BACKGROUND According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Tourette syndrome is a neurodevelopmental disorder, commonly associated with attention-deficit/hyperactivity disorder and obsessive– compulsive disorder. This condition typically begins in childhood or adolescence and is characterized by several motor and some vocal tics, usually accompanied by premonitory urges, occurring daily for over 1 year, and an absence of secondary causes such as substance abuse or neurological disorders (i.e. other movement disorders). First described in 1825 and considered very rare until the early 1980s, the prevalence of Tourette syndrome is about 1% in the paediatric population, affecting males up to 4 times more than females. Neurophysiological investigations suggest that complex alterations of dopamine and gamma-Aminobutyric acid metabolism and frontalsubcortical neurotransmission occur in Tourette syndrome, particularly involving basal ganglia. However, the pathophysiology of this condition is still unclear, leading clinicians to use countless treatment strategies including conservative and surgical options with different mechanisms of action, particularly modulating adrenergic, dopaminergic, or glutamatergic neurotransmission. Motor tics may interfere with normal movement and may cause significant impairment in daily functioning, particularly in social and occupational areas. As strongly recommended by the American Academy of Neurology (AAN), functional impairment related to tics must be assessed from the patients’ perspective. In this context, rehabilitation, as a highly person-centered health strategy designed to enhance functioning, may represent a core management approach for patients with Tourette syndrome. Rehabilitation consists of several interventions addressing functional limitations, including drugs. In Tourette syndrome, pharmacotherapy is usually indicated for patients who experience psychosocial and/or functional impairment. In this population, botulinum toxin injections may be considered to treat localized tics, particularly if these affect neck and/or eyes muscles, but also to reduce phonic tics and coprolalia. Botulinum toxin, a neurotoxin that inhibits acetylcholine release at the neuromuscular junction, is approved by the Food and Drug Administration (FDA) to manage different conditions, including spasticity and cervical dystonia. The evidence drawn from this Cochrane Review can help patients affected by this condition to improve their functioning and quality of life, and might support physiatrists in choosing an adjunctive treatment option for Tourette syndrome, for which, to date, there is no definitive cure.

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肉毒杆菌毒素对抽动秽语综合征患者的运动和声音抽搐是否有效和安全？带有评论的 Cochrane 综述摘要

背景根据《精神障碍诊断和统计手册》第 5 版，图雷特综合征是一种神经发育障碍，通常与注意力缺陷/多动障碍和强迫症有关。这种情况通常始于儿童期或青春期，其特征是几次运动和一些声音抽搐，通常伴有先兆性冲动，每天发生超过 1 年，并且没有继发性原因，如药物滥用或神经系统疾病（即其他运动障碍） ）。在 1825 年首次描述，直到 1980 年代初期才被认为非常罕见，图雷特综合征在儿科人群中的患病率约为 1%，男性的患病率是女性的 4 倍。神经生理学研究表明多巴胺和γ-氨基丁酸代谢和额叶皮层下神经传递的复杂改变发生在图雷特综合征中，特别是涉及基底神经节。然而，这种疾病的病理生理学仍不清楚，导致临床医生使用无数治疗策略，包括具有不同作用机制的保守和手术选择，特别是调节肾上腺素能、多巴胺能或谷氨酸能神经传递。运动性抽动可能会干扰正常运动，并可能导致日常功能严重受损，尤其是在社交和职业领域。正如美国神经病学学会 (AAN) 强烈建议的那样，必须从患者的角度评估与抽动相关的功能障碍。在这种情况下，康复、作为旨在增强功能的高度以人为本的健康策略，可能代表图雷特综合征患者的核心管理方法。康复包括解决功能限制的几种干预措施，包括药物。在图雷特综合征中，药物治疗通常适用于有心理社会和/或功能障碍的患者。在这一人群中，肉毒杆菌毒素注射可能被考虑用于治疗局部抽动，特别是如果这些抽动影响颈部和/或眼部肌肉，但也可以减少声音性抽动和阴道痉挛。肉毒杆菌毒素是一种抑制神经肌肉接头处乙酰胆碱释放的神经毒素，经美国食品和药物管理局 (FDA) 批准用于治疗不同的疾病，包括痉挛和颈肌张力障碍。