Multiple Tourette Syndrome (MTS)



Overview.

What is Multiple Tourette Syndrome?

Definition.

Multiple Tourette Syndrome is a childhood-onset tic disorder characterized by slowly progressive multi-site motor and vocal tics, the most severe type of tic disorder, also known as Tourette syndrome, a combined vocal and multi-motor tic disorder.

The disorder was once known as Tourette syndrome. The name “Tourette syndrome” is now considered inappropriate, as the incidence of Tourette’s is not particularly high and has a distinctly pejorative connotation, and is rarely used in clinical practice, with Tourette’s syndrome or multiple tic disorders being used instead.

Types

There are three types based on the condition.

Mild: Symptoms are mild and do not interfere with normal life, learning or social activities, etc.

Moderate: Symptoms are more severe, but less disruptive to life, school or social activities, etc.

Severe: Symptoms are more severe and significantly affect life, study or social activities, etc.

Incidence

The incidence of multiple tic disorders is (0.5 to 1)/100,000, which means about 1 in 100,000 people.

The onset of the disease is usually between 2 and 15 years of age, with a mean age of onset of 7.2 years. 93% of patients have onset of the disease before the age of 11 years. It is more common in males than in females, with a male to female ratio of (3-4):1.

The mean age at diagnosis was 16 years. The average time from onset to diagnosis is 10 years.

Questions you may be concerned about

Can Multiple Tourette Syndrome be cured?

Multiple Tourette Syndrome can be cured.

The disease often progresses slowly, and some of it may lessen or resolve with age and gradual improvement in brain development, with about 3% of patients resolving on their own. About half of the children who receive long-term, standardized medication can have their symptoms controlled or relieved, and can live as normal. Some children have poorer treatment results, and their symptoms may continue into adulthood or even for life, but generally do not affect their intelligence or life expectancy.

What should a child with Tourette’s syndrome pay attention to?

If your child suffers from Tourette’s syndrome, you should pay attention to your child’s emotions, avoid over-disciplining him/her and praise and encourage him/her to maintain a good and stable mood.

Encourage your child to participate in more activities, but avoid intense exercise to avoid overwork and stress. Eat a reasonable diet and get enough sleep. Factors that may aggravate the condition can be avoided, such as tension, anxiety, anger, shock, excitement, fatigue, and lack of sleep may aggravate the symptoms and should be avoided as much as possible.

What are the signs of Multiple Tourette Syndrome in children?

Multiple Tourette Syndrome is characterized by progressive development of multiple motor tics and vocal tics. Tics of the facial muscles are usually the most frequent, such as blinking, sideways glances, shrugging of the nose, and crooked mouth. A few patients have simple vocal tics, such as coughing and throat clearing.

As the disease progresses, the twitching increases in frequency, gradually to the shoulders, neck, limbs or trunk. Some patients have repetitive speech and obscene language, i.e., repeating the last words spoken by others, swearing, etc.

Etiology

The etiology and pathogenesis of multiple tic disorders are unclear, and may be caused by the interaction of genetic factors, neurophysiology, biochemical metabolism, and environmental factors during development.

Causes

Genetic factors

Some studies have confirmed that genetic factors are related to the disease, but up to now only many candidate related genes have been identified, and the actual causative gene has not been clearly confirmed and discovered.

Some studies have suggested that the disease is polygenic and that the genes for dopamine D2 receptor, dopamine hydroxylase and dopamine transporter protein 1 are involved in its development.

It has also been suggested that the disease is a monogenic disorder with autosomal dominant inheritance.

Neurofunctional factors

The relationship between this disease and neurobiochemical factors is complex and not conclusive.

Endocrine factors

Sex hormone metabolism may also be involved in the pathogenesis.

Environmental factors

Psychological stress and tension caused by the external environment may be related to the disease.

Some studies have shown that stress may induce the disease in genetically susceptible individuals (e.g., those with a family history).

Other Factors

Autoimmune abnormalities caused by β-hemolytic streptococcal infection may also have a role in the disease.

Pathogenesis

The pathogenesis of the disease has not been elucidated and may be related to a variety of factors affecting the metabolism of neurotransmitters (e.g., dopamine).

Central neurotransmitter imbalance, striatal dopamine overactivity, or dopamine receptor hypersensitivity may be key links in the pathogenesis.

Symptoms

The disease usually begins in early childhood, with early symptoms, in a variety of locations and forms, and is characterized by involuntary, sudden, rapid, repetitive muscle twitching, which is often accompanied by violent, involuntary vocalizations or obscenities.

