Gilles de la Tourette syndrome with pharmacoresistance to antipsychotics in pediatric practice: a case report

Abstract

Gilles de la Tourette syndrome is the most severe form of tic hyperkinesis in children, characterized by multiple motor and vocal tics. According to world statistics, the prevalence of this disease reaches 1% in the pediatric population, and the average age of clinical manifestation of symptoms is 6-8 years. At the current stage of medical care, in accordance with international clinical guidelines, the first-line drugs of choice are atypical antipsychotics (neuroleptics) of the 2nd generation, such as aripiprazole, alimemazine, risperidone and others. Their use is justified by their high efficiency in suppressing ticks. However, despite this, standard antipsychotic therapy is ineffective in about 30% of patients, which forms a resistance group. This creates a serious clinical problem and naturally raises the question of finding alternative therapeutic strategies. In such cases, consideration of drugs from other pharmacological groups becomes an urgent direction. As demonstrated by individual clinical cases and studies, monoamine reuptake inhibitors, in particular tetrabenazine, may be a promising option. It is assumed that their effectiveness is associated with the modulation of dopaminergic transmission, which makes it possible to achieve a reduction in tic symptoms in patients who initially did not respond to traditional treatment, and opens up new ways for personalized therapy of this complex neuropsychiatric disorder.