اثر پیوند Fecal Microbiota در کودک مبتلا به نشانگان توره The Effect of Fecal Microbiota Transplantation on a Child with Tourette Syndrome

1. Introduction Tourette syndrome (TS) is a neurobehavioral disorder that has occurred in childhood, and it is de>ned by the presence of both multiple motor tics and one or more phonic tics for more than 1 year and never tic-free for more than 3 consecutive months [1]. /e main treatments for TS include behavioral treatments, administration of α2-adrenergic agonists, administration of antipsychotics, and even deep brain stimulation (DBS) [2–6]. Although current therapies may partly ameliorate tic symptoms, inadequate control of tics and adverse side e5ects remain challenging for the treatment of TS. Previous studies have reported abnormalities in the cortico-basal ganglia-thalamo-cortical loops in patients with Tourette syndrome [7]. Stress, excitement, fatigue, and thermal stress can exacerbate the severity of TS, and infection with group A beta-hemolytic streptococci may induce and even aggravate tic disorders [1]. Recent research reports that gut microbiota substantially a5ects central physiology and function via the microbiota-gut-brain axis. Furthermore, gut microbiota plays an important role in some mental illnesses, such as depression, autism spectrum disorder, and Parkinson’s disease [8]. As a result, fecal microbiota transplantation (FMT) has been considered as a potential method to rebalance gut microbiota, and its eFcacy has been demonstrated in autism and epilepsy [9, 10]. /erefore, we hypothesized that gut microbiota might contribute to Tourette syndrome and assessed the e5ects of FMT on a child with TS. To our knowledge, this is the >rst report of FMT in a patient with TS. 2. Case Presentation A 9-year-old boy with TS was admitted to our hospital. His symptoms predominantly consisted of involuntary eye turning, headshaking, shrugging, and voice tics, which he had experienced for 2.5 years. He was diagnosed as de>cient in trace elements at a local hospital and received oral calcium tablets, with no relief of symptoms. After 6 months, the patient experienced an aggravation of the abovementioned symptoms, accompanied by trembling limbs, inattention, and memory impairments. /e patient received herbal medicine (not detailed in clinical notes), but this was ine5ective. One year ago, the patient visited our hospital and was diagnosed with TS. He had a negative result for antistreptolysin O titers (ASOTs). He was prescribed tiapride 100 mg tid and probiotics, including Bacillus subtilis, Clostridium butyricum, and Enterococcus. In the following two months, the patient’s symptoms improved. Six months ago, the tic symptoms once again increased, with the patient’s total Yale Global Tic Severity Scale (YGTSS) score reaching 31, including a motor tic score of 16 and a vocal tic score of 15. /e patient’s parents accepted our suggestion to trial FMT to relieve the patient’s tic symptoms.