In school-age and preschool-age children, involuntary stereotyped movements such as repeated blinking, eyebrow squeezing, making strange faces, snorting, nose fiddling, lip biting, tongue licking, grinning, canthargy, head nodding, head shaking, neck twisting, neck stretching, shoulder shrugging, hand or arm twitching, fist clenching, leg shaking, knee shaking, foot moving, etc. (simple motor tics), or appearing as simple repeated uttering, coughing, humming, clucking, or throat clearing, etc. (simple vocal tics), are often seen. This is also called tic disorder, or habitual spasticity, and is a transient tic disorder. Psycho-habitual tics in children are one of the most common types of neurological disorders in children, and are one of the most common types of tic disorders in children. The prevalence is reported to be 1%-7% in China, mostly in preschool and early school-age children, with boys being the most common. The main clinical manifestations are mostly simple motor twitches, which are relatively limited, generally eye and facial muscle twitches are common, and the symptoms fluctuate or shift in location within weeks or months, and may develop to the neck or upper and lower extremities; a few children may have simple vocal twitches; the twitches of the same child are generally fixed and stereotyped, but may also show a combination of various twitching symptoms; some children have several twitching symptoms, which may fluctuate at different stages. Some children have several twitching symptoms, which can be repeated at different stages. The duration of the disease usually does not exceed 1 year. It is neither epileptic nor chorea minor and usually has no significant impact on the child’s daily learning and adaptation to the environment. The child may have other neurological symptoms, such as restless sleep, night terrors, and enuresis. The frequency and severity of tic symptoms vary, but the common features are: 1 The basic form is a small twitch of a group or several groups of muscles, and the twitching is often sudden, rapid, stereotyped, and repeated alternately. 2 The child is often purposeless when twitching and cannot easily control himself, sometimes he can barely restrain himself for a moment, but then relapses, but he is conscious, and the movement is small when twitching. The range of movements is small, and can occur during rest, study, and activity, but does not affect the original movement; the twitching decreases or disappears when attention is distracted, and stops during sleep.3 Physical examination includes neurological examination, and there are usually no abnormal findings. The diagnostic criteria are as follows.
1. The onset of the disease is in childhood. 2. Motor twitches (single or multiple parts) or vocal twitches are present. 3. The twitching can be restrained by will for a short period of time (minutes to hours).
4. The severity, frequency and location of the twitching symptoms may change. 5. The twitching symptoms appear several times a day, day after day, and last at least 2 weeks but not more than 1 year.
6. Exclude extrapyramidal neurological diseases and other causes of muscle spasms. The possible causes of psychogenic-habitual tics in children are as follows: (1) Most of them are caused by mental, psychological and social factors, such as fright, parental reprimand, excessive academic demands, failure to satisfy one’s desires in life, emotional neglect or favoritism, family life events such as arguments in the family, certain tensions in the environment, emotional stress, etc. The tics become a manifestation of psychological stress. In some cases, the twitching becomes a manifestation of psychological stress, and the child initially has psychological anxiety or tension, followed by habitual twitching; in a few cases, the twitching is caused by imitating the actions of others. The onset of the disease is also related to the child’s psychiatric type, and those who are neurotic, timid and emotionally unstable are prone to this tendency. Children who are introverted, shy, timid, sensitive, and do not get along with others are more likely to have this type of tic reaction when they encounter something unpleasant. (2) Some of these tics are caused by physical illnesses and often start due to local irritation, such as conjunctivitis or impingement that causes eye discomfort and frequent blinking, pharyngitis that causes pharyngeal discomfort and clearing of throat and phlegm, or discomfort in clothing and itchy skin, which can become a protective or habitual action. When the local disease is eliminated, the twitching symptoms continue to exist and habitual twitching occurs. (3) Genetic factors
It is believed that transient tic disorder may be related to genetic factors because it is more common in the family members of children with tic disorder. (4) Instrumental factors
Perinatal damage, such as birth injury, asphyxia, etc., may be related to the disorder. (5) Pharmacogenic factors Certain drugs such as central nervous system stimulants and antipsychotics may produce side effects of tics when taken for a long time. The treatment of psychiatric-habitual tics in children is based on reducing the anxiety and tension of the affected child and eliminating the possible related etiology, together with measures such as distraction, psychotherapy, pharmacotherapy, and reasonable parenting. It is important to eliminate all kinds of tension factors, to raise the child reasonably and pay attention to the child’s psychological state, and to make the child lively and happy. Parents and teachers should give more guidance and consolation, and relatives and people around should not pay excessive attention to the child’s symptoms to avoid the child’s tension and anxiety and make the pathological inertia more fixed; moreover, they should not scold or punish, otherwise the number of twitches will become more frequent; excessive learning goals and requirements should be avoided, and the child should be guided to The child should be guided to engage in normal learning, cultural and sports activities, and encouraged to play with other children to divert attention; the nature and curability of the disease should be explained to the child to eliminate concerns, and the child’s own initiative should be brought into play to build confidence and gradually control the twitching episodes; diseases of the eyes, throat, skin, etc. should be treated promptly; some children can take some anti-anxiety drugs. Children’s mental and habitual tics belong to the category of “eye-zapping” and “twitching” in Chinese medicine, which is located in the brain (heart) and is closely related to the liver. At the beginning, it is advisable to de-stress the liver and clear the fire, then calm the liver and clear the heat, nourish the yin and quench the wind, and for a long time, nourish the liver and kidneys, and regulate the liver qi, so that the prescriptions can be used such as Danjuania Prosperity San, Gentian Diarrhea Liver Soup, Liver Quenching Wind Soup, Antelope and Hooked Vine Soup, Qiju Dihuang Tang and Consistent Decoction.