Pediatric tic disorder, also known as habitual spasticity syndrome, tic syndrome, and transient tic disorder, is a muscle twitching disorder that occurs in childhood. The incidence is high, ranging from 1% to 7%, with some reports of 4% to 23%. It is mostly seen in children of preschool and early school age. There is a clear predominance of males, with a male to female ratio of 3:1 to 4:1. Most of the cases are benign, but there are also refractory patients.
Etiology.
1, genetic factors
Transient tic disorder can have a family aggregation, the affected child family members suffer from tic disorder is more common, so it is thought that may be related to genetic factors.
2, somatic factors
At the beginning, twitching often occurs due to local irritation, such as ocular conjunctivitis, blinking due to impingement, nasal aspiration due to rhinitis or upper respiratory tract infection, and facial muscle twitching, and twitching symptoms continue to exist when local disease factors are removed.
3.Physical factors
Children with tic disorder are generally not quiet, sensitive to people and things, neurotic, demanding and stubborn, and often combined with some psychological symptoms, such as headache, abdominal pain, unexplained fever, constipation, asthma, enuresis, etc.
4.Emotional factors
Common factors include excessive parental demands on the child’s learning, excessive chastisement, the mother’s neuroticism, lack of mental quietness, excessive interventions that cause emotional disorders, especially anxiety and nervousness, tics that are reactions to psychological conflicts in the motor system, family disputes, parental divorce, death of relatives, etc. In addition, it is believed that the child has a history of motor In addition, it is believed that the twitching is related to the child’s history of restricted motor activity, such as parents’ excessive concern for the child’s safety or some early illnesses that restricted the child’s activity. This factor plays a major role in transient tic disorder.
5. Learning theory
At the beginning, the twitching may be a conditioned avoidance response, such as blinking with a foreign object in the eyes, or learning about some physical defects or pathologies of other people, but later it is enhanced by external causes, resulting in the formation of habitual twitching.
6.Pharmacogenic factors
Central nervous stimulants such as methylphenidate, and long-term use of antipsychotics may produce adverse reactions to tics.
Symptoms.
Mostly occurs in boys aged 5 to 10 years old, as a sudden, brief, repetitive, stereotyped twitchy attack of a group of muscles or two groups of muscles, manifested as blinking, squeezing eyebrows, showing teeth, making strange faces, shrugging shoulders, turning neck, nodding head, twisting of trunk, shaking arms or kicking feet, twitching of lower limbs, etc., intensifying when emotionally stressed, decreasing when mentally concentrated, disappearing when sleeping, dominated by a group of muscle twitches in one period, manifesting as The same symptom; but in another period another group of muscle twitching is shown, i.e., the variability of symptoms, the duration of the disease lasts for several months to a year, the frequency and severity of twitching varies, the lighter ones have no effect on the learning and living environment of the affected children, the heavier ones affect learning, disrupt the environment, and even cannot attend classes in the classroom.
Treatment
Treatment includes the following aspects.
1.Psychological behavior therapy
(1) Elimination of triggers: In transient tic disorder, especially in children whose tics are not long, it is often not difficult to find triggers in behavioral appointments. In young children, the trigger is usually the result of watching stressful television or video programs, playing video games, or hearing and seeing something that scares them, so it is crucial to find the trigger and eliminate it.
(2) Detailed analysis of psychological factors: The pre-morbid psychological factors of the child should be analyzed in detail to identify possible causative factors and then be addressed. Older children often have tics due to accidents, family conflicts, and too much pressure from studies. Mental conflicts and tensions caused by various conflict adjustments, family conflicts, excessive demands and coercion of parents and grandparents on the child must be resolved. If there are school factors, they should be resolved in collaboration with teachers. For factors that cannot be solved, supportive psychotherapy should be given to help the child analyze the mental triggers and find the correct way to deal with them.
