Gilles de la Tourette-Syndrom: Klinik, Ursachen, Therapie

Das Gilles de la Tourette-Syndrom ist eine chronische (> 1 Jahr) Tic-Störung mit multiplen motorischen Tics und mindestens einem vokalen Tic. Der Erkrankungsbeginn liegt im Kindes- oder Jugendalter vor dem 18. Lebensjahr. Die möglichen Ursachen, differenzialdiagnostische Überlegungen und die Therapiemöglichkeiten dieser durch oft vorhandene psychiatrische Komorbiditäten schwer beeinträchtigenden Erkrankung werden in diesem Beitrag vorgestellt.

Abstract

Gilles de la Tourette syndrome is a chronic neuropsychiatric movement disease with combined motor tics and at least one vocal tic for a minimum period of 1 year. It typically begins in the childhood (under 18 years of age).

Most of the patients with Tourette syndrome have comorbidities, which often impair their quality of life more than the tics themselves.

There are reported abnormalities in the cortico-striato-thalamo-cortical regions as well as in the neurotransmission of dopamine and other neurotransmission systems. Genetic and non genetic factors are discussed.

In each patient psychoeducation is the basis of treatment. Specific treatment is only needed in more severe tic disorders which cause evident psychosocial impairment.

Behavior therapy should be tried before drug treatment. For very severely affected adults, deep brain stimulation is a further treatment option.

Kernaussagen

• In Abhängigkeit von der Art der Tics und dem Verlauf werden Tic-Störungen unterschieden in:

  • transiente Tic-Störung,

  • chronische motorische oder vokale Tic-Störung,

  • Tourette-Syndrom.

• Das Tourette-Syndrom ist eine chronische Tic-Störung (Dauer > 1 Jahr), die durch das Auftreten von multiplen motorischen und mindestens einem vokalen Tic gekennzeichnet ist. Sie beginnt typischerweise im Kindes- und Jugendalter.

• Typisch für Tics sind spontane Fluktuationen und situative Einflüsse. Weitere Charakteristika sind ihre willentliche Unterdrückbarkeit und das den Tics vorangehende Vorgefühl.

• Bei der Mehrzahl der Patienten mit Tourette-Syndrom bestehen psychiatrische Komorbiditäten, am häufigsten eine ADHS, Zwänge, Depression, Ängste, emotionale Dysregulation und Autoaggression. Diese Komorbiditäten sollten daher in der Behandlung vorrangig berücksichtigt werden.

• Tics werden auf eine Fehlregulation in kortiko-striato-thalamo-kortikalen Regelkreisen zurückgeführt. Primär wird eine Störung im dopaminergen System vermutet. Es gibt auch Hinweise auf eine Beteiligung anderer Neurotransmittersysteme. Tic-Störungen werden durch ein Zusammenspiel genetischer und nicht genetischer Faktoren verursacht.

• In der Behandlung von Patienten mit Tic-Störungen sollte die Psychoedukation an erster Stelle stehen.

• Bei stärkeren Tics oder deutlicher psychosozialer Beeinträchtigung sollte entweder eine Verhaltenstherapie mittels HRT oder ERP und/oder eine medikamentöse Behandlung angeboten werden. Antipsychotika wie Aripiprazol, Tiaprid (bei Kindern), Risperidon und Sulpirid gelten als Medikamente der Wahl.

• Bei schwerst betroffenen, therapieresistenten Patienten kann auch eine operative Behandlung mittels tiefer Hirnstimulation in Betracht gezogen werden.

Schlüsselwörter

Gilles-de-la-Tourette-Syndrom - Tic-Störung - Komorbiditäten - Symptome - Ursachen - Therapie

Keywords

Gilles de la Tourette syndrome - tic disorders - comorbidities - symptoms - causes - therapy

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