Tic disorder

Introduction to tic disorder A group of syndromes characterized by involuntary, repetitive, rapid motion tics and/or vocal tics at one or more sites. These include transient tic disorder, chronic exercise or vocal tic disorder, vocalization and multiple motor joint tic disorder (twitch syndrome, Tourette syndrome). The tics are mainly characterized by motion twitching and vocal twitching, and muscle twitching occurs in one or more locations, including simple motion twitching or complex motion twitching. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific people Mode of infection: non-infectious Complications: anxiety disorder, affective mood disorder, obsessive-compulsive disorder, ADHD

Cause of tic disorder

(1) Causes of the disease

Because the clinical symptoms of tics are aggravated when nervous, the emotions are relieved, and disappeared during sleep, the influence of psychological factors can easily be regarded as the cause of this disease, but the real cause is not very clear, and more than genetic factors, Neurobiochemical factors are related to social psychological factors.

Studies have suggested that Tourette syndrome is an organic disease. After the drug treatment in the mid-1960s achieved significant results in Tourette syndrome, biological factors were taken seriously. In the past 20 years, the study has paid more attention to the obvious gender of this disease. Differences and high penetrance, neuroelectrophysiological EEG abnormalities can reach 12.50% ~ 66%, but its performance is non-specific, there is no meaningful change in evoked potentials, neuroanatomy studies may be mainly basal ganglia Pathway dysfunction or other parts of the brain are connected to the basal ganglia with damage or one, several biochemical loop abnormalities. In the neuropeptide and immune aspects, it is reported that the level of 2-globulin antibody in blood is related to the clinical severity of tic disorder. In addition, perinatal complications in children with low birth weight were significantly higher than those in the control group. At the same time, it was found that autoimmune reaction after -hemolytic streptococcus infection may lead to Tourette syndrome.

(two) pathogenesis

Genetic factors (25%):

Studies have confirmed that genetic factors are associated with the pathogenesis of Tourette syndrome, but the genetic pattern is unclear. Through family surveys, 10% to 60% of patients with tic disorder have a positive family history, and the coincidence rate of monozygotic twins is 75% to 90%. The coincidence rate of twin-oval twins is 8% to 23%. Family surveys also found that among the relatives of various tic disorder, the prevalence of obsessive-compulsive disorder and ADHD increased significantly. Another study considered Tourette syndrome and obsessive-compulsive disorder. It is a different manifestation of genes.

Neurobiochemical factors (21%):

The dopamine hypothesis suggests that Tourette syndrome is associated with hypersensitivity of dopamine overdose or dopamine D2 receptor after dopamine. Dopamine receptor antagonists such as haloperidol and pimozide (piperazine) can alleviate tic symptoms. Source opioids are associated with tic disorder and obsessive-compulsive disorder. There is evidence that the opiate receptor antagonist naltrexone can alleviate the twitching and attention deficit symptoms of Tourette syndrome. The 5-HT hypothesis is based on tryptophan hydroxylation in patients with Tourette syndrome. The enzyme activity is low, and the 5-HT reuptake inhibitor is effective in 40% of patients with Tourette syndrome, indicating that Tourette syndrome may be associated with obsessive-compulsive disorder. Some studies suggest that the disease and central noradrenergic system function Hyperthyroidism is based on aggravation of twitching symptoms under stress, and elevated levels of norepinephrine metabolite 3-methoxy-4-hydroxyphenylethylene glycol (MHPG) in cerebrospinal fluid, reducing central noradrenergic activity The drug aniline imidazoline (benzimidazoline) has a therapeutic effect on the disease.

Psychosocial factors (18%):

Children in the family, school, society encounter various psychological factors, as well as major events in life, can cause tension, anxiety, may induce tic symptoms, poor family education, strict discipline, too picky, harsh, school and Parents who exceed the actual level can cause tension and anxiety in the child, which in turn leads to tic disorder.