Early symptoms

Early symptoms (also known as aura symptoms or prodromal symptoms) precede the onset of the disease in 80% of cases, especially in older children, and often consist of indescribable inappropriateness or certain sensory abnormalities, as described below.

Burning sensation in the eyes, leading to blinking.

Tightness or painful spasms in the neck muscles that require stretching the neck or nodding to relieve.

A feeling of tightness in the limbs that requires stretching the arms or legs in order to be relieved.

A sense of nasal obstruction that requires wrinkling of the nose for relief.

Sounds such as throat clearing and dry coughing.

Itching sensation, relieved by twisting the shoulders.

Abnormal sensory disturbances to other people or objects, which need to be relieved by touching or attacking others, are more rare.

Tourette’s Symptoms

Twitching is a typical symptom of the disease, which is mainly categorized into the following five types. The symptoms may be mild or severe, sometimes relieved for a period of time on their own, or aggravated or alleviated under the effect of certain factors, and the site, frequency and intensity of the attacks may change, and may disappear during sleep.

Common aggravating factors: stress, anxiety, anger, shock, excitement, fatigue, lack of sleep, etc.

Common mitigating factors: concentration, mental relaxation, emotional stability, sleep, etc.

Simple motor tics

It is the typical manifestation of this disease, which may involve single or multiple parts, and the movements range from simple to complex.

It usually starts from the face, gradually develops to the head, neck and shoulder muscles, and then spreads to the trunk and upper and lower limbs.

Blinking: most common, mostly starting with a monocular blink.

Nodding.

Nose shrug.

Eyelid spasms.

Nocturnal teeth grinding.

Eyeball swiveling.

Rotations of the shoulders.

Persistent jaw opening.

Oblique neck.

Abdominal contracture.

Extension of limbs.

Bending of limbs.

Action-vocal tics

Action-vocal tics are the most typical and more frequent type.

The probability of a vocal tic occurring within 1 to 2 years after a simple tic is 79% to 98.5%.

Some may develop motor tics months to 1 year after vocal tics.

Vocal tics alone

Symptoms are varied, difficult to control consciously (only for a few minutes), and fluctuate over time.

The most common are grunts and barks.

More common are coughing, throat clearing, screaming or growling, and snorting and snorting.

There may also be guttural sounds, hemming and hawing, blowing, grunting, eructations, letting out a laugh, and sucking sounds.

Seizures during speech can cause certain words to suddenly become louder or change in sound and spit.

Complex motor tics

The movements are complex, varied and imitative, with an incidence of 73.1%.

Common movements are belching, obscene behavior, mimicking movements, head shaking, hitting oneself or others, jumping, kicking, dry heaving, throwing, touching oneself, others, or objects, bending over, and vomiting.

Other movements include stomping, kneeling, knee-bending motions, bending over, and pacing back and forth in a folded position.

Complex vocal tics

Imitation of speech: repeating the last words of someone else’s speech.

Verbal repetition: repeating the last words of one’s own speech.

Obscene speech: generally self-aware but difficult to control, expressing obscene words in an impolite manner, aloud, in inappropriate places and situations, occasionally substituting obscene gestures and lewd postures for speech.

Complications

Psychological behavioral disorders are often comorbid with corresponding symptoms, most commonly behavioral disorders such as obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD).

Obsessive-compulsive disorder

Mainly consists of obsessive-compulsive thoughts and compulsive behaviors, which may coexist or exist separately.

Involuntary recurring or persistent unrealistic thoughts, such as the constant silent reading of certain words, and the inability to get rid of them, bring about anxiety and distress.

Mostly manifestations of obsessive-compulsive ideas, with constant repetition of making actions, such as constantly washing hands, bathing, counting, storing, organizing, and sequencing.

Attention Deficit Hyperactivity Disorder

Mainly manifested as attention deficit disorder, such as difficulty in sustaining attention while listening to lectures, doing homework or other activities, being easily distracted by external stimuli, or often constantly shifting from one activity to another, resulting in academic disruption.

Other

When combined with other emotional and behavioral abnormalities, irritability, anxiety, depression, panic, assault, sexual harassment, anti-social behavior, and even self-injurious behavior may occur.

Consultation

Department of Medicine

Psychiatry

If a child has multiple involuntary tics with vocalizations or obscene language, he or she should be seen promptly.

Pediatrics

Pediatric patients may also visit the Department of Pediatric Neurology, the Department of Child Behavior and Development, and the Department of Pediatrics.

