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Telebehavioural therapy for children with tics

To reduce tic severity in children with Tourette syndrome, online behavioral therapy was as effective as internet-based education alone, and participants responded better, a small randomized trial found.

Intervention – 10 weeks of therapist support, Internet-delivered Exposure and Response Prevention (ERP) program – associated with a mean reduction of 6.08 points in the Yale Global Tic Severity Score Degree scale (22.25 at baseline to 16.17 at 3-month follow-up).

A therapist-supported control group who was not assigned an ERP experienced a similar 5.29-point improvement on the scale, according to Dr. Per Andrén, a clinical neuroscientist at Karolinska Institutet in Stockholm. Results, intention-to-treat analysis (from 23.01 to 17.72, P=0.17), and JAMA Network Open colleagues.

However, significantly more participants were classified as responders in the ERP group (47.2%) than in the control group (28.7%) at 3 months of treatment (OR 2.22, 95% CI 1.27-3.90).

Current guidelines of the American Academy of Neurology list a Class B recommendation for the use of Comprehensive Tic Behavior Intervention (CBIT) as first-line treatment of medication and other behavioral interventions. Conversely, ERP and remote CBIT received weaker C-level endorsements.

Overall, the latest evidence supports a stronger recommendation for ERP, especially the Internet-delivered ERP, says Tamara Pringsheim, MD. Dr. John Piacentini, a neurologist at the University of Calgary in Alberta and a pediatric psychologist at UCLA, in an editorial.

Although clinical guidelines recommend behavioral therapy as first-line treatment, the study authors note that there are limited options for patients with Tourette syndrome and chronic tic disorder. They suggested that implementing digital ERP interventions would increase the availability of this treatment to young people.

In the trial, the average cost of ERP of $117.38 significantly exceeded the control group’s $102.23. However, according to Andrén’s research group, the incremental cost per quality-adjusted life-year gained is below the Swedish willingness-to-pay threshold, and the probability that ERP is cost-effective is between 66% and 76%.

“Importantly, the validation of therapist-assisted teleinterventions has the potential to address several of the many significant barriers that individuals and families face in seeking effective treatment for tic disorder,” according to Pringsheim and According to Piacentini.

The pair traced differences in the treatment of tic disorders to the centralization of medical knowledge and skills in large cities.

Barriers to access to behavioral therapy due to lack of trained nursing professionals, long wait times, cost, and travel distances required to see a qualified therapist,” Prince Haim and Piacentini wrote. “The ability to use remote delivery systems with the support of therapists can greatly improve the acceptability and competence of care, and has yielded meaningful gains in our field’s ability to deliver therapeutic interventions. progress. “

A single-blind, parallel-group, superiority randomized clinical trial was conducted at Karolinska Institutet in Stockholm and recruited nationwide in Sweden.

To be eligible, children must have Tourette syndrome or chronic tic disorder and be between the ages of 9 and 17. This resulted in 221 participants (mean age 12.1 years, 68.8% boys) in April 2019 Enrollment through April 2021.

The ERP intervention consisted of 10 weeks of practicing tic suppression (response prevention) and gradually evoking hunches to make tic suppression more challenging (exposure). The control group who received structured education received 10 weeks of education on Tourette syndrome, chronic tic disorder, and common comorbidities. Behavioral exercises were also provided to this group.

Andrén and His colleagues acknowledged that children who did not receive either intervention lacked a third arm to control the natural passage of time. In addition, inclusion in the generally mild group may have diluted between-group differences, excluding participation with comorbid autism may limit the generalizability of the results. Finally, the short time frame may not fully reflect the social costs associated with Tourette syndrome.

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    James Lopilato is a Medpage contributor today Contributor. He covers a variety of topics currently being explored in medical scientific research.


The study was conducted by the Swedish Health, Work Life and Welfare Research Council, Stockholm Region and Funded by the Swedish Research Council.

Andrén reported no conflict of interest.

Prinsheim received Alberta Health and Alberta Children’s Hospital Funded by the Institute and employed by the American Academy of Neurology.

Piacentini is supported by the NIMH, the Patient-Centered Outcomes Institute, the TLC BFRB Foundation and Nicholas Foundation. Received consultancy fees from Spinnaker Health and publishing royalties from Guildford Press, Oxford University Press and Elsevier. Received presentations from Tourette Society of America, International Obsessive-Compulsive Disorder Foundation and TLC BFRB Foundation Remuneration.




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