Patient: My son is 8 years old and weighs 22 kg. He began to have tics from the age of 4 to 5 years old. Initially, the symptoms lasted for about a week each time they appeared, and then disappeared spontaneously, about two to three times a year. Subsequently, the duration lengthened, and the symptoms changed from the earliest blinking to raised eyebrows and throat clearing sounds. In February last year (i.e., the child was 6.5 years old), he was diagnosed at Children’s Hospital and started taking fluprednol, inosine and glutathione at the same time. By October of last year, the child’s symptoms were effectively controlled when the dose of fluprednol reached 1.5 pills in the morning and 2 pills in the evening. However, in early July of this year, he started to blink and raise his eyebrows again, along with looking up at the sun or lights.
1. Is looking up at the sun or looking up at the lights a form of Tourette’s syndrome?
2. Is it possible to increase the dosage of fluprednol in order to control the disease?
3. Is there a good medicine with better efficacy and less side effects?
Feng Zhe.
1, look at the sun, look at the light is what the situation, specific description.
2, can be added, but the child’s weight is too low, caution.
3, haloperidol is the treatment of twitching efficacy is the best, but at the same time the side effects are greater. You can consider thiopride and risperidone, which have fewer side effects.
4, you can see that the symptoms of twitching are fluctuating, in fact, there is no need to completely control with drugs, the degree is not heavy with the symptoms of life is completely fine, after puberty will mostly ease.
5, psychological treatment.
Patient: Dr. Feng: Hello! We are very happy to read your detailed reply, thank you from the bottom of our hearts! I would like to ask you a few more questions.
1.When looking at the lights or the sun, the child will deliberately look in the direction of the target, and more often than not, but not if he is very involved in playing.
2. The thiopride and risperidone you recommended are difficult to buy in Kunming, and haloperidol was sent to us from overseas. The children’s hospital has recommended that we switch to “Levetiracetam tablets”, but I don’t know the efficacy and side effects of this drug.
Is it necessary for us to bring our child to Shanghai to see you for an interview?
Feng Zhe.
1. This seems to be a conscious effort to see the light, so ask him directly why.
2, those kinds of drugs are very common, go to the psychiatric hospital will have.
3, there is no need to come, tic disorder is very common, no impact on growth and development, many drug dealers currently exaggerate its harm for the benefit of parents anxious and nervous. In fact, this is not a big problem, and there is no need to completely control the symptoms, too large doses of drugs although the control of the twitching, but may not be worth the loss. Some parents run around the country with their children, acupuncture and massage and drink medicine, but it adds to the psychological burden of the child. The actual fact is that you will not be able to get a lot of money by going around to seek medical help, but stay and take your child to play ball and swim and go on excursions.
4. Sorry I didn’t read it clearly, thanks to this doctor in Guangzhou for reminding me that anti-epileptic drugs are often used as an adjunct to tics.
Patient: Dr. Feng: Hello! I am glad to see your reply again, and I also read your replies to 56 other patients, which made me grow insightful on the one hand, and changed my mood on the other. I used to feel that fate was unfair for my son’s illness, but now I have mixed feelings when I see that there are children with more serious illnesses than my son. Since July of this year, I really have the determination and intention to take my son all over the country and try all kinds of treatments for his illness, but now I know I should pay more attention to my son’s mental condition, and I will follow your advice to accompany him to exercise more and make him relaxed and happy. …… I know this is the last time I ask a question, and I treasure it very much. I’ve decided to ask you for advice on the following questions.
1, according to the child’s current dosage (1.5 pills in the morning and 2 pills in the evening) still blinking, how long do I need to keep taking it?
2. Under what circumstances do I need to increase or decrease the dosage? (Doctors at the Children’s Hospital require that the dosage is reasonable if there are no symptoms)
3.Can you recommend a specialist or psychiatrist in Kunming or other cities for us?
4. Where can I find authoritative information about Tourette’s Syndrome? I will keep an eye on your website and hope to see more information about Tourette’s Syndrome, and I will contact you if you open a telephone consultation. Please contact me if you have the opportunity to visit Kunming, I would like to express my gratitude in person. Please remember my phone number. Thank you!
