Tourette's syndrome in children
Introduction
Introduction to Pediatric Tourette Syndrome Tourette Syndrome is a chronic neuropsychiatric disorder, also known as multiple tic disorder. This disease was first described by Itard in 1825. In 1885, French doctor Gillesdela Tourette reported 9 cases and detailed descriptions. The condition is named Tourette syndrome, a neuropsychiatric disorder characterized by multiple onset of exercise tics accompanied by vocal tics in the onset of childhood and adolescence. Can be associated with many behavioral problems, such as attention deficit hyperactivity disorder, obsessive-compulsive disorder, sleep disorders and mood disorders, which increase the severity and complexity of the disease, but also bring some difficulty to treatment. Multiple tic disorder is a type of ticdisorders whose pathogenesis and pathogenesis are still unclear. It can interfere with and impair children's cognitive function and development to varying degrees, affecting social adaptability. basic knowledge The proportion of illness: the incidence rate is about 0.02% Susceptible people: children Mode of infection: non-infectious Complications: Children's sleep disorders Childhood mood disorders
Cause
Pediatric tics of the cause of slang syndrome
Genetic factors (30%):
Tourette syndrome has a clear genetic predisposition and has been investigated from the family (the incidence of tic disorder in the family members of the disease is 40% to 50%), twin studies (consistency of single-ovary twin tic disorder) Separation analysis (genetic approach tends to autosomal dominant inheritance with incomplete penetrance), linkage analysis and genomic imprinting, etc., has carried out more research work on the genetic problems of this disease, providing multiple tics The evidence related to heredity, but so far there is no clear conclusion about the disease-causing gene of this disease.
In the future, the hotspots of molecular genetics research on tics of snoring syndrome will be the study of gene localization or gene expression. The use of genetic linkage and association methods to find the pathogenic genes of this disease is the main direction of research in the future, including examination of multiple Trache gene products, regulation of gene expression, and interactions with other systems, as the search for associated DNA markers progresses, before the location of multiple tic disorder disease genes, it is time to begin collecting non-genetic factors. After the localization of multiple tic disorder genes, molecular biology techniques can be used not only for genetic diagnosis, but also for carriers from dangerous populations.
Central neurotransmitter imbalance (20%):
At present, most scholars believe that there is a central neurotransmitter imbalance in multiple tic disorder. A variety of central neurotransmitter abnormalities play an important role in the pathogenesis of this disease. Various neurotransmitters in the basal ganglia and related structures The interaction is very complicated, mainly related to monoamine neurotransmitters such as dopamine, serotonin and norepinephrine. It is first discovered that dopamine has a certain relationship with the onset of multiple tic disorder. Synaptic dopamine hyperactivity and dopamine receptor hypersensitivity in the striatum of the basal ganglia.
Neurobiochemical changes (20%):
(1) Opioid peptides: Opioid peptides that interact with dopamine neurons are concentrated in the basal ganglia. Opioid peptides may have important effects on exercise control, and they play an important role in the pathophysiology of multiple tic disorder. Gillman is equal. In 1985, children with multiple tic disorder were found to have low endogenous opioid dysfunction. Current studies on enkephalin, endorphin and dynorphin indicate that they are associated with dopamine, serotonin and gamma-amino in the central nervous system. There is a close relationship between the butyric acid system, and the alteration of opioid peptide may cause the dysfunction of the above system to cause multiple tic disorder.
(2) Prolactin: Patients with multiple tic disorder have dopaminergic hypersensitive factors (such as prolactin) on the hypothalamic-pituitary axis. Multiple tics of striatal dopamine receptor hypersensitivity may be produced by dopaminergic hypersensitivity. Mediated by the release of factor function, from the perspective of dopaminergic hypersensitivity factors, prolactin secretion should be higher in patients with multiple tic disorder, and some scholars used radioimmunoassay in 1996 for 39 cases of multiple Plasma prolactin levels in children with tic disorder were measured and found to increase plasma prolactin levels, suggesting that prolactin may be involved in the pathogenesis of multiple tic disorder.
(3) Sex hormones: In humans, brain regions with basic reproductive functions may be located in the basal ganglia and limbic systems. These brain regions are under the control of sex hormones, and their developmental abnormalities may be related to the onset of multiple tic disorder. Various steroid hormones may play a role in the expression of symptoms of multiple tic disorder, with androgen being most prominent.
(4) Cyclic adenosine: cAMP is a second messenger of neurotransmitters such as dopamine, norepinephrine, serotonin or histamine, which plays an important role in regulating central nervous system activity. Phospho-adenosine is significantly reduced in some brain regions of multiple tic disorder, such as the frontal, temporal, and occipital regions. The functional changes of various neurotransmitters associated with the onset of multiple tic disorder may be caused by abnormal second messengers.