Preparation

Preparing for your visit: registering, preparing your documents, and frequently asked questions.

Tips for your visit

Tourette’s syndrome is a multifactorial disorder. A detailed medical history will help the doctor make a better diagnosis.

Special reminder: Children need to be supervised by their families. It is recommended to bring the perinatal history of the child and the mother with you to the doctor’s office, and to take good care of the child to avoid risk-taking behaviors, aggressive behaviors, and self-injurious behaviors.

Preparation checklist

Pay particular attention to the time of onset of symptoms, special manifestations, etc.

（What are the symptoms (of the child) and how long have they lasted?

In what situations do the symptoms occur?

Do the symptoms tend to get worse?

Are there any other psychological or physical problems?

Are there family members with similar conditions?

Any blood relatives with psychosomatic disorders?

Have you ever suffered from any psychosomatic illness?

Have you been seen in another hospital before and what was the diagnosis?

Results of tests in the last six months, which can be brought to the doctor’s attention

Laboratory tests: blood tests, hormone tests, thyroid function tests

Imaging tests: brain CT, magnetic resonance imaging, ultrasonography

Other tests: Psychological examination

Medication in the last 3 months, if available, bring the box or package with you to the doctor’s office.

Atypical antipsychotics/second-generation antipsychotics: clozapine, olanzapine, risperidone, aripiprazole

Antidepressants: paroxetine, fluoxetine, venlafaxine, sertraline

Central stimulants: methylphenidate immediate-release tablets (Ritalin), methylphenidate extended-release tablets (Focus)

Antiepileptic drugs: carbamazepine, phenobarbital, sodium valproate, topiramate

Diagnosis

There is a lack of specific diagnostic indicators for this disease. Doctors make the diagnosis mainly based on the symptoms of tics and psychological and behavioral disorders, and after excluding other diseases.

Disease Diagnosis

Medical history

The onset of the disease is preceded by indescribable discomfort or certain sensory abnormalities.

Symptoms may appear at an early age.

Clinical manifestations

There are typical symptoms of tics.

Systemic and neurological examination: there are usually no positive neurological signs, which helps to differentiate from other organic diseases.

Psychiatric examination: mental status can be examined through conversation to find out whether it is accompanied by psychological behavioral disorders, as well as to help differential diagnosis.

Laboratory examination

Including blood routine, urine routine, stool routine examination, etc., can understand the general physical condition, mostly without special results.

Electrophysiologic examination

Electroencephalogram (EEG) can reflect brain function to a certain extent and is mainly used to exclude epilepsy and other diseases.

Generally there is no abnormality, a few may have non-specific EEG abnormality.

Imaging examination

It mainly includes cranial CT and magnetic resonance imaging (MRI) examination, which can exclude other organic diseases such as craniocerebral injury.

Most of the examination results are not abnormal, and some of the cranial MRI results may show that bilateral caudate nucleus and nucleus pulposus are smaller than normal, and bilateral basal ganglia are asymmetric.

Diagnostic criteria

The commonly used diagnostic criteria at home and abroad are not very different, with minor differences.

Diagnostic criteria of China Classification and Diagnostic Criteria of Mental Disorders (3rd edition) (CCMD-3)

Symptomatic criterion: The manifestation of multiple motor tics and one or more vocal tics, which are mostly complex tics, and the two mostly occur simultaneously. The tics may be controlled by will for a short period of time, intensify under stress, and disappear during sleep.

Severe criteria: daily life and social functioning are significantly impaired, and the child is in great distress and annoyance.

Course of the disease: onset of the disease before 18 years of age, symptoms may continue into adulthood, tics occur almost every day, multiple times a day, lasting at least 1 year, or occurring intermittently and not relieved for more than 2 months in a year.

Exclusion Criteria: Involuntary tics and vocalizations cannot be explained by other disorders.

Diagnostic and Statistical Manual of Mental Disorders (5th edition) (DSM-5) diagnostic criteria in the US

Has multiple motor tics and 1 or more occurring tics, but the two do not necessarily occur at the same time.

After the first episode of tics, the frequency of tics can increase or decrease, and the duration of the illness is more than 1 year.

The onset of the disease occurs before the age of 18 years.

Disease is not caused by certain substances (e.g., cocaine) or other diseases (e.g., Huntington’s disease or viral encephalitis).

Differential Diagnosis

Transient Tourette Syndrome

Similarities: general symptoms are similar to Tourette’s syndrome.

