Acupuncture for tic disorders in children 2021
Inspired by You et al 2021.[1]
TD – tic disorders
key to acronyms
YGTSS – Yale Global Tic Severity Scale
TSS – total tic score (of the YGTSS)
GSS – global severity score (of the YGTSS)
ADHD – attention deficit hyperactivity disorder
OCD – obsessive compulsive disorder
This is a retrospective observational study from Shanghai. There are some similarities to the large retrospective cohorts I have featured here previously, but this one is new and different.
The data comes for a single centre and so the number of patients included is smaller (n=250), but the condition and patient population is such that prospective research would be quite challenging.
Tic disorders (TD) are neuropsychiatric disorders characterised by the presence of involuntary contractions of muscle groups that result in motor movements or verbal utterances and sounds.
The YGTSS was used to measure the severity of TD.[2] This is a semi structured clinical interview and is currently said to be the gold standard for evaluation TD.[3]
YGTSS – Yale Global Tic Severity Scale
The YGTSS enables evaluations of number, frequency, intensity, complexity, and interference of motor and phonic tics, covering the past week. Each domain is scored on a 6-point scale (range 0–5) with a separate rating for ‘overall impairment’ regarding the patient’s daily life and activities (range 0–50). The total tic score (TTS) is the sum of the total motor tic score (0–25) plus the total phonic tic score (0–25) and is the most common score used for assessment of tic severity (0–50). The GSS is the TSS plus the overall impairment rating (0–100). This paper refers to the YGTSS total which they calculate in the same way as the TSS.
Between June 2020 and March 2021, the centre treated 293 children with TD aged 4 to 16 years, of which 138 received acupuncture as well as conventional treatment. Children with co-morbidities such as ADHD or OCD were not included. Cases were excluded where records were incomplete, follow-up was not performed, or the acupuncture treatment was for less than 2 months (only 5 were in this latter category). This left 128 receiving conventional treatment for TD and 122 having both conventional treatment and acupuncture. Propensity score matching was performed for sex, age, household registration, parental education level, family structure, body mass index, heredity and YGTSS. Nearest neighbour matching was used, which resulted in two equal groups of 78 children.
The acupuncture points used were mostly on the scalp
The acupuncture was performed 3 times a week for 12 weeks and the points used were mostly on the scalp (Sishengcong, GV24, ST8, GB8). I make it 9 points on the scalp with additional use of LI4 if there were facial symptoms, Yintang and Yuyao for blinking and CV22 and Yuyao if the patient presented with strange sounds in the throat. Needles were inserted perpendicularly 0.5–2mm and left in place for 20 minutes.
The results show a difference in outcomes observed between the groups in favour of those that received acupuncture. There seemed to be a larger difference on vocal tics than on motor tics.
Whilst the results are somewhat encouraging, this intensity of treatment is not really practical outside China and other countries of the Far East where acupuncture is firmly established. I am also a little concerned about how acceptable it would be in younger children in the West. To quote from the paper:
Behavioural techniques such as demonstration, and distraction were applied to reduce the patient’s fear of the procedure, and increase the friendliness and compliance.
I guess that’s fine then 😉
I have asked Fed to join the webinar on Wednesday do give a psychiatrists perspective.
References
1 You H-Z, Zhou Y-F, Yu P-B, et al. The Efficacy of Acupuncture on Tic Disorders in Children: A Retrospective and Propensity Score-Matched Study. Front Pediatr 2021;9:745212. doi:10.3389/fped.2021.745212
2 Leckman JF, Riddle MA, Hardin MT, et al. The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry 1989;28:566–73. doi:10.1097/00004583-198907000-00015
3 Haas M, Jakubovski E, Fremer C, et al. Yale Global Tic Severity Scale (YGTSS): Psychometric Quality of the Gold Standard for Tic Assessment Based on the Large-Scale EMTICS Study. Front Psychiatry 2021;12:626459. doi:10.3389/fpsyt.2021.626459
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