Tic disorder is a neuropsychiatric disorder that begins in childhood and adolescence and is characterized by involuntary, repetitive, rapid motor tics in one or more parts of the muscles with vocal tics. It may be accompanied by inattention, hyperactivity, obsessive-compulsive movements and thinking or other behavioral symptoms. Its etiology and pathogenesis are not yet clear. I. Diagnosis (a) clinical manifestations 1, motor tics: often manifested as blinking, eyeball rotation, squeezing eyebrows, rolling eyes, frowning, lip biting, teeth, open mouth, nodding, shaking the head, stretching the neck, shrugging the shoulders and other movements. The twitching of limbs and trunk muscles is less common. 2, vocal tics: generally manifested as repeated clearing of the voice, coughing, snorting, spitting sounds, humming, barking and so on. It can also be characterized by complex vocalizations, such as repetitive speech or meaningless voice, boring tone, or repetition of the same obscene language. 3. Behavioral symptoms: most commonly accompanied by inattention, hyperactivity, obsessive-compulsive movements, obsessive thoughts, impulsivity, aggression, self-injurious behavior, learning difficulties, and mood disorders. (ii) Auxiliary examination The diagnosis of this disease mainly relies on clinical manifestations. The diagnosis of the disease mainly depends on the clinical manifestations. Auxiliary examination is necessary to find the organic cause of the disease. For example, blood sedimentation and anti-streptococcal hemolysin O are examined to rule out microdactylism. (III) Diagnostic criteria 1. The onset of the disease is before 21 years of age, and most of them are between 2-15 years of age. 2, There are recurrent, involuntary, repetitive, rapid, purposeless tics affecting multiple muscle groups. 3.Multiple tics and one or more vocal tics are present at some time, but not necessarily at the same time. 4, Can be restrained by will for minutes to hours. 5, The intensity of symptoms varies over weeks or months. 6, The tics occur several times a day, almost daily. The duration of the disease is more than 1 year, and the symptoms are not relieved for more than 2 months in the same year. Exclude chorea, hepatomegaly, epileptic myoclonic seizures, pharmacogenic involuntary movements and other extrapyramidal pathologies. 8, auxiliary diagnostic indications: obscene language; obscene behavior; imitation of language; imitation of movement; repetitive speech. Accompanying symptoms: hyperactivity disorder and behavioral problems in children; nonspecific electroencephalogram abnormalities; positive signs; psychiatric symptoms. Differential diagnosis This syndrome needs to be differentiated from chorea, hepatomegaly, myoclonus, delayed-onset movement disorder, acute movement disorder, dysthymia, and childhood schizophrenia. Treatment The principle of treatment is to give equal importance to drug treatment and psychological behavioral treatment, and pay attention to the individualization of treatment. (A) General treatment, including behavioral therapy, supportive psychological counseling, family therapy and so on. For children with mild Tourette’s syndrome who have good social adaptability, only psychological behavioral treatment can be considered, which mainly focuses on psychological adjustment and psychological guidance. (The purpose of treatment is to alleviate the discomfort and pain associated with tics, so that the patient can lead a normal life as far as possible. For mild or moderately severe tic disorders, clonidine and tiapride can be used; for severe cases, pimozide, haloperidol, aripipra-zole and risperidone can be used, Topiramate, etc., should be started in small doses and slowly increased until the efficacy of the drug is optimized and adverse effects are minimized. A combination of medications may be considered when a single medication only partially improves the symptoms of tic disorders or when there are complex concomitant symptoms. When the condition of tic disorder is basically under control, maintenance therapy is still needed, usually for six months to one year, and the maintenance dose is usually 1/2 to 2/3 of the therapeutic dose. Discontinuation of medication should be gradual based on the reduction of dosage, and should not be stopped abruptly. If symptoms recur or worsen, the drug should be resumed or the dose should be increased. (1) Haloperidol: Haloperidol is the drug of choice and is effective in about 85% of children. The initial dose for children is 0.25-0.5mg/d, and the dose can be increased every 3-5 days according to the efficacy and adverse effects. Before stopping the drug, gradually reduce the dosage in order to avoid the recurrence of tic symptoms. 5-12 years old children’s therapeutic dosage of 0.5-8mg / d, the general effective dose of 2 ~ l0mg / d, divided into 2 ~ 3 times orally. Anti-tremor paralytic drugs such as phenazopyridine (Antan) may be added to reduce extrapyramidal reactions. Common side effects are drowsiness, malaise, dizziness, constipation, tachycardia, dysuria, extrapyramidal reactions (acute dystonia, inability to sit still, tremor paralysis syndrome, etc.). There are reports that this drug can cause depressive symptoms, so it should be used with caution in children with a history of depression. (2) Pimozidete: a selective central dopamine antagonist. The effect is the same as haloperidol, but the sedative effect is light, can cause electrocardiogram changes, so the drug process must monitor the electrocardiogram changes. The initial dose for children is 0.05mg/kg orally once a day in the morning, and the dose can be increased every 3 days. The daily dose ranges from 0.5 to 6 mg, and before discontinuation, the dose is gradually reduced to avoid recurrence of tic symptoms. Side effects are similar to those of conventional antipsychotics, but delayed dyskinesia is less common. (3) Tiapride is a methyl maple o-anisoyl derivative with antagonistic effect on dopamine. The dose is 50~100mg/d, divided into 2~3 times orally. It is also required to be co-administered with Benzhexol (Antan). Side effects are mainly dizziness, weakness and drowsiness. If the initial dose is too large, nausea and vomiting may occur (4) Clonidine (Clonidine) has an a-receptor blocking effect, and can act directly on the central dopamine neurons and norepinephrine system to alleviate the motor tics and vocal tics, and improve the accompanying inattention and hyperactivity symptoms. Coladin is less effective than haloperidol and pimozide, but safer. In addition to sedative effects, there are side effects such as dry mouth, transient hypotension, dizziness, and insomnia. The initial dose is 0.025～0.05 mg/d, and increase 0.05mg every 3～4 days.The common dose is 0.2～0.45mg/d, divided into 3～4 times. Use with caution in cardiovascular disease and renal impairment. Start with a low dose and slowly increase the dose according to the clinical response. Gradually reduce the dose before discontinuing the drug to avoid recurrence of tic symptoms or rebound hypertension. (5) Topiramate (topiramate) See section I, Treatment, for details. (C) other Chinese medicine and acupuncture also have a certain effect on tic disorders, in addition to immunotherapy, deep brain electrical stimulation and surgical methods are trying to be used in the treatment of this disease (D) new developments in treatment In recent years, some people have proposed behavioral therapy known as the opposite of the habit reversal training (habit reversal training, HRI) can reduce the symptoms of tics. For example, for children with vocal tics, they can perform closed-mouth, rhythmic and slow abdominal deep breathing, thus reducing the symptoms of tics. In addition, there are self-monitoring and relaxation training therapy, but the opposite habit training is the most effective. Prevention Parents should create a warm family environment for their children and eliminate unnecessary psychological burdens. Master the correct parenting methods, avoid the child to blame, abuse and other ways. When the child has a variety of tic symptoms, parents maintain a calm state of mind, give indifference, ignore, etc., at the same time, can be used in a variety of ways to divert the attention of the child to reduce the number of tic episodes. Adults should not pay too much attention to their children when they have seizures, and should encourage them to participate in rhythmic physical activities, arrange regular work and rest time, and avoid excessive tension and fatigue, which will help the symptoms disappear.