Nowadays, there are more and more cases of pediatric tic disorders, which mainly manifest as some abnormal movements such as squinting, making faces, twisting the body, and abnormal vocalizations such as M or throat clearing and nose sniffing. Many parents and even doctors mistake these children’s performance as bad problems, and it is more common to clinically misdiagnose the performance of repeated blinking as “conjunctivitis”, misdiagnose the performance of long-term dry cough and throat clearing as “chronic pharyngitis”, misdiagnose long sighs as The diagnosis of “myocarditis” or “epilepsy” due to twitching in different parts of the body is misdiagnosed. We would like to draw your attention to this and review the knowledge with you, and ask for your comments if there is anything wrong.
What is tic disorder?
This disorder is also called “Tourette’s syndrome” or “multiple tics”. It is a disorder characterized by involuntary, sudden, multiple twitches and the presence of violent vocalizations and obscenities along with the twitches. It is more common in males, with a male to female ratio of 3:1. 90% of cases start between the ages of 2 and 12. In 1885, the French physician George Gilles de la Tourette reported 9 cases and described them in detail, hence the name Tourette’s syndrome.
Etiology of tic disorders
The etiology of Tourette’s syndrome is not well understood and may be related to genetics, biochemical and metabolic disorders, brain and somatic diseases or injuries, trauma, and psychological stress factors. It is believed that the cause may be abnormal dopamine function in the basal ganglia of the brain. Some scholars have reported a close relationship with dietary habits, such as an increased chance of the disorder in children who consume large amounts of coloring, caffeine-rich beverages, food additives, or seafood. Recent studies have found that some tic disorders appear or worsen after a cold. Although the factors are not clear, perinatal injuries, physical illnesses in infancy and childhood, central nervous system injuries and medications, and stressful factors should be avoided.
What are the manifestations of tic disorder?
The main manifestations are involuntary, repetitive, rapid, aimless motor twitching in one or more parts and M or vocal twitching. Motor twitching often manifests as blinking, nodding, frowning, pouting, nose sniffing, shrugging, arm lifting, kicking, twisting body, making faces, puffing stomach, long sighing, etc. Some even develop to jumping, still things, hitting themselves and picking up things to smell, etc. Abnormal sound mainly manifests as barking like growling, dry cough, throat clearing, nose sucking, shushing, even cursing, swearing, repeating other people’s or their own words. The seizures can occur in several ways at the same time, and the movements are more stereotypical, as few as 10 times a day or hundreds of times a day. The number of seizures increases when the mind is tense and nervous, decreases when concentrating on something, and disappears when sleeping. It can be self-controlled for a while, but it is difficult to self-control for a long time. It can be mixed with many behavioral problems, such as attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder, sleep disorder, and mood disorder. It is often misdiagnosed as trachoma, conjunctivitis, pharyngitis, myocarditis, epilepsy and so on.
The symptoms of the disease are sometimes mild and sometimes severe, with a wave-like progression, and may be stationary for a period of time. New symptoms may replace the old ones, or new symptoms may appear in addition to the original ones. Although the disease does not diminish intelligence, it can cause learning difficulties due to hyperactivity and obsessive-compulsive behavior in some children, and the mental burden.
How to diagnose tic disorder?
1. Multiple motor twitches and one or more vocal twitches are present at certain times during the course of the disease, but not necessarily at the same time.
2. Multiple episodes of twitching in a day, (usually in bursts) almost every day, or intermittent episodes lasting more than a year.
3. The location, number, frequency, complexity and severity of the twitches change over time.
4. Onset before age 21.
5. It does not occur with psychoactive substance intoxication or a known central nervous system disease such as viral encephalitis.
Hazards of tic disorder
The disease has a tendency to heal itself, but in practice the rate of self-healing is low, and there is a period of about 10 years from onset to adolescence, during which the condition changes in a variety of ways. In particular, children with abnormal behavior cannot control their own activities and involuntarily do things that harm others or even endanger their lives. In addition, the lack of concentration and purposeless activities make learning difficult and will affect their education in the long run. In addition, parental scolding and discrimination from outsiders can affect the psychological development of the child, which is very unfavorable for entering society as an adult. Therefore, parents should take the initiative to cooperate with the doctor in the treatment of their child’s illness, and use medication early and reasonably.
Treatment of Tourette’s Syndrome
For children with mild cases who have good social adjustment ability, psychotherapy should be the main treatment. This includes helping to understand the disease correctly, communicating with teachers and classmates, cautioning parents not to pay too much attention to the child’s tic symptoms, arranging the child’s daily life reasonably, reducing the pressure of learning, and making the child as happy as possible in a relaxed environment.
For children with severe symptoms that affect their daily life, learning or social life, additional medication is needed. Western drugs such as haloperidol and Tebri are often used to control symptoms by acting on neurotransmitters and receptors, and it usually takes one to several weeks or longer for the twitching symptoms to disappear, and then continue to be taken for 3-6 months before the drug is gradually reduced and stopped under the guidance of a doctor. It should be noted that side effects such as torsional spasm, hand and foot tremors, difficulty in opening mouth and tongue extension can occur with long-term heavy application, while the side effects can be reduced by taking Antan. According to the different clinical manifestations, the identification and use of drugs are effective, and the effect is more satisfactory when combined with acupuncture and auricular posting.
It should be noted that food additives and caffeinated beverages can contribute to the development of behavioral problems in these children, so consumption should be minimized. Colds can also trigger or aggravate the disease, so it is important to prevent and treat colds.
How to do psychotherapy?
Psychotherapy is an important part of the treatment of tic disorders and is the main means of preventing relapse and reducing comorbidities. At present, the following two aspects are often used.
1, psychological transfer method: clinical observation found that the symptoms of tic disorder are aggravated when nervous and anxious, reduced when relaxed, and disappeared when sleeping. Therefore, when a child has a tic attack, do not force him to control it, it is best to use the transfer method, such as asking him to help you pass the newspaper or do something lighter. This will reduce tension, anxiety and low self-esteem, and gradually reduce and alleviate tic symptoms through purposeful physical activities.
2. Cognitive support therapy: Children are deeply inferior and socially withdrawn due to abnormal movements such as eye-rolling. The more nervous and inferior the child is, the more serious the symptoms become, and the more serious the symptoms become, the more nervous and inferior the child feels in this vicious circle and cannot extricate himself. If the parents are still nagging, overly restrictive and endlessly blaming at this point, it is like adding insult to injury. Therefore, the best way to break the vicious circle is to analyze the condition together with the child under the guidance of a psychologist, to correctly understand that tic symptoms are just like a physical cold and fever and are not a bad disease, to increase confidence in overcoming the disease, and to eliminate the feeling of inferiority.
Most of the children can heal themselves through the above psychological treatment in a relaxed and happy living and learning environment.
How to distinguish tic disorder from epilepsy?
1, tic disorder has its own developmental pattern, mostly from repeated blinking, in a wave-like progression, gradually developed to the neck, shoulders, limbs and the whole body. In contrast, epilepsy has a fixed form of seizure in the same child.
2. Tic disorders are mostly accompanied by abnormal vocalizations in the throat, while epilepsy is not.
3. Tic disorders mostly do not affect intelligence and do not have abnormal neurological signs, while intractable epilepsy is often accompanied by mental retardation and positive neurological signs.
4, Although tic disorders may have EEG abnormalities, they are mostly nonspecific and do not have epileptic discharge waves.
5, Anti-epileptic drugs cannot control tic disorder seizures, while drugs such as haloperidol are effective in treatment.