tic disorder in children
Introduction
Introduction to children with tic disorder A ticdisorder is a period of onset of childhood and adolescence, characterized by involuntary, purposeless, repetitive, rapid movement of a part or multiple muscles of motor muscles and vocaltics. Can be associated with other behavioral symptoms, including inattention, hyperactivity, self-injury and obsessive-compulsive disorder. The cause of tic disorder is not understood, and the course of the disease is different. If it persists for a long time, it can become a chronic neuropsychiatric disorder. According to many survey data, tic disorder is related to genetic factors, and the twins have a higher prevalence rate. The first-degree relatives of children with tic disorder have tic disorder, Tourette syndrome and other mental illnesses are more common than normal people. It is believed that the genetic pattern may be autosomal dominant or polygenic. basic knowledge The proportion of illness: 0.003% Susceptible people: more common in children 5-7 years old Mode of infection: non-infectious Complications: obsessive-compulsive disorder, children with ADHD, depression
Cause
Causes of tic disorder in children
Genetic factors (20%):
According to many survey data, tic disorder is related to genetic factors, and the twins have a higher prevalence rate. The first-degree relatives of children with tic disorder have tic disorder, Tourette syndrome and other mental illnesses are more common than normal people. It is believed that the genetic pattern may be autosomal dominant or polygenic.
Neural serialization factor (20%):
Through the study of neurotransmitters and behaviors and the mechanism of action of psychotropic drugs, this disease is related to changes in neurobiochemical metabolism. Some scholars believe that this disease is caused by striatal dopamine hyperactivity or post-synaptic dopamine receptor hypersensitivity; Some scholars believe that tic disorder is related to norepinephrine and serotonin dysfunction, or because of the decreased inhibition of gamma-aminobutyric acid (GABA) in the brain, resulting in tics. In addition, the study of endorphins in recent years. It indicates that the imbalance of various neurotransmitters such as dopamine, serotonin and -aminobutyric acid in the central nervous system may be secondary to dysfunction of endogenous opioid system, so it is believed that endorphins are in the pathological mechanism of Tourette syndrome. It has important influence, but the changes related to neurobiochemistry still need further study.
Organic factor (15%):
Tourettes may be associated with perinatal damage (abnormal birth, asphyxia, etc.), and about 50% to 60% of EEG abnormalities in children with Tourette's syndrome, mainly due to increased slow wave or spike, but no specific changes. In a few cases, head CT abnormalities, nervous system soft signs are more common, some people think that tics-slang syndrome, behavioral movement abnormalities are related to amygdala-striatum access disorder; involuntary vocalization may be with the cingulate gyrus and brain It is related to dry irregular discharge, so it is considered that this disease is an organic disease.
Psychosocial factors (10%):
Children suffering from trauma, excessive tension and other effects may induce or twitch symptoms. Some people think that some stress events during pregnancy, the first three months of pregnancy is a risk factor for dysfunction in offspring; postnatal stress It also increases the onset of individuals with genetic susceptibility.
Other factors (5%):
Infected with drugs, taking drugs (such as central stimulants and antipsychotics) may cause tic disorder.
Prevention
Child tic disorder prevention
The active implementation of various types of mental health education while applying drug therapy plays an important role in the early healing of this disease.
One. Health education for parents of children.
two. Health education for children.
three. Mental health education for school teachers.
Many parents are very concerned about the child's prognosis. This disease is a developmental disorder, which means that it gradually relieves with age. It was thought to be a lifelong disease. Recent studies have shown that this disease There is a possibility of natural remission, the prognosis is relatively good, and the tics may gradually decrease or naturally relieve over time.
Complication
Child tic disorder complications Complications obsessive-compulsive disorder hyperactivity disorder depression
The most common comorbidities are:
(1) Attention Deficit Hyperactivity Disorder (ADHD), which is mainly characterized by distraction and/or hyperactivity, commonly known as ADHD.
(2) Obsessive-compulsive disorder (OCD), including various obsessive-compulsive concepts and behaviors that occur alone or at the same time, continue to appear repeatedly in thoughts and actions, knowing that they are not right, cant stop, sometimes cant get rid of, sometimes its painful, and self-harm can occur. If you bite your tongue, bite your skin, damage your skin, disfigure, etc., often leave infections or scars, and even reveal suicidal thoughts that you don't want to live. Be wary of this and prevent accidents.
(3) Conduct disorder (CD) and oppositional defiant disor2der (ODD), as the name implies, have anti-social tendencies and cannot be ignored. Many parents often mistakenly believe that these performances are not morbid, especially for ODD. Its just that the temper is screaming and suppressing, and the condition is worse.
(4) Learning Disability (LD) is impaired cognitive function, mainly dyslexia and mathematics difficulties, which can seriously affect academic performance.
(5) mood disorder (MD) In the case of depression and mood, adult-type alternating depression 2 mania can also occur in children and adolescents, and the relationship with TS is unknown.
(6) Anx2iety disorder (AD), mainly fear and uneasiness, such as fear of separation from relatives, fear of family members, fear of going to school, long-term excessive fear of strangers afraid of social interaction, and even worrying about the future future, uneasy Wait.
(7) Autism and related diseases, including language disorders and Asperger syndrome, which is the same as autism.
