(A) Tourette’s syndrome (TOURETTESYNDROME,TS), also known as vocal and multiple motor combined tic disorder or multiple sexual tics or multiple tics or impulsive tics, scientifically defined as Tourette’s syndrome is a class of chronic neuropsychiatric disorders characterized by multiple motor tics with involuntary vocalizations, which was identified as a syndrome by a French doctor in 1825. The syndrome was identified by a French physician in 1825 as a syndrome. It is a syndrome characterized by multiple involuntary twitching, speech or behavior disorders. It is more frequent in males than females, with a ratio of (3-4):1. 90% of the cases start between 2 and 12 years of age. It is characterized by transient, rapid, abrupt, and varying degrees of involuntary movements, beginning with frequent blinking, eyebrow squeezing, nasal aspiration, and mouth pouting. It starts with frequent blinking, eyebrow squeezing, nose sucking, pouting, mouth opening, tongue stretching, head nodding, etc. As the disease progresses, the twitching gradually diversifies, alternately appearing such as shrugging shoulders, twisting neck, shaking head, kicking legs, flinging hands or twitching limbs, etc.; vocal twitching often has a variety of, with explosive repeated vocalizations, clear noise and grunts, individual syllables, unclear words, inappropriate accents or constant oral obscenity, characterized by impatience, capriciousness and irritability. The symptoms of tic disorder are fluctuating, progressive, and chronic, sometimes mild and sometimes severe, sometimes relieving themselves for a period of time. The site, frequency and intensity of the tics may change, and may increase when the child is stressed, anxious, tired, or sleep deprived, and decrease when the child is relaxed, and disappear after sleep. It is often accompanied by a lack of concentration in class or a decrease in performance. In severe cases, the movement and pronunciation may affect the learning and classroom order. The child’s intelligence is generally normal, but some children may have psychological problems such as inattention, learning difficulties and emotional disorders.
Classification of Tourette’s syndrome.
The course of Tourette’s syndrome may be transient or chronic, and some may even last a lifetime. Transient tics generally do not affect the child’s academic performance, while chronic tics can affect the child’s academic performance and lead to adjustment disorders.
There are three types of Tourette’s syndrome according to their clinical symptoms and course.
① temporary tic disorder (tic disorder, simple tics or called habitual spasms in children);
② chronic motor tic disorder;
(iii) vocal and multiple combined tic disorders (also known as tic obscura syndrome, Tourette′s syndrome).
Generally speaking, these three types, have continuity. Transient tic disorder can develop into chronic motor tic or vocal tic disorder due to the continuity of the disease. About half of the patients with Tourette′s syndrome have the first symptom of simple motor tics and present with Tourette′s syndrome after several days or months. In addition, transient tic disorder can be accompanied by attention deficit hyperactivity disorder, which can occur after stimulant use and can affect children’s academic performance.
(B) What are the hazards of Tourette’s syndrome?
1, the harm of tic disorder is obvious, because the symptoms of tic disorder are often ridiculed by classmates. The most important thing is that the child has a low self-esteem. The child has a low self-esteem and an isolated personality. In the long run, the child becomes lonely. This is a very good way to get the most out of your life.
2, children with Tourette’s Syndrome inattentiveness is likely to cause a decline in academic performance, some failing, or even repeating a grade. This can cause great pain to the child and parents.
(C) Diagnosis of Tourette’s syndrome.
1. Doctors are unfamiliar with this disease, so that they are confused by a wide variety of symptoms. The dry cough caused by laryngeal muscle twitching is misdiagnosed as chronic pharyngitis and bronchitis; blinking and frowning are misdiagnosed as conjunctivitis; moving nose is misdiagnosed as chronic rhinitis, etc.
2, parents do not agree with this disease. Rarely do you see a doctor because you keep blinking and shrugging your shoulders, mostly because you think it’s a bad habit. When they go to the hospital to see other diseases and are asked about the situation by the doctor, the parents do not cooperate with the answer and are often told “it’s okay, it’s just a little problem”. After the doctor told the parents, they did not trust them and opposed the consultation, thus delaying the diagnosis.
3. Patients have a certain degree of inhibition of symptoms, so when light patients intentionally cover up their tic symptoms, parents and doctors are not easily aware of them.
Some doctors believe that the tic-obscene syndrome must have obscenities, but in fact only 1/3 of patients develop obscenities a few years after the onset of the disease.
(d) How is tic disorder in children caused?
