Objective: 1) To evaluate whether comorbidities influence Comprehensive Behavioral Intervention for Tics (CBIT) response.
2) To evaluate the response of tic phenotypes and location to CBIT.

Background: Multiple randomized controlled trials have demonstrated that CBIT significantly improves motor and vocal tics in patients with Tourette syndrome (TS). While attention problems are frequently hypothesized to impair tic suppression therapies, the results have been inconclusive. A differential response to CBIT based on tic phenotype and location also has not been well studied. These issues, if better understood, could help inform more optimal candidates for CBIT.

Method: A retrospective real-world analysis of a single Tourette Association of America (TAA) Center of Excellence tertiary referral center was undertaken. Excluded were patients with two or less CBIT therapy visits. The patient and/or the parent completed a tic hierarchy questionnaire at the initial therapy and final visits (target was 10 therapies).

Results: There were 48 patients (77.1% males) with a mean age of 16.3±10.8 years and a mean number of visits of 5.9±2.2. Twenty-eight patients (58.3%) responded completely (n=16) or partially (n=12) to CBIT, while 20 patients (41.7%) did not meet pre-established therapy goals. Baseline clinical characteristics and comorbidities were similar between groups with the exception of more attention deficit hyperactivity disorder (ADHD) in the partial response subgroup (p=0.048). Tic phenotypes were assessed. Darting eyes, facial grimace, head forward, throwing head back, shrugging shoulders, quick flexion/extension of arms and stimulus-dependent tics revealed improvements with CBIT (p<0.05).

Conclusion: This single center experience suggests that ADHD and tic phenotype may influence CBIT outcome in clinical practice. This small cohort revealed a more positive effect on tics including head and neck and/or proximal upper extremity involvement. Larger and prospective studies will be needed to fully characterize CBIT response in real-world conditions.

This abstract is an expansion on preliminary data that was previously presented as a poster at MDS 2016 International Congress, on June 21, 2016. This abstract will be presented at the upcoming 2020 AAN Annual Meeting (Toronto, ON, Canada) on April 30, 2020.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cbit-response-in-clinical-practice-the-potential-importance-of-comorbidities-and-tic-location/