Differences: Symptoms last less than 1 year.

Chronic Tourette Syndrome

Similarities: Both may present with motor or vocal tics and have similar symptoms.

Differences: Chronic tics only present with motor tics or vocal tics, both tics are different is present, and the duration of the disease is more than 1 year.

Huntington’s disease

Similarities: both can present with choreic, clonic or spastic tics.

Differences: Huntington’s disease tends to start after the age of 30 and genetic testing shows increased copy number of CAG repeat sequences, mostly greater than 40.

Hepatomegaly

Similarities: Both can present with dystonia or dystonic twitching.

Differences: Laboratory tests for hepatomegaly show low serum copper blue protein, high urinary copper, and a positive corneal K-F ring on physical examination.

Rheumatic chorea

Similarities: Both may present with twitching-like movements throughout the body.

Differences: Rheumatic chorea may have a history of A-hemolytic streptococcal infection. Laboratory tests show an increase in the number of leukocytes in the peripheral blood, an increase in the erythrocyte sedimentation rate, an increase in the C-reactive protein, and an increase in the anti-streptococcal hemolysin “O” test potency.

Epileptic myoclonic seizures

Similarities: Both can have jerky movements.

Differences: epileptic myoclonic seizures are short-lived and have characteristic EEG changes.

Chorea – Echinococcosis

Similarities: Both may present with twitching of the corners of the mouth, lip biting, spasms, and/or abnormal sounds.

Differences: Laboratory tests in chorea-acanthocytosis show neural acanthocytes in more than 15% of red blood cells and elevated serum creatine kinase.

Mental retardation

Similarities: Both may present with stereotyped, tic-like movements.

Differences: Mental retardation is accompanied by functional delays in language, socialization, and cognition.

Craniocerebral trauma

Similarities: Both may present with motor or vocal tics.

Difference: Craniocerebral trauma usually has a clear history of trauma and cranial injury is visible on imaging.

Pharmacogenetic involuntary movements

Similarities: Both may present with motor or vocal tics.

Difference: Pharmacogenetic involuntary tics have recent use of a stimulant drug such as cocaine and a positive drug screen.

Restless legs syndrome

Similarities: Both can present with lower extremity hyperactivity.

Differences: Restless legs syndrome is most common in middle-aged and older adults, and symptoms often worsen at night during rest, and are not accompanied by tics in other parts of the body, except for sensory abnormalities in the lower extremities and symptoms of lower extremity hyperactivity.

Treatment

Aim of treatment: to improve the symptoms and reduce the impact on daily life, study or social activities.

Treatment methods: mainly include educational intervention, psychotherapy, medication, neurosurgery, transcranial magnetic stimulation and so on.

Treatment principle: There is no specific treatment method, and it is necessary to identify the symptoms that have the greatest impact on life, and then adopt individualized treatment plans for the symptoms. Educational intervention and psychotherapy are preferred, and when the effect is not good, medication must be combined with other means of treatment.

Educational interventions

Regardless of the type of treatment, it is necessary to provide educational interventions for the child’s learning problems, social adaptability and self-esteem, especially for parents, teachers, classmates and other people who have more contact with the child, in order to create a comfortable, warm, and harmonious environment, so as to achieve a better therapeutic effect.

Measures for children

Participate in sports and cultural activities to relax.

Avoid exposure to undesirable stimuli that may induce tic attacks, such as playing video games, watching scary movies, eating spicy and stimulating foods, etc.

Encourage the child to contact and socialize with people around him/her so as to increase his/her social adaptability.

Measures for parents

Record the child’s behavior during seizures, preferably with video equipment, to help the doctor determine the condition during the next visit.

Understand and pay attention to the child’s behavior, and avoid excessive criticism due to lack of understanding, and do not take punitive measures to increase the child’s mental stress.

Communicate with the child more often to improve communication with the child and help him/her eliminate psychological pressure and comply with the treatment, so as to improve the therapeutic effect.

Measures for teachers and classmates

Teachers also need to understand the medical knowledge related to the disease and correctly understand the behavior of the child.

Teachers should not blame the children too much in their studies, but should educate them patiently, take care of them and help them solve their problems in life and study.

Teachers also need to let other students know about medical knowledge to avoid discriminating against the child because of the symptoms caused by the disease.

Psychotherapy

Treatment principle: often used in combination with medication, it is usually necessary to adopt one or more psychological treatment methods according to different situations, and gradually find the most suitable method.

