
Of the entire cohort, 20 patients (7.3%) fulfilled all the criteria proposed in this algorithm to define refractoriness to prescribed antitic medications. Compared to non–treatment-refractory (n = 254), treatment-refractory TS patients (n = 20) had significantly higher mean total intelligence quotient ( P = 0.008) and mean Yale Global Tic Severity Scale-Total Tic Score scores ( P < 0.00001). The 20 treatment-refractory TS patients reported a higher frequency of a family history of TS (60% vs. 46.1%), and a lower rate of associated neuropsychiatric comorbidities (55% vs. 66.9%), although these differences did not reach statistical significance.
Conclusions |
In general, a greater tic severity might be associated with higher risk of refractoriness to pharmacological treatment for tics. Considering the paucity of literature research exploring the frequency of severe cases of TS who were refractory to medical treatment, further studies are needed to consolidate applicability within routine clinical care of this recently developed consensus definition of pharmacological treatment refractoriness for TS.
Le texte complet de cet article est disponible en PDF.Keywords : Tourette Syndrome, Tics, Medication, Tic refractoriness, Treatment failure
Plan
| Ethical approval: This research study was conducted retrospectively from data obtained for clinical purposes. The enrollment and patient data management were conducted in accordance with the ethical standards of the institutional requirements and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all participants’ parent or legal guardian to carry out all the procedures adopted, that were performed as part of the routine clinical assessment, with the possibility that the collected data could be used later for clinical research. |
Vol 174
P. 54-61 - janvier 2026 Retour au numéro
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