Clinical case: Gilles de la Tourette syndrome with early onset

Abstract

Gilles de la Tourette syndrome (TS) is the most severe clinical form of tic hyperkinesis in children. According to world statistics, up to 1 % of children suffer from this disease, and the average age of clinical manifestation of TS is 6–8 years. TS is characterized by a clear gender feature – the prevalence among boys is 3-4 times higher than among girls. The etiological factor of the disease is still unknown, but it is generally believed that a genetic predisposition, perinatal damage to the central nervous system and traumatic events play a role in the development of TS. The key pathogenetic mechanisms of tic development in this case are: impaired inhibitory effect of the cortex on subcortical movement centers, predominance of excitatory neurotransmitters (dopamine, glutamate) inhibitory (gamma-aminobutyric acid) as well as microbiotic disorders that affect the central nervous system through the enteric nervous system. At the current stage of providing medical care to sick children with this diagnosis, according to international clinical guidelines, it is necessary to prescribe drugs from the group of antipsychotics, and the most effective drugs are considered to be generation 2 (aripiprazole, respiridon, quetiapine, tiaprid). However, the safety of these drugs has been poorly studied in the pediatric population; in addition, most of them are indicated for use in children from the age of 6. Accordingly, the question arises how to treat a patient with this diagnosis at an earlier age. In this clinical case, it was shown that nootropic drugs with anxiolytic activity can be effective in Gilet de la Tourette syndrome with early onset, when the appointment of antipsychotics, which are the first line of therapy, is still unacceptable.