{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T05:40:06Z","timestamp":1778910006215,"version":"3.51.4"},"reference-count":84,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2020,12,18]],"date-time":"2020-12-18T00:00:00Z","timestamp":1608249600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>Gilles de la Tourette syndrome (GTS) is a childhood onset neuropsychiatric disorder characterized by the presence of motor and vocal tics. The clinical spectrum of GTS is heterogeneous and varies from mild cases that do not require any medical attention to cases that are refractory to standard treatments. One of the unresolved issues is the definition of what constitutes treatment-refractory GTS. While for some other neuropsychiatric disorders, such as obsessive\u2013compulsive disorder (OCD), a clear definition has been established, there is still no consensus with regard to GTS. One important issue is that many individuals with GTS also meet criteria for one or more other neurodevelopmental and neuropsychiatric disorders. In many individuals, the severity of these comorbid conditions contributes to the degree to which GTS is treatment refractory. The scope of this paper is to present the current state-of-the-art regarding refractory GTS and indicate possible approaches to define it. In closing, we discuss promising approaches to the treatment of individuals with refractory GTS.<\/jats:p>","DOI":"10.3389\/fneur.2020.589511","type":"journal-article","created":{"date-parts":[[2020,12,18]],"date-time":"2020-12-18T06:49:47Z","timestamp":1608274187000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":13,"title":["Refractory Gilles de la Tourette Syndrome\u2014Many Pieces That Define the Puzzle"],"prefix":"10.3389","volume":"11","author":[{"given":"Natalia","family":"Szejko","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Lombroso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael H.","family":"Bloch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angeli","family":"Landeros-Weisenberger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James F.","family":"Leckman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2020,12,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1007\/s00787-010-0143-3","article-title":"Tourette's disorder and other tic disorders in DSM-5: a comment","volume":"20","author":"Roessner","year":"2011","journal-title":"Eur Child Adolesc Psychiatry."},{"key":"B2","doi-asserted-by":"publisher","first-page":"16097","DOI":"10.1038\/nrdp.2016.97","article-title":"Gilles de la Tourette syndrome","volume":"3","author":"Robertson","year":"2017","journal-title":"Nat Rev Dis Primers."},{"key":"B3","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1097\/00004583-198907000-00015","article-title":"The yale global tic severity scale: initial testing of a clinician-rated scale of tic severity","volume":"28","author":"Leckman","year":"1989","journal-title":"J Am Acad Child Adolesc Psychiatry."},{"key":"B4","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1002\/mds.26891","article-title":"Systematic review of severity scales and screening instruments for tics: critique and recommendations","volume":"32","author":"Martino","year":"2017","journal-title":"Mov Disord."},{"key":"B5","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1212\/WNL.0000000000007467","article-title":"Comprehensive systematic review summary: treatment of tics in people with Tourette syndrome and chronic tic disorders","volume":"92","author":"Pringsheim","year":"2019","journal-title":"Neurology."},{"key":"B6","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1007\/s00787-011-0163-7","article-title":"European clinical guidelines for Tourette syndrome and other tic disorders. 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