摘要 台北長庚紀念醫院中醫藥劑部藥師林佩蓉 張思平 桃園長庚紀念醫院中醫藥劑部藥師童承福 (Tic) (attention-deficit hyperactivity disorder, ADHD) (obsessive compulsive disorder, OCD) tourette syndrome 壹 前言 1885 (Gilles de la Tourette) (multiple tics) (echolalia) (coprolalia) (Tourette syndrome, TS) 0.5-3% (ADHD) 60-70% (OCD) 30-50% 1,2 貳 臨床表現與評估診斷 (Tic) Tic (motor tics) (phonic or vocal tics) 3 (premonitory urgy) 80% Tic Tic disorder ( ) (Huntington's disease) Manual of Mental 藥學雜誌 122 11 綜合評論中西醫治療妥瑞症
Commentary 綜合評論Disorders, edition IV-Text Revision (DSM-IV- TR) 4 Tic 18 1 參 病理機轉 (Group A β-haemolytic streptococci, GABHS) (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection, PANDAS) (basal ganglia) - - (cortico-striatal-thalamo-cortical) (dopamine) 5 肆 西醫治療 (Tic) ( ) 4 Tic (habit reversal therapy, HRT) (repetitive transcranial magnetic stimulation, rtms) (deep brain stimulation, DBS) 4 表一治療 的常用藥物 ( -Adrenergic agonists) - D2 (Dopamine D2 receptor antagonists) - D2 5-HT2 (Dopamine D2 receptor antagonists and 5-HT2 serotonin receptor antagonists) ( ) - D2 5-HT2 (Dopamine D2 receptor and 5-HT2 serotonin receptor partial agonists) (Dopamine-depleting agent) Guanfacine Clonidine Haloperidol Pimozide Fluphenazine Risperidone Ziprasidone Aripiprazole Olanzapine Quetiapine (extrapyramidal syndrome, EPS) QTc interval EPS QTc interval Tetrabenazine 12 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.1
綜合評論伍 中醫治療一 古代中醫文獻記載與觀點 - () 6,9,10 表二辨證分型與治療藥學雜誌 122 13 " " " " 6 二 病因病機與辨證論治 ( ) 7,8 ( ) 6,9,10 11 7 圖一病因病機示意圖
綜Commentary 合評論三 穴位治療 12 四 相關臨床實證研究 2010 555 97.3% 13 146 2 75 71 (Haloperidol) 2 92%77.46% 14 15 陸 結論 14 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.1
1. Du JC, Chiu TF, Lee KM, et al: Tourette Syndrome in Children: An Updated Review, Pediatr Neonatol 2010; 51(5): 255-64. 2. Wang HS, Kuo MF.: Tourette's syndrome in Taiwan: an epidemiological study oftic disorders in an elementary school at Taipei County, Brain Dev 2003; 25(Suppl 1): S29-31. 3. Kenney C, Kuo SH, Joohi JS, et al: Tourette's Syndrome, Am Fam Physician 2008; 77(5): 651-8. 4. McNaught KStP, Mink JW: Advances in understanding and treatment of Tourette syndrome, Nat Rev Neurol 2011; 7: 667-76. 5. Leckman JF, Bloch MH, Smith ME, et al: Neurobiological Substrates of Tourette's Disorder, J Child Adolesc Psychopharmacol 2010; 20(4): 237-47. 6. 2007; 5(1): 14-5 藥學雜誌 122 15 綜合評論參考資料 : 7. 2011: 294-307 8. 2011; 7(1): 52-5 9. 2013; 30(4): 11-2 10. 2006: 349-54 11. 2011; 3(5): 393-5 12. 2011: 149-50 13. 2010 14. 2013; 45(8): 160-1 15. 2011; 27(6): 994-6 禪荷