Aims of treatment: to improve tic symptoms, intervene in psychological and behavioral disorders, and improve social functioning.

Treatment methods: including behavioral therapy, supportive psychological counseling, family therapy and so on.

Behavioral therapy

Core part: It is awareness training and competitive response training, using antagonistic response to stop tic episodes. For vocal tics, the counter-response can be to stop the vocal tics by tightly closing the mouth and taking slow rhythmic deep breaths through the nose; for action tics, the counter-response is to tighten the muscles that correspond to the tics.

Complementary treatment components: include self-monitoring, relaxation training, contingency management, motivational procedures, and generalization training.

Habit reversal therapy is combined with functional assessment and function-based interventions to reduce the occurrence of maladaptive behaviors that make tics worse in daily life.

Other behavioral treatment modalities include exposure and response prevention and educational group therapy.

Supportive Counseling

Doctors will provide psychological adjustment and counseling to the child and parents to encourage the child to establish a good psychological state, eliminate tension and low self-esteem, and slow down or eliminate parents’ worry and anxiety.

Family Therapy

The doctor will provide guidance to the parents, asking them to arrange the child’s daily routine and activities to avoid excessive stress and fatigue.

Parents should also help the child to monitor himself/herself and praise and encourage him/her when his/her symptoms subside.

Medication

Aim of treatment: To relieve or control tics, obsessive-compulsive symptoms, attention deficits and other manifestations through medication, and to improve the quality of life.

Timing of medication: Consider using medication when symptoms significantly affect daily life and when educational interventions and psychotherapy are inappropriate, ineffective, or impossible to implement.

Treatment principle: It is necessary to start with a small dose, and then gradually increase the dose or slowly discontinue the drug after judging the efficacy.

Therapeutic effect: In general, drugs can only reduce the symptoms of tics by 25% to 50%.

Reminder: All the following medications should be used in accordance with the doctor’s instructions, do not adjust the dose or stop the medication on your own.

Medications for Tourette’s Symptoms

Because of the inherent fluctuations in tics, medications should be used under close observation, for a long period of time, and should be tapered very slowly.

Mainly haloperidol and pimozide, are more effective drugs, the two efficacy is comparable, but more adverse effects (especially sedative effect), is now more often in other drugs when the control is not good.

Fluphenazine and thiamphenicol (also known as Tabrizol) also have good efficacy, and the adverse effects are mild and mostly tolerated.

Other medications include aripiprazole, risperidone, and ziprasidone.

The drugs of choice for the treatment of mild to moderate tics are mainly colistin and guanfacine.

Major adverse effects include sedation, dry mouth, headache, nervousness, insomnia, and cardiac arrhythmias.

Monitoring of blood pressure and electrocardiogram is recommended with the drug.

It can be used in situations where medications such as haloperidol are not as effective.

The main adverse effects are lethargy, extrapyramidal reactions, insomnia, inability to sit still, etc. It can increase the risk of depression, suicidal ideation, and suicidal behavior, and needs to be monitored.

Such as clonazepam and topiramate.

Mainly used for focal action tics or occurrence of tic symptoms, such as frequent blinking, dystonic tics, neck tics, etc. It can reduce the muscle contraction at the injection site and improve tic symptoms.

The main adverse effects are soreness at the injection site, weakness, and loss of voice.

Drugs for obsessive-compulsive symptoms

Drugs such as fluoxetine, sertraline, fluvoxamine, escitalopram, paroxetine, etc. are available and usually need to be combined with drugs for tic symptoms.

The main adverse effects are headache, sedation, insomnia, nausea, vomiting, diarrhea, anorexia, and sexual dysfunction, as well as an increased risk of suicidal ideation and suicidal behavior.

Chlorpromazine, primarily, is not recommended as a first choice and is considered when two separate SSRIs are ineffective.

Major adverse effects include Q-T interval prolongation, ventricular tachycardia, fatigue, dizziness, dry mouth, sweating, tremor, constipation, urinary retention, and weight gain.

Medications for attention deficit hyperactivity disorder

Methylphenidate and amphetamine are the most commonly used, or preferred, medications, but have adverse effects that cause or worsen tic symptoms and are not recommended for use alone.

Colistin and guanfacine are effective in controlling tic symptoms and are also effective in concomitant attention deficit hyperactivity disorder.

Tomoxetine, primarily, is effective in controlling attention deficit hyperactivity disorder and does not affect tic symptoms.