Etiology: The cause is not yet fully understood, but it is now believed to be due to organic changes in the nervous system. It is also related to genetic factors, brain development and mental factors. The main factors include: 1: genetic 2: neurobiochemical factors
3: organic factors
4: Psychosocial factors: such as trauma or other major life events 5: B hemolytic streptococcal infection.
The main factors causing tic disorder in children may be
1: Maternal factors: maternal pregnancy hyperthermia, history of obstructed labor, history of postnatal asphyxia, neonatal hyperbilirubinemia, cesarean delivery, etc.
2, infection factors: upper respiratory tract infection, tonsillitis, mumps, rhinitis, pharyngitis, chicken pox, various types of encephalitis, viral hepatitis, etc.
3, mental factors: fright, emotional excitement, sadness, watching thrilling TV, novels and stimulating cartoons, etc.
4, family factors: parental tension, divorce, reprimanding or scolding children, etc.
5, other: such as epilepsy, trauma, carbon monoxide poisoning, toxic indigestion, allergies, etc.
(E) What is the difference between Tourette’s syndrome and ADHD in children?
ADHD in children has a higher incidence than Tourette-Obscene Syndrome, so people are more aware of ADHD. Because the names are similar, it is easy to confuse the two. However, the causes and signs and symptoms of ADHD are different, and they are two very different disorders that must be distinguished.
ADHD, also known as mild brain dysfunction syndrome, is a relatively common behavioral abnormality in children. The child has normal or basically normal intelligence, but has deficits in learning, behavior and temperament. Most children with ADHD show excitability, poor sleep, feeding difficulties, etc. from infancy and early childhood. As they grow older, their activities increase significantly, and their movements are uncoordinated, with difficulties in fine movements such as threading needles and buttoning, inattentiveness, emotional impulsiveness, lack of control; they are usually argumentative and easily agitated; they are disobedient, unreasonable, impolite, and do not avoid danger, etc.; they have a positive finger test.
In the case of tic-obscene syndrome, the main manifestation is muscle group twitching, and some children have a combination of hyperactivity symptoms. However, ADHD in children is never characterized by tics, which is the key to differentiate the two.
(F) Treatment
1.Psycho-behavioral therapy Psychological treatment for the child, encourage the child to participate in sports activities, reasonable arrangements for work and rest time, to avoid excessive stress and strain.
2.Medication
Usually, drug therapy should be used as early as possible for tic and obscene syndrome, and dopamine receptor blockers have better efficacy. At present, the western medical treatment of this disease are to control the symptoms, the etiology of treatment has not been reported. The most commonly used drugs are haloperidol and Tebretol. However, their corresponding side effects are more obvious, such as extrapyramidal adverse reactions, slow movement, increased muscle tone, difficulty in opening the mouth, etc. Serious cases can affect the continuation of treatment, while taking Antan can reduce the side effects. Phenothiazines, such as Endorphin, are also effective, but some believe that symptom control and stabilization are not as good as the first two drugs. Tetrabenazine, a drug that inhibits dopamine synthesis and depletes dopamine, also has a better effect in some patients, but side effects are also obvious.
In conclusion, western drugs act on neurotransmitters and receptors to control symptoms faster, but because of the non-selective pharmacological effects, they also have obvious side effects that control normal muscle groups while controlling symptoms. Some patients have to interrupt the treatment because of the prominent side effects or cannot be offset, which affects the treatment and prognosis of the disease.
3.Surgical treatment
The prognosis for tic disorder is generally good. The tic-obscene syndrome is a chronic neuropsychiatric disorder with a prolonged course, and most of the symptoms can be controlled with medication, but it is necessary to maintain medication treatment for a long time. For those who cannot be controlled by medication and are 18 years of age or older, stereotactic minimally invasive surgery can be considered, and the age can be relaxed for patients with severe symptoms that seriously affect social functioning. There are two main surgical methods: one is the deep brain nucleus destruction (commonly known as “cell knife”), but generally only unilateral destruction, while the chance of bilateral complications is higher; the other is the latest surgical treatment method is deep brain electrical stimulation (DBS, commonly known as “brain pacemaker”) surgery (first started by Professor Vandewalle in 1999). This kind of surgery is neuromodulation surgery, which has the advantages of not destroying the normal structure of the brain, reversible and adjustable, etc. Most patients can achieve better treatment results, and some patients can be cured after neuromodulation treatment, but its mechanism is still unknown,probably related to the rebalancing of the metabolism or receptors of some neurotransmitters in the inner brain clusters through electrical stimulation.