Pediatric tic disorder
Pediatric tic disorder, also known as habitual spasm syndrome, ticsyndrome, and transient tic disorder, is a muscle tic 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 male predominance, with a male to female ratio of 3:1 to 4:1. Most of the cases are benign, but there are also refractory patients.
Symptoms
It occurs mostly in children aged 5 to 10 years. It is a sudden, brief, repetitive, stereotyped twitching attack of one or two groups of muscles. It is characterized by blinking, squeezing eyebrows, showing teeth, making strange faces, shrugging shoulders, turning the neck, nodding, twisting the torso, shaking the arms or kicking the feet, and twitching the lower extremities, etc. It intensifies during emotional stress, decreases during mental concentration, and disappears during sleep. In one period, a certain group of muscle twitches predominates, showing the same symptoms; but in another period, another group of muscle twitches is shown, that is, the variability of symptoms. The duration of the disease lasts from several months to one year. The frequency and severity of the twitching varies, with mild cases having no effect on the child’s learning and living environment, and severe cases affecting learning, disrupting the environment, or even not being able to attend classes in the classroom.
Pathogenesis
During the development of children, the motor analyzers of the brain are highly excitable and prone to twitchy reactions, especially in children with special qualities, when there are various mental factors or imitation of others’ actions, they are prone to form such motor conditioned reflexes, which become pathologically inert. It may start as a reaction to certain stimuli and become habitual twitching over time.
1, genetic factors transient tic disorder can have family aggregation, the affected child’s 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 often due to local irritation and twitching. For example, blinking due to ocular conjunctivitis and impingement irritation, nasal aspiration and facial muscle twitching due to rhinitis or upper respiratory tract infection. When the local disease factors are removed, the twitching symptoms continue to exist.
3, physical factors Children with tics are generally not quiet, sensitive to people and things, neurotic, demanding and stubborn. They are often combined with psychological symptoms, such as headache, abdominal pain, unexplained fever, constipation, asthma, and enuresis.
4, emotional factors often related to the family, common factors such as parents of the affected children too high learning requirements, too much blame, mothers often have neurotic, mentally not quiet. Excessive intervention causes emotional disorders in children, especially anxiety and tension, and twitching is the reaction of psychological conflicts in the motor system. Family arguments, parental divorce, death of a loved one, etc. It is also thought to be related to a history of motor activity restriction, such as excessive parental concern for the child’s safety or some early illness that limited the child’s activity. Mental stimulation can also be a trigger. The child may have recently suffered an accident, such as an illness, hospitalization, or a dangerous encounter. Or the child may watch stressful television or video programs, play stressful games such as video games, etc. The tics become a manifestation of psychological stress. This factor plays a major role in transient tic disorder.
5, learning theory The initial twitching may be due to conditioned avoidance reactions, such as blinking with a foreign object in the eyes, or learning some physical defects or pathologies of other people, which later play an enhancing role due to external causes, resulting in the formation of habitual twitching.
6. Pharmacogenic factors The long-term use of central nervous stimulants such as methylphenidate and antipsychotics may produce adverse reactions to tics.
Subtypes.
1, acute simple (or transient) childhood tic disorder The majority of symptoms of tic disorder begin with simple, non-random motor tics, and very few are simple vocal tics. Common eye and facial tics include blinking, eyebrow squeezing, eye rolling, lip biting, mouth opening, head nodding, head shaking, neck stretching, and shoulder shrugging. A small number of pure vocal tics manifest as repeated coughing, throat clearing, and humming sounds. Symptoms can fluctuate and shift sites over weeks or months. Most often it develops before the age of 12 years, and the most common is blinking. Symptoms persist for 2 weeks to 1 year to disappear spontaneously. Physical examination includes neurological examination and there are usually no abnormal findings.
2. Chronic simple childhood tic disorder is more common before the age of 15 and less common in adults. It manifests as a group or two muscle twitches without excessive changes. It lasts for a long time and can be present for life.
3. Subacute or persistent simple or multiple twitches can be seen in childhood and adolescence. In simple cases, one or two groups of muscle twitches last for more than 1 year and disappear naturally by adolescence. In the case of multiple twitching with vocalization, it is not certain whether the symptoms disappear by adolescence, and this should be distinguished from multiple twitching-obscene syndrome (Tourette syndrome).
4, multiple tics – obscene syndrome (Tourette syndrome) The above typology is not complete, especially between type 3 and type 4 there is some confusion. Therefore, “multiple tic-obscene syndrome” is discussed separately here.