Feng Zhe.
1. I am glad you read all my replies and it made me feel like it made sense to take the time to answer the questions. There are very few child psychiatrists in China, and it took me a while to go online and realize that it was a mess, with tics and ADHD being churned up by the commercial market.
2, As far as I know there are no doctors specializing in child psychiatry in Yunnan, and currently there are none in many provinces.
3, on the question of the correct information about tics, you can look at articles in medical professional journals, or medical textbooks, but it is possible that lay people may sometimes misunderstand its meaning.
4. I will answer your question seriously again, and later I will have time to write a summary of tic disorders and put it here.
I. Regarding treatment goals.
It is not proven that medication can influence the prognosis and natural course of tic disorder, but only symptomatic control of tic symptoms. Therefore, when choosing medication, it is important to weigh the advantages and disadvantages of the treatment against the side effects, and use medication only when the benefits of treatment outweigh the disadvantages. For transient twitching and mild chronic twitching, medication should be used only when possible or with minimal side effects.
It is not advisable to control them until they are completely free of symptoms.
II. About haloperidol.
Haloperidol is used more often in China, probably because there are few professional child psychiatrists. Haloperidol is the most classic drug for tics, and many doctors think of haloperidol when they see tics, and know little about other drugs.
The maximum dose of haloperidol can be up to 12 mg, however, its side effects are relatively large and it is not recommended to use too large a dose.
It is maintained for 3-6 months for chronic tics and 1-2 years for polydactyly.
There are also some doctors who routinely add Antan to haloperidol to counteract its side effects, which is also a bad practice.
III. Regarding other drugs.
Thiopride is also frequently used and has fewer side effects than haloperidol, is less effective than haloperidol, and tends to be less effective after a period of treatment; it may be preferred in children with mild cases.
There are also drugs that are used even less often, mainly because most doctors don’t know much about them, so I won’t go into detail.
There are quite a few herbal medicines for tics, as a Western doctor I do not understand Chinese medicine, so I do not oppose or support it. It should be noted that there are already a large number of Chinese medicines that have been investigated and dealt with by the FDA, and the chaotic and important market as well as the excessive false advertising requires careful selection.
IV. On recurrence.
Many parents mention recurrence and changeable symptoms, which is exactly what tics are, often a fluctuating course of the disease. Psychological factors, respiratory infections are often triggering factors. In recent years, it has been found that most patients’ tic symptoms improve significantly by adolescence, and even disappear completely. Only a small percentage of children have delayed symptoms, see “Call Me Number One” that I have introduced.
V. About psychotherapy.
1. It is worth noting that parents often bring their children to the clinic with significant anxiety. If the child’s twitching is deliberately focused on and stopped, it may aggravate the symptoms or increase the tension in the family, the latter being the main reason for the aggravation or persistence of the disease. It is not necessary to pay attention to and stop the child’s twitching, which may be more therapeutic than medication.
Some children with long duration and heavy symptoms may be in a stressful family environment for a long time and may have low self-esteem and poor self-awareness, thus losing confidence. The latter will aggravate the tic symptoms and form a “vicious circle”.
3. Children with tics are often ridiculed and mocked by their peers for showing uncontrollable symptoms, resulting in low self-esteem. They are also affected by the anxiety of their parents who are too worried and often go to the hospital to see the doctor, and they see their illness as too serious, forming a psychological shadow. Therefore, it is important for them to have a proper understanding of the disease, correct incorrect perceptions of the disease, and avoid excessive fatigue and stress in daily life. Help children to handle their relationship with peers properly, face ridicule and mockery from peers correctly, and improve their self-confidence.
4. Manage the child correctly, do not criticize and blame the child for the tic symptoms, and do not always remind the child to control them. Reduce the symptoms by arranging the child’s life, study, and diversion, such as arranging chores or other activities when the symptoms are obvious, or even letting the child engage in rhythmic physical activities to reduce involuntary tics through conscious physical activities.