Medications for other symptoms

If there is a combination of other symptoms, medications also need to be applied symptomatically. If aggressive and impulsive behaviors are present, antiepileptic drugs, lithium, propranolol, colistin, and antipsychotics may be considered, but there is a lack of evidence-based medical evidence to confirm their efficacy.

Neurosurgical treatment

For a small number of refractory children who are not treated with various medications, deep brain electrical stimulation can be considered for treatment, which is mainly applicable to children over 12 years old.

Neuromodulation therapy

For children who have been ineffectively treated with a variety of drugs, repeat transcranial magnetic stimulation, transcranial microcurrent stimulation, electroencephalographic biofeedback and other neuromodulation therapies can be tried, but only a small number of studies have proved that it is effective, and there is no exact indication.

Traditional Chinese Medicine (TCM)

Traditional Chinese medicine (TCM) treats this disease mainly by applying traditional Chinese medicine prescriptions through the Eight Principles of Diagnosis and Diagnosis, and also needs to be supplemented with acupuncture, tuina and other therapies at the same time, but there is a lack of evidence-based medical evidence to support its efficacy.

Special reminder: secret prescriptions, biased prescriptions, folk remedies and other methods of treating this disease have no scientific basis, and the indications and effectiveness are not clear, and the safety is difficult to guarantee, so it is not recommended to use them.

Prognosis

Cure

The disease often progresses slowly, and some of it can be reduced or alleviated with age and gradual improvement of brain development.

About half of the children with the disease can be controlled or relieved after receiving long-term, standardized drug treatment and can live as normal.

Some children have poorer treatment results, and their symptoms may continue into adulthood or even throughout their lives, but their intelligence and life expectancy are generally not affected.

Harmfulness

Repeated episodes of motor tics and abnormalities can cause great pain to the child, seriously affecting the child’s normal life, learning and social adaptability.

Often combined with obsessive-compulsive disorder, attention deficit hyperactivity disorder, learning difficulties, sleep disorders, mood disorders, self-injurious behaviors, character disorders, and rage episodes, etc., which will aggravate the condition, increase the difficulty of treatment, and also affect the child’s personality, psychology, and many other aspects.

Daily life

Daily life

The following aspects should be paid attention to in daily life.

Stabilize mood

Parents should pay attention to their children’s emotions, avoid overly strict discipline, praise and encourage their children more, and let them maintain good and stable emotions.

Exercise in moderation

Parents should encourage their children to participate in more problematic activities, such as playing table tennis, etc., which can exercise body coordination, help children concentrate, and also help children learn to communicate with others.

Exercise should not be too intense, about 30 minutes is appropriate to avoid overwork and tension.

Reasonable diet

Reasonable diet, balanced nutrition, try to keep the diet light, avoid spicy and stimulating food.

Try not to let your child eat junk food, such as fried and barbecued food.

Try to avoid all caffeinated beverages and foods, such as coffee, chocolate, and certain functional drinks.

Do not allow your child to overeat meat (raw and heavy, no more than a poker box size amount per day), and eat more fresh vegetables and fruits.

Regular work and rest

Children should be allowed to develop the habit of going to bed early and waking up early to get enough sleep and avoid staying up late.

Create a good home environment

Maintain a good family physical environment, e.g. keep the living environment tidy, noise-free and at a suitable temperature.

Maintain a good family interpersonal environment, such as harmonious relationship and cozy atmosphere among family members.

Avoid aggravating factors

Nervousness, anxiety, anger, shock, excitement, fatigue, lack of sleep, etc. may aggravate the symptoms and should be avoided as much as possible.

Prevention

The exact cause of Tourette’s syndrome is still unclear, and there is a lack of preventive measures against the cause, mainly early detection, early diagnosis and early treatment.

Regular physical examination

It is believed that this disease is related to heredity. People with a family history of the disease should pay attention to regular medical checkups and seek medical attention when abnormal symptoms occur.

Avoid infection

Some studies believe that β-hemolytic streptococcus is related to this disease, so in times of climate change, we should pay attention to keeping warm to avoid infection with β-hemolytic streptococcus, and should actively treat the infection.

Attention to mental health

Psychological stress and tension caused by external environment may also be related to this disease. Parents should pay attention to their children’s psychological health and avoid giving them too much psychological pressure.

Improve diet

Choose natural foods as much as possible and avoid allergic foods.

Allow children to develop good eating habits, not picking and choosing food, and maintain a suitable body weight.

Minimize the consumption of processed foods with high sugar and oil content, such as fried chicken, creamy cakes and sugary milk tea.