Tic disorder prevention

I. Parents' health education

1. Correctly understand the clinical symptoms of tic disorder. According to the survey, 93.0% of the parents had no knowledge of the clinical symptoms of tic disorder. Some parents often mistakenly think that their children are naughty and strange when they have clinical symptoms such as blinking and squeezing nose. They accuse, swear and even beat their children from time to time. It causes a heavy psychological burden on children. Some children worry about their parents watching themselves when they are eating with their parents or watching TV. They are nervous and fearful, and they are anxious and anxious, which makes the symptoms of twitching worse, which is not conducive to the recovery of children. To this end, parents must be made aware that the symptoms of the child are caused by the disease, rather than deliberately strange, parents should stabilize their emotions, create a warm family environment for the child, and eliminate the unnecessary psychological burden of the child. Conducive to the recovery of the disease.

2. Understanding of the cause: The cause of the disease has not been known so far. Previous studies have considered genetic, organic, physical, psychological and other factors. This survey found that children with tic disorder are often associated with psychological factors and inappropriate parental education. Some children often get worse after a cold. For this reason, parents are made aware of the predisposing factors of the disease, so that parents can master the correct parenting methods, avoid blaming and swearing, and also twitch when the child catches a cold. Symptoms can be aggravated, and the symptoms can be alleviated by taking a cold medicine.

3. Behavioral therapy: Symptoms of children with tic disorder are often controlled in a short period of time. When the child is in concentration during class or during physical activity, the symptoms may temporarily disappear. According to this situation, parents can be taught to perform correct behavioral therapy. When the child has various tic symptoms, the parents maintain a calm state of mind, give indifference, ignore ignorance, etc., and can use various methods to transfer the child's attention. If you tell a story, talk to the school about it, etc., make your attention shift, thus reducing the number of tics.

4. For the symptoms associated with children with tic disorder, such as learning difficulties, emotional anxiety, compulsive behavior, aggressive behaviors, etc. Parents should be taught positive education, care for them, and actively cooperate with the corresponding medication.

5. Actively cooperate with drug treatment: children with low-dose haloperidol treatment are often prone to extra-cone reaction, which makes parents feel fearful and stop drug treatment. For this reason, parents should explain the common side effects of drugs. , how to deal with after the occurrence of side reactions and other knowledge. Generally, after a week of taking the medicine, the symptoms are obviously reduced or disappeared. Some parents are afraid of affecting the child's learning after taking the medicine, and they stop taking the medicine to make the symptoms appear. They should educate the parents on the correct understanding of the drug treatment, insist on taking the medicine, and regularly review and improve the medication. Compliance.

2. Health education for children

In recent years, it has been reported that children with tic disorder should adopt behavioral therapy with opposite habit training. For this reason, we have adopted this therapy and received satisfactory results with drug therapy. The specific method is that when the child has vocal tics, the child is regularly trained in closed movements. When the child has abdominal muscle twitching, the child is subjected to slow-paced abdominal breathing training to relieve the tic symptoms. In addition, relaxation training can be used. When the tic symptoms frequently occur, the child can be relaxed and trained to teach the child to relax from the head, neck and shoulders, upper limbs, trunk, upper and lower limbs, and whole body muscles. If you imagine the scene at the seaside, you can also train the child to take a deep breath relaxation method, let the child stand, shoulders drooping, and close your eyes and slowly take a deep breath to eliminate the child's nervousness and reduce the tics.

3. Mental health education for school teachers

All children with tic disorder are primary and middle school students. When there is tics in school, the teacher does not know about it, and criticizes and accuses the child, which makes the symptoms worse, especially when some children with tic disorder have difficulty in learning. The teacher misunderstood and inappropriately criticized the child. For this reason, when the parents took the child to see a doctor, they contacted the school teacher through the parents, took the phone number, and conducted a telephone consultation in time to guide the teacher to the child. Awareness, tolerance and indifference to the symptoms that appear. Actively carry out beneficial cultural and sports activities to enable children to grow up in a relaxed and pleasant environment.