Symptom
Children with tic disorder symptoms common symptoms involuntary movement tic disorder learning difficulties myoclonic aggression behavior inattention
Mainly based on medical history and clinical examination, careful observation of tic symptoms and general behavioral performance has an important role in diagnosis. Children with tic disorder may be in short-term control of twitching in front of the physician, easily overlooked and missed diagnosis, and the symptoms are easily Misdiagnosis, it is necessary to identify the main symptoms and secondary symptoms to determine the nature of the disease.
Examine
Child tic disorder check
Child tic disorder check items: ceruloplasmin, EEG, neurological examination, brain CT examination.
Mainly based on medical history and clinical examination, careful observation of tic symptoms and general behavioral performance has an important role in diagnosis. Children with tic disorder may be in short-term control of twitching in front of the physician, easily overlooked and missed diagnosis, and the symptoms are easily Misdiagnosis, it is necessary to identify the main symptoms and secondary symptoms to determine the nature of the disease.
Diagnosis
Diagnostic identification of children with tic disorder
Diagnostic criteria:
Diagnostic criteria for tic disorder (transient tic disorder): 1 onset in childhood; 2 with exercise twitching, or vocal tics; 3 twitching can be restrained by will for a short period of time (minutes to hours); 4 intensity or twitching of symptoms Can be changed; 5 disease period lasts at least 1 month but not more than 1 year; 6 excludes extrapyramidal system neurological diseases and other causes of muscle spasm.
The diagnostic criteria for Tourette syndrome: 1 onset before the age of 21, most between 2 and 15 years old; 2 recurrent, involuntary, repetitive, rapid, purposeless twitching, affecting multiple groups of muscles; more than 3 A twitch and one or more vocal tics, both of which occur at some point but do not necessarily have to exist at the same time; 4 can be restrained by the will for minutes to hours; 5 the intensity of the symptoms changes over weeks or months 6 twitching several times a day, almost every day, the course of disease is more than 1 year, and the symptoms are relieved in the same year no more than 2 months; 7 exclude small chorea, liver bean degeneration, epileptic myoclonus, Drug-induced involuntary movement and other extrapyramidal lesions.
Diagnostic criteria for chronic exercise or vocal tic disorder: (1) must meet the 1, 2, and 3 items listed in transient tic disorder; (2) muscle twitching or involuntary vocalization occurs multiple times a day, almost daily or intermittently Appeared, the intensity is generally unchanged, and the disease period is more than 1 year.
According to the different clinical features and the course of the disease, the tic disorder is divided into the following categories:
1, transient tic disorder (also known as tic disorder; children's habitual sputum), is the most common type of clinical, mainly for simple exercise tics, such as blinking, wrinkles, biting lips, tooth, Narrowing, hoeing, nodding, shrugging and other involuntary tics; a few cases are simple vocal twitching, showing repeated coughing, suffocating or clearing sound.
2. Combined vocal and multiple motor tic disorder (Tourette syndrome (hereinafter referred to as TS) or twitch-slang syndrome, which is a complex and diverse type of symptom, severe type In 1825, Itard first described the symptoms of TS. In 1985, the George Gilles dela Tourette system reported 9 cases. Therefore, TS clinical features are multi-site, with a variety of forms of exercise tics, often starting from the eye, face, and then Gradually develop into the limbs, and even the muscles of the whole body are twitched, which can be expressed as simple movements such as blinking, eyebrows, eyeball rotation, strangeness, tongue extension, turning head, shrugging, belly, inhalation, etc. Complex motion twitching, such as impulsive touch on others or surrounding objects, jabs, stomping, walking, squatting, squatting, or repeated series of continuous meaningless movements, most cases appear simultaneously or sequentially Vocal tics, manifested as simple vocalization such as clearing, coughing, snuffing, snoring or barking; recurrent vocal repetitive speech or Sentence, bored tone, repeating stereotyped Tourette (coprolalia) and so on.
Children with TS are often accompanied by inattention, hyperactivity, obsessive-compulsive disorder, aggressive behavior, self-injury behavior, learning difficulties and emotional changes, thus making children more psychologically plagued and hindering social adaptation.
The course of TS progresses slowly, the symptoms can fluctuate, the new symptoms replace the old symptoms, and the severe procedures are different. Most of the children with this disease have normal intelligence and generally know that they are sick.
3, chronic motor or vocal tic disorder (chronic motor or vocal tic disorder) is more common in adults, it has the characteristics of tic disorder, but exercise tics and vocal twitch do not exist at the same time, and the symptoms are relatively unchanged, can last for several years, Even for life.
4. Other undetermined tic disorder.
Differential diagnosis
Tic disorder is generally identified with the following diseases:
1, Sydenham small chorea caused by rheumatic infection, is also more common in children, but characterized by dance-like abnormal movements, no vocal tics, signs of rheumatic infection and positive test results, anti-rheumatic treatment is effective.
2, liver bean degeneration (Wilson disease) is caused by copper metabolism disorders, liver damage, extrapyramidal signs and mental disorders, corneal KF pigment ring, plasma ceruloplasmin reduction can be distinguished.
3, myoclonus is a seizure, each time lasting for a short time, often accompanied by disturbance of consciousness, EEG high rhythm abnormal, anti-caries effective.
4, other extrapyramidal damage such as acute motor disorders, tardive dyskinesia, acromegaly, Huntington's disease, etc. must be distinguished.
