Farmacoterapia e qualità della vita nella sindrome di Gilles de la Tourette

BACKGROUND: Few studies have used standardized and specific instruments to assess the Health-Related Quality of Life (HR-QoL) in Tourette Syndrome (TS). Moreover, there are no studies focusing on pharmacotherapy and HR-QoL. AIMS: We compared the clinical characteristics and the HR-QoL in youth and adult TS patients with and without pharmacological treatment. METHODS: We recruited 112 TS patients (94 males; age range 7-64 years). All patients were evaluated by a trained neuropsychiatrist in TS and completed the Gilles de la Tourette Syndrome-Quality of Life scale (GTS-QoL). Clinical features of TS and severity of tics were assessed by specific clinical rating such as the Yale Global Tic Severity Scale (YGTSS) and Tourette’s Syndrome Diagnostic Confidence Index (TSDCI). Results were compared between patients with and without pharmacological treatment. We also divided the sample in two groups (< 18 years and > 18 years), and the same comparison was performed both between groups (young patients vs adult patients) and within each group. RESULTS: Forty-four TS patients (39,3%) were on pharmacotherapy (23=monotheapy; 16=dualtherapy, 5=politherapy). Of note, 86 patients (76.8%) fulfilled diagnostic criteria for at leas one comorbid condition. No significant differences were found in HR-QOL between youth and adult TS patients with pharmacotherapy. However, young patients on pharmacotherapy showed higher mean scores on GTS-QoL Obsessive Scale (p=0,009) than peer without treatment. As expected, comparing the mean scores of GTS-QoL with YGTSS and TS-DCI scores we found a significant correlation between HR-QoL and tic severity ratings. Age-related analysis showed that in young patients the presence of OCS correlated with higher GTS-QoL Obsessive (p=0,043), whereas adults reported higher scores on the majority of GTS-QoL domains in correlation with the presence of OCD, ADHD and sleep problems. DISCUSSION: The treatment for patients with TS is based on a broad diagnostic process. The use of drugs for treatment of TS, especially in children, must be done only when tic interfere with daily life, cause subjective discomfort and cause sustained social/emotional problems. Indeed, our results showed that adult TS patients for whom it was necessary a pharmacotherapy are those who had worse HR-QOL. Moreover, patients with pharmachoterapy showed higher severity of TS’ symptoms