The Efficacy And Safety Of Aripiprazole For The Treatment Of Tic Disorders In Children

BackgroundTic disorder(TD)is a neuropsychiatric disorder characterized primarily by the moter and/or vocal tics,which is one of the most common cinesipathy in childhood.It begins mostly in childhood,with a prevalence of about 6.1%,with more males than females,The ratio of men to women is about 3 to 4: 1.In recent years,the incidence of TD has been increasing year by year,and some can be extended to adulthood,which can seriously affect the learning,diminish the quality of life and social ability of children,and bring heavy psychological burden to children and their parents.But the etiology is unclear,which may associated with genetic and genetic abnormalities,nerve autoimmunity and infection,neurobiochemistry(such as neurotransmitter abnormalities),perinatal events,and psychosocial factors(such as severe trauma,academic frustration,chronic stress,negative mental factors,such as depression)and trace elements.At present,the exact pathogenesis of TD is unkonwn.One of the more recognized mechanisms is the presence of Abnormal dopamine release or supersensitive dopamine receptors in patients with TD.According to this theory,the clinical pharmacological treatment of TD encompasses classical antidopaminergic agents such as tiapride,haloperidol,etc,but are also associated with poor tolerability and compliancy because of the adverse effects such as drowsiness,fatigue,extrapyramidal symptoms,etc.In recent years,it has been reported at home and abroad that aripiprazole can be used in TS children who are insensitive to thiapride,haloperidol and other drugs.And there are few adverse reactions,which provides a new clue for clinical treatment of tic disorder.The Yale Global Tic Severity Scale is a quantitative index for evaluating the severity of clinical symptoms in children with tic disorder.It is continuous among the various types of tic disorder,and can not be divided absolutely,so at present,this scale is often used in clinical practice to evaluate the condition of the disease,evaluate the curative effect and communicate among pediatricians.Objective1.With a randomized,before and after treatment controlled parallel-group clinical study,compare the differences of YGTSS four scores and YGTSS 12 reduction rates of children with tic disorder between aripiprazole group and tiapride group at baseline,week 2,week 4,week 8 and week 12 to explore the clinical efficacy of oral aripirazole in the treatment of Tic disorder.2.Compare the incidence of adverse reactions in children with aripiprazole group and tiapride group to explore the safety of oral aripirazole in the treatment of Tic disorder.MethodsSelect newly diagnosed tic disorders children from June 2017 to October 2017 in neurology department of children in the First Affiliated Hospital of Zhengzhou University,according to the random number table method,the odd number entered the aripiprazole group,and the even number entered the tiapride group,which were separated with oral aripiprazole and tiapride for 12 weeks.Remove the patient who is intolerance,failing to use the drugs as required,missing visitors,etc.The patients were assessed by outpatient or telephone follow-up at baseline,week 2,week 4,week 8 and week 12.Yale global tic severity scale was used to assess the outcome and evaluate the efficacy of oral aripirazole in the treatment of Tic disorder;Side effects scale was used to evaluate the safety evaluation of two drugs.The experimental data were analyzed by SPSS21.0 software for statistical analysis.Results1.At the baseline,84 cases were included,but one case without regular medicine in aripriprazole group was excluded,so finally were 83 caces.the differences of age,gender,disease duration,disease type in aripiprazole group and tiapride group were not statistically significant(P > 0.05),and the YGTSS four scores of motor tics,vocal tics,functional impairment,total score was no significantly difference(P > 0.05).2.The YGTSS four scores decreased in both group significantly at week 2,week 4,week 8 and week 12(P<0.05),but there was no significant difference between the two groups(P > 0.05).3.After 12 weeks treatment,the aripiprazole group:25 cases were cured,14 cases were markedly effective,1 cases was effective,1 cases ineffective,and the total efficiency was 95.12%;the other group were 24 cases cured,16 markedly effective,2 cases effective,1 cases ineffective,and the total efficiency was 92.85%.The efficiency of the two groups was compared,while the difference was no statistically significant(P>0.05).4.The adverse effects in the aripiprazole group were 3 cases drowsiness,1 case nausea,and 1 case dizziness;and the other group were drowsiness(3 cases),nausea(1 case),dizziness(1 case)and weight gain(3 cases).Both were without unusual CEG and severe adverse reactions such as extrapyramidal symptoms,etc.There was no significant difference in the incidence of adverse reactions between the two groups(P > 0.05).Conclusions1.Aripiprazole is an effective medication compared with tiapride.2.Aripiprazole is relative safe,and it can be a new choice for the treatment of tic disorders.