(3) Give parents the necessary guidance: explain to the parents of the affected child the nature of the disorder and do not panic, which will eliminate the reinforcing effect caused by excessive parental concern. Parents are often overly concerned about tics, so they should be made aware of the causes of tics and make reasonable arrangements for the child’s life, studies and activities. Do not remind the child of the symptoms of tics. Instead, they should ignore the child’s tics, which can gradually subside. In most cases, the symptoms will disappear spontaneously after a few months. Help the child to eliminate triggers and provide a good and relaxed family environment. Muscle relaxation therapy and operant handling are expected to have good results. When the child receives behavioral treatment, it is important to obtain the cooperation of the child and the parents and to give the parents the necessary guidance to assist in the treatment.
(1) Elimination of triggers: In transient tic disorder, especially in children with short duration of tics, it is often not difficult to find triggers in behavioral appointments. In young children, the trigger is usually the result of watching stressful television or video programs, playing video games, or hearing or seeing something that scares them, so it is crucial to find the trigger and eliminate it.
(2) Detailed analysis of psychological factors: The pre-morbid psychological factors of the child should be analyzed in detail to identify possible causative factors and then be addressed. Older children often have tics due to accidents, family conflicts, and too much pressure from studies. Mental conflicts and tensions caused by various conflict adjustments, family conflicts, excessive demands and coercion of parents and grandparents on the child must be resolved. If there are school factors, they should be resolved in collaboration with teachers. For factors that cannot be solved, supportive psychotherapy should be given to help the child analyze the mental triggers and find the correct way to deal with them.
(3) Give parents the necessary guidance: explain to the parents of the affected child the nature of the disorder and do not panic, which will eliminate the reinforcing effect caused by excessive parental concern. Parents are often overly concerned about tics, so they should be made aware of the causes of tics and make reasonable arrangements for the child’s life, studies and activities. Do not remind the child of the symptoms of tics. Instead, they should ignore the child’s tics, which can gradually subside. In most cases, the symptoms will disappear spontaneously after a few months. Help the child to eliminate triggers and provide a good and relaxed family environment.
Muscle relaxation therapy and operant handling are expected to have good results. When the child receives behavioral treatment, it is necessary to obtain the cooperation of the child and parents, and give the parents the necessary guidance to assist in the treatment.
2. Behavior modification
Encourage the child to control the tics on his own, use positive reinforcement such as rewarding him for his efforts to overcome and reduce the tics, and use relaxation to reduce the child’s mental tension, which is more effective for young children.
3.Medication
Tic disorder generally does not require medication, but only when the tics significantly affect the child’s movement and speech, interfere with interpersonal relationships and classroom learning, medication will be given.
(1) Eliminate triggers: tonsillitis, allergic conjunctivitis, rhinitis, and episodic sensation are sometimes triggers of tics in children. Therefore, these diseases should be treated first.
(2) Haloperidol: It can block dopamine receptors. The dose is 0.02~0.05mg/(kg-d), starting from small amount orally, 0.25mg, 2 times/d, and gradually increase the dose when it is ineffective until satisfactory effect, so that the symptoms can be controlled without side effects. In children, it can be 1-6mg/d. This drug is likely to cause extrapyramidal side effects, among which acute dystonia and inability to sit still are the most common. High dose application can also cause myocardial damage.
(3) Chinese medicine treatment. Chinese medicine is effective in treating this disease, without side effects. It can be used to calm the liver and subdue Yang, quench the wind and stop spasm, clear phlegm and heat, calm the heart and mind, clear the liver and fire, quench the wind and stop spasm, strengthen the spleen and liver, promote the flow of qi and phlegm, slow down the liver and spleen, quench the wind and stop spasm, nourish the yin and blood, soften the liver and quench the wind, etc., so that the child’s symptoms can be significantly relieved.
Prognosis
The prognosis of transient tic disorder is good, and most children can improve on their own after eliminating the triggers. However, if medication is used only for the symptoms of tic disorder, without looking for the trigger and giving the child proper guidance, the tic disorder may persist and even become chronic motor tic disorder.