The Need for a Proper Definition of a “Treatment Refractoriness” in Tourette Syndrome

social functioning of the patient, in some cases to an extent in which even after regression of symptoms the return to a normal social life is impossible. Moreover, DBS for TS seems to have significant incidence of complications and thus its indication must be evaluated adequately before proceeding (Servello, 2010). Conversely, drug treatment has been used when treating a young patient with a significant social impairment, but again, important adverse event may issue (Bestha, 2010). Drug therapies involve antipsychotic medications that have been shown to be weighted by significant adverse effects that may persist during adulthood to a point that recently the need for more strict treatment guidelines has been required (Panagiotopoulos, 2010; Pringsheim and Pearce, 2010). Considering the experiences presented in international literature, a structured protocol for drug therapies is usually not cited, and reports describe “maximum dose of established treatments” (Kuhn, 2007), “an inadequate response to at least two dopamine blockers or catecholamine depletors” (Maciunas, 2007), “failure of best treatment by medication (antipsychotics), or intolerance after a minimum of 6 months of treatment” (Welter, 2008). Indication to treatment be it invasive or conservative should be considered on the basis of a definition of refractoriness to treatments proposed in the previous “step” of the algorithm. Our guideline is that patients need to be observed in order to document (1) the most impairing feature of that specific TS picture – this also helps when determining the appropriate target for DBS, and (2) the evolution of the clinical picture – and thus the need for an invasive treatment on the basis of the severity of clinical manifestations and the need for specific medications on the basis of clinical manifestations. At our Institution (IRCCS Galeazzi, Milan, Italy) patients are followed with at least 2 years The need for a proper definition of a “treatment refractoriness” in Tourette syndrome