若不进行治疗,估计抽搐将会时而严重时而缓解,并在应激时加重。 短暂性抽搐性运动障碍的预后良好,1 年内抽搐症状会消退,虽然这种诊断通常在回顾时作出。
Tourette 综合征
Tourette 综合征的病程变化可能较大。 最严重的抽搐时期多见于 10~12 岁之间的儿童。[129]Bloch MH, Leckman JF. Clinical course of Tourette syndrome. J Psychosom Res. 2009 Dec;67(6):497-501.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3974606/http://www.ncbi.nlm.nih.gov/pubmed/19913654?tool=bestpractice.com[130]Leckman JF, Zhang H, Vitale A, et al. Course of tic severity in Tourette syndrome: the first two decades. Pediatrics. 1998 Jul;102(1 Pt 1):14-9.http://www.ncbi.nlm.nih.gov/pubmed/9651407?tool=bestpractice.com 12 岁后直到成年,多数(即 59%-85%)青少年抽动的发生率和严重程度会逐渐下降。[129]Bloch MH, Leckman JF. Clinical course of Tourette syndrome. J Psychosom Res. 2009 Dec;67(6):497-501.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3974606/http://www.ncbi.nlm.nih.gov/pubmed/19913654?tool=bestpractice.com[131]Hassan N, Cavanna AE. The prognosis of Tourette syndrome: implications for clinical practice. Funct Neurol. 2012 Jan-Mar;27(1):23-7.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812751/http://www.ncbi.nlm.nih.gov/pubmed/22687163?tool=bestpractice.com 对 58 名患有 Tourette 综合征的青少年和年轻成人的随访研究显示,26% 的抽动症状消退,46% 的症状减少,14% 保持不变,14% 恶化。[132]Erenberg G, Cruse RP, Rothner AD. The natural history of Tourette syndrome: a follow-up study. Ann Neurol. 1987 Sep;22(3):383-5.http://www.ncbi.nlm.nih.gov/pubmed/3479043?tool=bestpractice.com 另一项研究显示,18 岁时有 50% 的患者的抽搐症状完全消退。 早发性抽搐和合并症的存在可能会导致特异性认知能力缺陷。[133]Debes NM, Lange T, Jessen TL, et al. Performance on Wechsler intelligence scales in children with Tourette syndrome. Eur J Paediatr Neurol. 2011 Mar;15(2):146-54.http://www.ncbi.nlm.nih.gov/pubmed/20739206?tool=bestpractice.com
共病
抽搐性运动障碍的治疗效果与整体健康或成年期社会和教育能力无关。[2]Singer HS. Tourette syndrome and its associated neurobehavioral problems. In: Swaiman KF, Ashwal S, Ferriero DM. Pediatric neurology: principles and practice. 4th ed. Philadelphia, PA: Elsevier; 2006:887-98. 在涉及 186 名患者的观察性研究中,未发现抽搐的严重性和行为症状的频率之间存在线性关系。[89]Rosenberg LA, Brown J, Singer HS. Behavioral problems and severity of tics. J Clin Psychol. 1995 Nov;51(6):760-7.http://www.ncbi.nlm.nih.gov/pubmed/8778123?tool=bestpractice.com 因此,对许多患者而言,治疗并解决其合并症可能比单独控制抽搐更有帮助。[129]Bloch MH, Leckman JF. Clinical course of Tourette syndrome. J Psychosom Res. 2009 Dec;67(6):497-501.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3974606/http://www.ncbi.nlm.nih.gov/pubmed/19913654?tool=bestpractice.com