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題名 | 妥瑞症的臨床診斷與治療=Clinical Diagnosis and Management of Tourette Syndrome |
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作者 | 王煇雄; Wang, Huei-shyong; |
期刊 | Acta Neurologica Taiwanica |
出版日期 | 20010900 |
卷期 | 10:3 2001.09[民90.09] |
頁次 | 頁220-228+219 |
分類號 | 417.5825 |
語文 | chi |
關鍵詞 | 兒童; 神經精神異常; 妥瑞症; Tourette syndrome; Children; Neuropsychiatric disorder; Tic; |
中文摘要 | 以tic為主要臨床症狀的妥瑞症(Tourette syndrome)經常會合併出現專心不足-過動異常、強迫症、學習能力不足、自我傷害的行為,或其他精神行為的問題。其盛行率可能高達1/200以上,是人類最常見的神經精神異常疾患之一。目前醫學界已不再像過去一般認為妥端症之家族性病案高達一至三成之多,意味著妥瑞症可能與基因異常有關。此外,諸多神經藥理、電生理、神經影像等研究顯示,妥瑞症患牙可能因其腦部對多巴胺(dopamine)有高反應性(hyper-responsiveness),造成「皮質-紋狀體-視丘-皮質迴路」(cortical-striatal-thalamo-cortical)的問題而現上述臨床症狀。臨床醫師面對一個以tic表現的病患時,應如何下妥瑞症的診斷?首先,要排除續發性的可能病因(即所謂的「類妥瑞症」);接下來需瞭解tic出現了多久,如果tic出現沒多久,一般而言有九成以上的患者屬於在一年內將自然消失的「一過性tic異常」。tic不嚴重者可先靜觀其變,如果tic出現超過一年以上,則可因tic之主要表現型態分為全是動作型的「慢性動作型tic異常」、全是聲語型「慢性聲語型tic異常」、與合併出現多樣動作型tic和聲語型tic的「妥瑞症」。高達七、八成之妥瑞症的tic症狀並不嚴重,不需使用樂物控制,反而是家人、師長、朋友和社會,對此疾病的瞭解和接納是最重要的。其他患者則可能需藉助藥物之幫忙來改善症狀。目前常使用之樂物中,haloperidol不再是第一選擇,應優先選用clonidine或atypical neuroleptics,如risperidone等;其他有許多藥物可試用。在臺灣,醫學界和教育界對於妥瑞症的宣導與認識還不夠,往往造成妥瑞症患者求學與生活上的困擾,希望讀者藉由本文對妥瑞症有進一步之認識。 |
英文摘要 | Tics are major clinical symptoms of Tourette syndrome which has high comorbidity with attention deficit-hyperactivity disorder, obsessive compulsive disorder, learning disability, self injury behavior, or other psychobehavior problems. Its prevalence could be as high as 1/200. Tourette syndrome is no more a rare or degenerative disorder; it’s a model of neuropsychiatric disorder in children. Although the pathogenesis of Tourette syndrome is still uncertain, the high includence of familial cases up to 10 to 30% suggest a possibility of genetic origin. Pharmacological, electrophysiological, and neuroimaging evidences all implicate the hyper-responsiveness of dopamine influencing the cortical-striatal-thalamo-cortical circuits of patients with Tourette syndrome. Facing patients with tics, first of all we must exclude the possibilities of Tourettism with secondary etiologies. Ninety percent of patients with primary tics occur transiently and spontaneously subside within one year. Those patients with tics persisting longer than a year will be chronic tic disorder or Tourette syndrome depending on how many types of motor and/or vocal tics they have ever had. Ties are mild in 70 to 80% of patients with Tourette syndrome. For then, understanding and acceptance from family, teachers, and friends are most important. When tics are so severe that medication is necessary, haloperidol is no longer fthe first or only choice. Clonidine or atypical neuroleptics such as risperidone should be used first for their minor side effects. Many other medicines are still in trial. It is hoped that the readers can understand this common disease and help the patients cope with the symptoms from Tourette syndrome. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。