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Abstract: The child had a 3-year history of intermittent seizures with motor and vocal tics and recurrent disease. After admission, he was given aripiprazole tablets and thiopride hydrochloride tablets, as well as psycho-behavioral therapy and repeated transcranial magnetic stimulation neuromodulation treatment, and was discharged after the seizures subsided. The child was discharged after the seizures subsided. Pediatric Tourette’s syndrome is often recurrent, so the treatment should be adjusted according to the actual situation of the child, with individualized dosage and treatment course, and combined with psycho-behavioral therapy for better results.
Basic information】Male, 11 years old
Disease Type】Pediatric Tourette’s Syndrome (TS)
Hospital】The First Affiliated Hospital of Zhengzhou University
Time of consultation】December 2019
Treatment plan】Medication (aripiprazole tablets + thiopride hydrochloride tablets) + psycho-behavioral therapy + repetitive transcranial magnetic stimulation neuromodulation
Treatment period】Inpatient treatment for 4 days, outpatient follow-up after 1 month
Treatment effect] The disease was controlled and the child’s twitching symptoms were reduced.
I. Initial consultation
More than 3 years ago, the child developed involuntary blinking, vocalization in the throat, head, shoulder and limb twitching, with frequent daytime episodes, about 5-6 minutes, aggravated by stress, and disappeared after sleep. In the last month, his condition worsened with blinking, rapid shaking of both upper limbs with vocalization in the throat, and chest tightness. The child’s development was normal, and he was admitted to the hospital for physical examination: no abnormalities were found in the cardiopulmonary and abdominal examinations, the muscle strength and tone of the limbs were normal, and there were no signs of ataxia. Preliminary diagnosis: pediatric tics and obscenities syndrome.
Treatment
First of all, we considered the diagnosis of pediatric apraxia syndrome, communicated with the family, and suggested to improve the ASO, copper blue protein, cranial MRI, EEG and other tests to exclude other problems. Further investigation of cranial MRI showed no abnormality (normal basal ganglia), ASO, copper blue protein and EEG showed no abnormality, no hepatomegaly, epilepsy, streptococcal infection, rheumatic chorea, still consider the diagnosis of TS, adjust the dose of aripiprazole tablets and thiopride hydrochloride tablets according to the child’s condition, ask the psychiatric psychology department for consultation, joint psycho-behavioral treatment, such as psychological counseling for parents and the child, debugging The child’s psychological state, health education, correct understanding of the disease by the child and parents, and guidance to the family not to pay excessive attention to the child’s twitching symptoms, as well as repeated transcranial magnetic stimulation neuromodulation treatment.
Treatment effect
The first-line drugs for tic disorder, aripiprazole tablets and thiopride hydrochloride tablets, were selected, and the dosage was adjusted according to the child’s condition, combined with psycho-behavioral therapy and neuromodulation therapy. The child was discharged after 4 days of hospitalization, and was instructed to review outpatient after 1 month.
Notes
We are glad that the child’s condition has improved after treatment. We suggest that the child should continue the drug consolidation treatment after discharge, and intensify the treatment for 3-6 months, and adjust the drug dosage according to the child’s condition.
Parents should pay attention to the child’s psychological and emotional abnormalities, and help the child to reduce stress and maintain emotional stability. At the same time, pay attention to the regularity of work and rest, regular diet, avoid overeating, appropriate reduction of spicy and stimulating food, and pay attention to the prevention of infection.
V. Personal insight
Tic disorder is a common disease in children, and pediatric tic obscura syndrome is one of the relatively serious types, which can adversely affect children’s life, learning, self-esteem, etc. Moreover, the disease itself is affected by a variety of factors, external pressure, disease factors, etc. Therefore, in addition to conventional therapeutic drugs, it is also extremely important to treat the child with appropriate psychological behavior therapy, eliminate the child’s sense of shame due to the disease, and maintain emotional stability. The dosage and course of medication for the child should be individualized as well as the patient, and appropriate adjustments should be made according to the child’s specific situation to strive for good efficacy and minimize adverse effects.