Objective: To investigate the status of monotherapy for newly diagnosed
tic disorders and its comorbidity in children, so as to provide a reference for clinical medication. Methods: A questionnaire survey was conducted to collect the application experience of monotherapy for newly diagnosed
tic disorders and comorbidities in 110 pediatric neurologists and psychiatrists from Chinese
Tic Disorders Study Consortium from February to August in 2019. Doctors were asked to rate treatment options based on a rank 5-point scale with "1" least appropriate and "5" most appropriate. The
drug evaluation index was based on the comparison of the median score of a single
drug with the overall scores of all drugs in this disease (M (Q1, Q3)), single
drug M ≥ overall Q3 was recommended as preferred drugs; overall Q1≤ single
drug M < overall Q3 was considered as secondary drugs; single
drug M < overall Q1 was considered as unsuitable drugs. Results: Among 110 electronic questionnaires, 94 (86%) were availably responded, responding doctors included 37 (39%) males and 57 (61%) females, the age of responding doctors was (48±10) years, and their working year was (17±10) years. In the investigation of the first and second monotherapy for newly diagnosed
tic disorders in children without comorbidities, there were no preferred drugs for mild
transient tic disorders. The scores of
clonidine,
aripiprazole and
tiapride were 4 (3, 4), 4 (3, 4), 4 (4, 5) scores respectively, and were greater than overall scores (3 (2, 4) scores), so they could be recommended as the preferred drugs for moderate chronic
tic disorders, the recommendation for initial mild
Tourette syndrome (TS) treatment was the same as preferred drugs for moderate chronic
tic disorders. Similarly,
clonidine,
aripiprazole,
tiapride and
haloperidol could be recommended as the preferred drugs for other kinds of
tic disorders. As for the second monotherapy, the preferred drugs for moderate
transient tic disorders, mild chronic
tic disorders and severe TS were all
aripiprazole,
tiapride,
haloperidol,
sulpiride,
clonidine and
topiramate. While
clonidine,
aripiprazole,
tiapride could be considered as preferred drugs for severe
transient tic disorders, moderate to severe chronic
tic disorders and mild to moderate
tic disorders. In the investigation of monotherapy for newly diagnosed
tic disorders in children with comorbidities, for moderate chronic
tic disorders and TS comorbid with
obsessive-compulsive disorder,
aripiprazole (4 (3, 5) scores) and
sertraline (4 (3, 4) scores) were preferred drugs,the median scores of which were all greater than overall scores (3 (3, 4) scores), they were also the preferred treatment for severe
transient tic disorders and mild chronic
tic disorders. For mild and moderate
transient tic disorders, severe chronic
tic disorders and TS comorbid with
obsessive-compulsive disorder,
aripiprazole,
fluvoxamine,
fluoxetine,
haloperidol and
sertraline were preferred drugs. When comorbid with
attention deficit hyperactivity disorder (
ADHD), severe
transient tic disorders, moderate chronic
tic disorders and TS,
tomoxetine and
clonidine were recommended as preferred drugs (both 4 (4, 5) scores), and
tomoxetine and
clonidine were also the preferred treatment for severe TS. For severe chronic
tic disorders comorbid with
ADHD,
clonidine (5(4, 5) scores) was preferred
drug, greater than overall scores (4 (3, 5) scores), while for mild and moderate
transient tic disorders clonidine,
tomoxetine,
guanidine and
methylphenidate were recommended as preferred drugs. For mild chronic
tic disorders and TS comorbid with
ADHD tomoxetine was preferred
drug. When comorbid with
sleep disorders, there were no preferred drugs for mild
transient tic disorders;
estazolam (3 (2, 3) scores) was the preferred
drug for mild chronic
tic disorders and TS comorbid with
sleep disorders. For othe kind of
tic disorders comorbid with
sleep disorders,
estazolam,
melatonin and
clonazepam were preferred drugs. When comorbid with anxiety and
depressive disorders, for all kinds of
tic disorders sertraline was recommended as preferred drugs, the median scores of
sertraline were all (4 (3, 5) scores) in severe
transient tic disorders, moderate to severe chronic
tic disorders and moderate TS, and greater than overall scores (3 (3, 4) scores). While severe chronic
tic disorders comorbid with anxiety and
depressive disorders,
fluvoxamine could also be chosen as preferred drugs. Conclusions:
Drug therapy is not recommended for mild
transient tic disorders, while
tiapride,
aripiprazole,
clonidine, and
haloperidol are mainly preferred drugs for the other kinds of
tic disorders. Corresponding drugs should be selected when
tic disorders are combined with
obsessive-compulsive disorder,
ADHD,
sleep disorders, anxiety, depression, etc.