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Terapia conductual para niños con trastorno de Tourette: un ensayo controlado aleatorizado
John Piacentini1, Douglas W Woods, Lawrence Scahill
1UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Room 68-251, Los Angeles, CA 90024, USA. jpiacentini@mednet.ucla.edu
JAMA
|May 21, 2010
Resumen
Una intervención conductual integral redujo significativamente la gravedad de los tics en niños y adolescentes con trastorno de Tourette. Este tratamiento eficaz mostró resultados duraderos, ofreciendo una alternativa prometedora a los medicamentos antipsicóticos.
Área de la Ciencia:
- Neurología Neurología.
- Psiquiatría Infantil Psiquiatría Infantil
- Ciencias del comportamiento Ciencias del comportamiento.
Sus antecedentes:
- El trastorno de Tourette es una condición neurológica crónica de inicio en la infancia.
- Los medicamentos antipsicóticos son tratamientos de primera línea, pero tienen efectos adversos.
- Las intervenciones conductuales requieren evaluación en ensayos controlados a gran escala.
Objetivo del estudio:
- Determinar la eficacia de una intervención conductual integral para reducir la gravedad de los tics en niños y adolescentes.
- Para comparar la intervención conductual con un tratamiento de control en un ensayo aleatorizado.
Principales métodos:
- Un ensayo aleatorizado, observador ciego y controlado que involucró a 126 niños (de 9 a 17 años) con trastorno de Tourette o tics crónicos.
- Los participantes fueron asignados a una intervención conductual integral (n=61) o terapia de apoyo y educación (n=65).
- Las evaluaciones incluyeron la Escala Global de Gravedad de Tic de Yale y la Escala Clínica de Mejoras de Impresiones Globales, con seguimiento a los 3 y 6 meses.
Principales resultados:
- La intervención conductual dio lugar a una disminución significativamente mayor en la gravedad de los tics (escala global de gravedad de los tics de Yale) en comparación con el grupo de control (P < .001).
- Más niños en el grupo de intervención conductual mostraron una mejora significativa (escala de Impresiones Globales Clínicas-Mejora; 52.5% vs 18.5%, P < .001).
- Las ganancias del tratamiento fueron duraderas, con el 87% de los encuestados que mantuvieron los beneficios a los 6 meses, y baja desgaste (9,5%).
Conclusiones:
- La intervención conductual integral es más efectiva que la terapia de apoyo y la educación para mejorar la gravedad de los síntomas en niños con trastorno de Tourette y tics crónicos.
- Esta intervención ofrece una opción de tratamiento viable y eficaz con resultados duraderos.
- Otras investigaciones deberían explorar la eficacia a largo plazo y una implementación más amplia.
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