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Yıl:2000; Cilt: 7; Sayı: 2>> Özet
Çocuk ve Gençlik Ruh Sağlığı Dergisi; 2000;7(2):113-121
Tourette Bozukluğu: Tanı ve Tedavisinde Yenilikler
P Öner
Ankara Üniversitesi, Tıp Fakültesi, Çocuk ve Ergen Ruh Sağlığı ve Hastalıkları Anabilim Dalı, Ankara.\r\n\r\n
Amaç: Tourette Bozukluğu (TB), sosyal, duygusal akademik alanlarda ciddi sorunlar yaratabilen bir hastalıktır. Bu yazıda TB’nun patofizyolojisi, eşzamanlı bozukluklarla ilişkisi ve tedavisi hakkındaki yeniliklerin gözden geçirilmesi amaçlanmıştır. Yöntem: Son 10 yıl içerisinde yayınlanan araştırma ve gözden geçirme yazıları incelenmiş ve bu yayınların 76’sından yararlanılmıştır. Bu yayınlar seçilirken, geniş örneklem üzerinde çalışılan, yeni bir bakış açısı getiren ve adından sıklıkla söz edilen araştırmalar olmasına dikkat edilmiştir. Sonuçlar: Beyin görüntüleme çalışmaları ve nörobiyolojik çalışmaların sonuçlarına göre günümüzde hastalığın patofizyolojisinde en çok üzerinde durulan bölgeler, bazal ganglionlar ve kortiko-striato-talamokortikal yolaklar (circuits)dır. Otozomal dominant geçtiğinin düşünülmesine karşın TB’ndan sorumlu olan gen henüz bulunamamıştır. Bu hastalık ve eşlik eden diğer bozukluklar günümüzde artık geniş bir yelpazenin parçaları olarak kabul edilmektedir. TB’na, Obsesif Kompulsif Bozukluk (OKB), Dikkat Eksikliği Hiperaktivite Bozukluğu (DEHB) gibi bozukluklar sıklıkla eşlik eder ve hastalar genellikle birçok durumun içiçe geçtiği karmaşık olgular şeklinde ortaya çıkarlar. TB ile birlikte görülen OKB olgularının ayrı bir alt tip olduğu düşünülmektedir. TB’nda birbirinden çok farklı tedavi biçimlerinin etkili olduğu görülmüştür. Tartışma : TB ve eşzamanlı bozukluklar, altta yatan ortak bir mekanizmanın farklı görünümlerde ortaya çıkmış şekilleri olarak düşünülmektedir. Bu yüzden altta yatan fizyopatolojik mekanizmayı araştıran daha fazla sayıda çalışmaya gereksinim vardır. Bu çalışmalar, hastalığın tedavisine de ışık tutacaktır.
Tourette's Disorder: Advances in Diagnosis and Treatment
Objective: Tourette’s Disorder (TD) causes serious problems in social, emotional and academic areas. In this article, it is intended to review the pathophsyiology, comorbidty and treatment of the disorder. Method: Published literature in the last 10 [year]s in reviewed and 76 of them are used. The articles that had large samples and, helped developing a new perspective are chosen. Results: Results of neuroimagining and neurobiological studies show that, the most important brain regions in pathophysiology of TD are basal ganglia and cortico-striato-thalamo-cortical circuits. Although it is thought to be inherited in an autosomal dominant way, the responsible gene is not found yet. This disorder and comorbid other disorders are now considered parts of a broad spectrum. TD is frequently comorbid with obsessive-compulsive disorder and attention deficit hyperactivity disorder and patients are usually seen as complex cases. Conclusion: TD and comorbid disorders are thought to be the different manifestations of the same underlying disorder. Therefore, more studies exploring this underlying pathophysiologic mechanism are crucial.

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