Tic disorder complications Complications anxiety disorder affective mood disorder obsessive-compulsive disorder hyperactivity disorder

The symptoms of tic disorder are from mild to heavy, complex and variable, not only as tics, but also in a variety of emotional and behavioral problems. Often lead to inferiority, trouble and affect others' daily life and learning. According to the survey, 60% of chronic tic disorder and Tourette syndrome combined with ADHD, 59% with obsessive-compulsive disorder, 15% with conduct disorder, 25% with learning difficulties, 2U% with mood disorder, 18% with anxiety, 14% with self Injury, 20% of social skills have problems, 25% have sleep problems, and 37% have difficulty controlling temper. Therefore, it can be seen that the disease is harmful to children's physical and mental health.

Symptoms of tic disorder Common symptoms murmur repeated self-speaking tic disorder irritability learning difficulties forced behavior imitating speech learning disorder slang slang obsessive-compulsive behavior

1. Basic symptoms:

Simple exercise twitch refers to blinking, vertical nose, pouting, shaking head, shrugging, etc. Complex movement twitch refers to multiple groups of muscles, and several parts of the movement appear at the same time, such as sudden squat or jump, sudden limbs, touch yourself or Others, tapping themselves, etc., vocal twitching is divided into simple vocalization and complex vocalization: simple vocalization for clearing, clearing the nasal cavity, and making "ah, ah" screams; complex vocalizations appear slang, repeating language, imitating language, , etc. Exercise tics is a rhythmic, involuntary, rapid, and repetitive muscle twitch that can be controlled by the will to not attack in a short period of time. Before twitching, there is an uncomfortable feeling called sensory twitching.

2. Clinical type:

(1) Transient tic disorder: also known as tics or transient tic disorder, usually starting after 3 years of age, 4 to 7 years old is the most common, is the most common and lighter type, showing simple Exercise twitching, the starting part of exercise twitching is often a muscle group of the face, starting from the alternating twitching of facial features, such as squeezing eyes, frowning, licking, licking, biting lips, swinging the head, necking, shrugging, etc. He is now, and gradually develops into the upper limbs or lower limbs. A few of them are simple vocal tics, such as clearing, coughing, screaming, snoring, and making "ah" and "yeah" snoring. At the beginning, they are small and not noticed. Twitching can be restrained by the will for several minutes to several hours, nervous, emotionally irritable or poor, or suffering from physical symptoms, symptoms disappear after falling asleep, some symptoms are fixed in a certain part, lasting 1 to 2 months, some The twitching position of the child changes indefinitely, alternately occurs, and the attack occurs several times a day for at least 2 weeks, but not more than 1 year. The symptoms of this type are mild, the treatment effect is better, and some cases are relieved by themselves. The child is sensitive and shy. , not gregarious, Yixing Excitement and excitement can be accompanied by enuresis, night terror or stuttering.

(2) Chronic exercise or vocal dysfunction: refers to the general characteristics of clinical performance in accordance with tic disorder, can have simple motor tics and complex exercise tics, or only vocal tics, and the symptoms are extensive, except for the face, neck, shoulder Outside the muscle group, often involving the upper and lower limbs, trunk, frequent symptoms, and lasting, often more than 1 year, a few only manifested as simple chronic vocal twitching, no more than 3 groups of muscles in any twitch, exercise twitching and vocal tics in the course of the disease Alternating, the frequency of tics may occur every day, but also intermittently, but the interval of seizures will not exceed 2 months. This type of symptoms is heavy, and it has a great impact on children's learning and life. Most of them require at this stage. Diagnosis and treatment, but the treatment response is worse than the previous type, and it is not easy to fully control.

