Algorithm of diagnosis and treatment of Gilles de la Tourette syndrome and tic disorder, adapted for the Republic of Moldova: a review

Abstract

Introduction. In the last years the high prevalence of the tic disorder and Gilles de la Tourette syndrome (GTS) was confirmed. The available therapies can temporarily suppress the tics, but not eliminate them definitively, that implies a strict individual assessment of the risks and benefits for every patient. The recent scientific studies confirmed the efficiency of some diagnostic and therapeutic options, and infirmed the other ones. Thus, a qualitative analysis and adjustment of the recommendations to the actual conditions and possibilities of the Republic of Moldova (RM) is required. Material and methods. All the guidelines for the diagnosis and treatment of GTS and tic disorders were found in the PubMed database. The articles containing the keywords „Tourette diagnosis“, „Tourette treatment“, „tic diagnosis“ or „tic treatment“ and published after 2021 were selected. The availability in RM of the medications recommended by the international guidelines was verified on the site of the Medicines and Medical Devices Agency of RM. The final text includes the qualitative analysis and synthesis of the recommendations, adapted to the conditions and possibilities of RM. Results. The diagnosis of tics needs only clinical observation, and usually other investigations are not indicated. It is extremely important to identify patients whose tics do not need treatment, but just monitoring and informing about their nature. There are three main therapeutic methods directed against tics: behavioural therapy, pharmacotherapy, and, in some particular cases, neurosurgical approach (deep brain stimulation). The first two methods are available in RM. The efficiency of other tics treatment had been not confirmed yet. A particular attention is paid to the management of the specific comorbidities of GTS and tics. Conclusions. The diagnosis of tics is based on the recognition of their clinical manifestations and precise anamnesis. Only some patients with tics need treatment but all of them should be informed about the tics’ nature, causes and evolution. The behavioural therapy could be effective in some patients, while in others would be more convenient the pharmacotherapy or the combination of both. The neurosurgical treatment (deep brain stimulation) is reserved to severe tics, that are resistant to other therapies.