The following are some of the factors that can cause fluctuations in symptoms, so as to avoid these triggers, such as excessive fatigue, excessive study pressure, peer tension, family conflicts, colds and tonsillitis, etc.
The best thing you can do for your child is to manage your emotions well.
Patient: Dr. Feng: Hello! I’ve been reading your replies online whenever I can, and I’ve been wanting to communicate with you for a long time, but I’ve seen a lot of your advice and I’ve been worried about giving you trouble, so I’ve been waiting until now. Since I read your reply on September 16, I’ve been working on my own emotions and my child’s psychology, slowly reducing his prednisone from September 20 (the doctor told him to add it when his condition recurred in July), and reducing his clopidogrel by half from October 10, taking only 1.5 pills in the morning and 1.5 pills in the evening. The child has no other symptoms except that he looks up at the light when he eats and flings his hands when he does his homework. I am telling you this because I feel that although my child has not fully recovered, his condition has not recurred much after his medication has been reduced, and we parents are no longer as helpless and anxious as before. I hope I can report better news to you next time! I hope I can report better news to you next time!
Feng Zhe.
I am glad to see that your child is stable and this is the result of your joint efforts.
The medication reduction needs to be slow and it is important to be prepared for the fluctuating tic symptoms. If the tics do not cause injury to your child, feel distressed, or have social difficulties, the best thing to do is to face the tics and not care about them.
Good luck to the whole family!
Patient: Dr. Feng: Hello!
I am contacting you again after a year to tell you the good news: my child’s dosage has been reduced to 1/4 pill of Fluprednol in the morning and 1/4 pill in the evening since January 1. My child’s symptoms are that he occasionally cranks his neck when he is tired and looks at the sun when he is outside, but other conditions such as blinking, raising his eyebrows and clearing his throat do not occur. For one year, I have been adhering to your philosophy of weighing the pros and cons of treatment against the side effects, and using medication only when the pros of treatment outweigh the cons. The occasional tic symptoms in my child have convinced me that your philosophy is correct, so I have insisted on reducing my child’s medication as long as I think there is nothing wrong with him. I plan to stop all of my child’s medication after the Chinese New Year. I consider that 1/4 of the medication each morning and evening is not very effective, so I would like to stop it all at once, don’t you think?
The last thing I want to say to you is: from the heart of our family, we are truly grateful. If I hadn’t received your guidance, I might still be under the wrong treatment method of some doctors, and I would have been conflicted by the constant increase of medication for my child! I hope more parents of children with Tourette’s Syndrome will read your article and benefit from it, and I wish you and your family: Happy Chinese New Year! All the best!
Feng Zhe.
I’m glad to hear this, most parents don’t give me any feedback after the consultation, in fact I would love to have people come back and tell me how things have changed. Many parents found this Q&A helpful after I turned it into an article, and I think they want to know the progress too.
The child has been on the medication for a short time and the dosage is currently very low, so I also think it is a good time to stop. Although the tic symptoms may fluctuate, after such a long time, you should have some understanding of the tics and have learned what to do with them. Just pay attention to the complications.
Patient: Dr. Feng: Hello!
I just found out today on the Internet how you changed your unit.
My child has not been taking medication since February this year. As you said, the condition does fluctuate a bit, probably because the child was too tired to play during the holidays and did not get enough rest. However, the overall situation has been relatively good for the past eight or nine months. Since she is no longer on medication, she is in good spirits and has made great progress in her studies, and has received many compliments from her teachers, which I could not imagine before. Thank you for your compassion and more importantly, you are a good doctor with medical skills and medical ethics! I wish you all the best!
Feng Zhe.
I changed units and am currently on rotation.
Thank you for your continuous feedback and good luck!
Patient: Dr. Feng: Hello! I am contacting you again after three years because I want to tell you that my child has stopped taking medication for the past three years and is now in the first year of school and everything is normal. Thank you very much for your professional guidance to get us parents out of the misunderstanding! Thank you! I wish you good health forever!