(3) Tourette syndrome: also known as the occurrence of combined with a variety of exercise tic disorder or tics-spoken syndrome (de la Tourette's syndrome, referred to as TS), the symptoms often start with a slight twitching of facial muscles, gradually affecting the neck, shoulders, upper The lower limbs and the trunk can form complex twitches in many parts. Some cases have twitching and sudden impulsive movements at the same time and appear as peculiar postures, such as kicking, squatting, bending, walking, and irresistibly impulsive touch. Objects and others, or tapping, jab action; serious self-injury behavior, such as biting the lip, pulling the tooth, pricking the eye, poke the nose and other actions, is similar to the symptoms of forced impulsive disorder, vocal tics and exercise tics simultaneously exist, Can be used for simplicity or complexity, expressed as a single voice, such as animal-like screams, meaningless words or slang for repeated stereotypes and imitating speech, who have accounted for 10% of the children, most of the symptoms are frequent. The intensity is high, which has a great impact on the physical and mental health of children. About half of the children are accompanied by hyperactivity, attention to short-term, voluntary impulses, learning difficulties and other forms of emotional disorders.

The disease is a slow course of disease, the symptoms are good and bad, and often appear alternately. The symptoms can be improved in most cases after treatment, but the cure is more difficult. Generally, the children have normal intelligence and the symptoms are obviously relieved after adolescence.

Some people used the Bender-Gestalt test to test the patient. The results showed that the patient had significant damage to the right cerebral hemisphere. About 50% to 60% had EEG abnormalities, mainly slow wave or spike wave increase, and about 25% had skull. CT abnormalities, but clinical findings seem to be lower than this report.

3. Other symptoms: About 50% to 60% of patients with obsessive-compulsive symptoms, 50% to 60% with ADHD, and can be combined with emotional instability, irritability, destructive behavior and aggressive behavior and learning difficulties, etc., 30% ~44% of children with self-injury behavior, sputum behavior, the use of central nervous system stimulants can induce aggravation of tics.

Tic disorder check

The diagnosis of tic disorder in children is still based on clinical phenomenological diagnosis. Therefore, in addition to routine physical examination, nervous system and necessary auxiliary examination to exclude other diseases, detailed mental examination is necessary, which can correctly diagnose tic disorder and accompanying Psychiatric symptoms, however, many people do not pay attention to this, international research has the use of brain single photon emission computer scanning as a secondary diagnosis, and the trend of useful gene diagnostic techniques.

Tic disorder diagnosis and identification

Diagnostic points

1. Transient tic disorder:

1 onset before the age of 18. 2 There are single or multiple motion twitches or audible twitches, often manifested as simple motion twitching. 3 twitching occurs every day, many times a day, has lasted for two weeks, but no more than 12 months. 4 Except for Tourette syndrome, small chorea, other diseases of the nervous system or drugs.

2. Chronic exercise or vocal tic disorder:

1 onset before the age of 18. 2 The main clinical manifestations of exercise twitching or vocal twitching, but the movement twitching and vocal twitching do not exist at the same time. 3 twitching often many times a day, can occur every day or intermittently, tics lasting more than one year, no remission period lasting more than two months in a year. 4 Except for Tourette syndrome, small chorea, other diseases of the nervous system or drugs.

3. Sound and multiple movements combined with tic disorder:

1 appears as a variety of motion twitches and one or more vocal tics, both of which exist simultaneously. 2 Daily life and social function are obviously impaired, and the child feels very painful and troubled. 3 onset before the age of 18. The twitch occurs every day, many times a day, lasting more than one year; or intermittently, the symptoms are relieved within two months. 4 exclude other diseases.

Differential diagnosis

1. Rheumatic chorea (small chorea):

More common in children, caused by rheumatic infection, characterized by dance-like abnormal movements, no vocal tics, signs of rheumatic infection and positive test results, anti-rheumatic treatment is effective.

2. Myoclonic epilepsy:

For a type of epilepsy, the symptoms are similar to exercise tics, but the symptoms are accompanied by epileptic EEG, no vocal twitching, EEG examination is helpful for diagnosis, and antiepileptic treatment is effective.

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