Treatment
1.Psycho-behavioral therapy
(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 TV 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, as well as treat the tics from the root cause.
(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 academic pressure. 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 solved in collaboration with teachers. For factors that cannot be resolved, supportive psychotherapy should be given to help the child analyze the mental triggers and find out 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 triggers for tics and make reasonable arrangements for the child’s life, studies and activities. Do not remind the child of the symptoms of tics. Instead, the child’s tics should be ignored and the symptoms will 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.
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 methods to reduce the child’s mental tension, which is more effective for young children.
The tics generally do not require medication, but only when the tics significantly affect the child’s movement and speech, interfere with interpersonal relationships and classroom learning, medication is given.
(1) Eliminate triggers: tonsillitis, allergic conjunctivitis, rhinitis, episodes of sensation, etc. are sometimes triggers of tics in children. Therefore, these diseases should be treated first.
(2) Haloperidol (HAL): It can block dopamine receptors. The dose is 0.02~0.05mg/(kg・d), start from small amount orally, 0.25mg, 2 times/d, and gradually increase the dose when it is ineffective until the effect is satisfactory, 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. To prevent extrapyramidal side effects, Antan or scopolamine can be used in combination.
(3) For children with severe anxiety, diazepam (Valium) (1.25-2.5 mg, 2 times/d) or clonazepam (Librium) (2.5-5 mg, 2 times/d) may be added.
The disease can be cured spontaneously or with treatment within a few months. Some children can be delayed for several years.
1, pediatric tics dietary therapy formula.
Fresh fish steamed (especially sea fish) fish contains many substances beneficial to the development of intelligence, steamed to eat, the composition of less destruction, with educational effect.
The two medicines are cooked into a porridge with round-grained rice and eaten once a day in the morning, which has the function of tonifying the kidneys and spleen and pressing the heart and soul.
Poria yam porridge: Poria powder and fresh yam boiled together with corn flour in the right amount boiled into a porridge, can strengthen the spleen to help transport, to eliminate phlegm and dampness.
2, pediatric tics eat which food is good for the body.
Animal brains and bone marrow: steamed and boiled are available, often eaten to benefit the kidneys and fill the marrow, improve attention and memory.
Milk and natural foods containing water and vitamins: the most suitable for the daily consumption of the affected children.
3, pediatric tics best not to eat which food: should not often eat fried food such as instant noodles, shabu-shabu, grilled lamb skewers, etc., but also should not eat more greasy and sweet food and raw and cold food and drinks.
Prevention
To prevent this disease, avoid imitation of any bad habits, avoid mental stimulation, and prevent children from developing bad conditions such as anxiety.
Pathology
The etiology of tic disorders in children is not fully understood. It is believed that children with special qualities are prone to develop abnormal motor conditioned reflexes when there are various psychological factors or imitation of others’ movements.
Differentiation of diseases
1, tic – obscene syndrome this syndrome is often multiple muscle twitching, involuntary movements at the same time a variety of, and accompanied by involuntary throat whine or cursing (obscene language), so the twitching of multiple and its accompanying obscene language for the characteristics of the syndrome.
2, attention deficit hyperactivity disorder Hyperactivity is completely different from the muscle twitching of tic disorder, and accompanied by attention deficit and impulsivity, it is not difficult to distinguish.
3, epilepsy certain types of epilepsy such as temporal lobe epilepsy can appear smacking and other actions; myoclonic epilepsy has the performance of local muscle jerking seizures, but often in epilepsy is seizure, while tic disorder is more frequent twitching. Seizures are generally not controlled by the will, whereas tics can be controlled by the will for brief periods of time. Epilepsy mostly has impairment of consciousness and specific changes in EEG, while tic disorder has no such changes.
4, chorea This is caused by rheumatic lesions involving the extrapyramidal system, there may be involuntary involuntary movements of the limbs and face, in addition to changes in body temperature, blood sedimentation, C-reactive protein and ASO, and streptococcal infections before the onset of the disease, these help to differentiate from tics.
Ancillary diagnostic laboratory tests.
Routine tests such as blood, urine and stool are normal.
Other ancillary tests.
EEG and other tests should be done, and some children may have abnormal graphics.
Complications
It can cause psychological disorders such as low self-esteem, anxiety, and social disorders.
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 tic symptoms, without looking for the trigger and without giving the child proper guidance, the tic symptoms may persist and even become chronic motor tics.