Pathological factors (15%):
(1) Perinatal abnormalities: some perinatal abnormal factors appearing during maternal or childbirth, such as malnutrition or certain diseases during pregnancy, premature birth, expired birth, asphyxia at birth, etc., may lead to brain development disorders It affects the severity of multiple tic disorder and is considered to be an important risk factor for the onset of multiple tic disorder.
(2) Immunopathological damage: In recent years, studies have reported that 20% to 35% of the incidence of multiple tic disorder is related to autoimmune pathological damage after infection, of which about 10% is related to group A hemolytic streptococcal infection. When the twitch suddenly increases or the drug treatment does not respond, patients with multiple tic disorder should be examined for the presence or absence of group A beta-hemolytic streptococcus infection.
Mental factors (5%):
Almost all patients have increased twitching symptoms when they are under stress. Some psychotherapy can relieve tics. Therefore, it emphasizes the role of mental factors in the pathogenesis of this disease. It is now considered scared, emotional, sad, watching thrilling horror TV. Mental factors such as excessive mental stress caused by irritating cartoons may be associated with the onset of multiple tic disorder.
Other factors (2%):
Long-term or high-dose application of central stimulants (such as methylphenidate), antipsychotic drugs (such as clozapine), levodopa, carbamazepine and aminophylline, may induce multiple tic disorder or exacerbate tics .
Prevention
Pediatric Tourette Syndrome Prevention
At present, the cause of this disease is not fully understood. Preventive measures should actively prevent and control various perinatal abnormalities, prevent pregnancy during pregnancy, prevent premature birth, expired birth, suffocation at birth, etc., and actively prevent and treat infectious diseases. It is reported that some children are related to hemolytic streptococcal infection, and it is also necessary to prevent mental over-stimulation, scare and caution with drugs such as central stimulants.
Complication
Pediatric Tourette Syndrome Complications Complications, childhood sleep disorders, childhood mood disorder
Behavioral problems often occur, such as obsessive-compulsive disorder, attention deficit hyperactivity disorder, learning difficulties, sleep disorders, mood disorders, self-injury behaviors and defamation behaviors.
Symptom
Pediatric Tourette Syndrome Symptoms Common Symptoms Irritability Anxiety Tension Myoclonus Learning Difficulties Dry Cough Fatigue Sleep Disorders Behavior Hepatolenticular Degeneration
The onset age of Tourette Syndrome is 1 to 21 years old, and the average onset age is 6 to 7 years old. Men are significantly more than women, at least 3 times more. Most cases of multiple tic disorder start from 2 to 15 years old. Preschool and school-age children are the peak population, 90% of them start before the age of 10, and most often 5 to 9 years old.
The performance of multiple tic disorder in behavioral problems also varies with gender, with more attention deficit hyperactivity disorder in male patients and more with female obsessive-compulsive disorder, Kurlan (1992) It is speculated that this gender difference in multiple tic disorder may be due to the influence of sex hormones in the early development of the central nervous system.
The first symptom of multiple tic disorder is exercise tics or vocal tics, which may occur simultaneously or simultaneously. Usually, the eye, face or head is taken as the first symptom, such as blinking, licking or shaking your head, etc. Gradually develop to the neck, shoulders, limbs or trunk, 38% to 59% of the first symptoms of eye pumping, blinking is considered to be the most common first symptom of multiple tic disorder, vocal pumping action is the first start of multiple tic disorder Symptoms account for 12% to 37%, usually composed of clear lice, dry cough, sniffing nose, bark or screaming, and proverbs only account for 1.4% to 6%.
Examine
Pediatric Tourette Syndrome Examination
The results of general laboratory tests are not special. EEG and brain imaging studies, such as brain CT, MRI, etc., should be performed to understand and exclude brain lesions.
Diagnosis
Diagnosis and diagnosis of convulsions in children with slang
1. small chorea minor (chorea minor) rheumatic chorea usually occurs in 5 to 15 years old, dance-like abnormal movement accompanied by signs of rheumatic fever such as decreased muscle tone, increased erythrocyte sedimentation rate, anti-streptolysin The results of O and mucin determination were increased. The course of the disease is self-limiting, no vocal twitching, and anti-rheumatic treatment is effective.
2. Hepatolenticular degeneration, also known as Wilson disease (Wilsons disease) is caused by copper metabolism disorders, liver damage, extrapyramidal signs and mental disorders. It can be seen that the characteristics of corneal Kayser-Fleisher pigment ring and plasma ceruloplasmin decrease can be identified.
3. Myoclonosis can occur at any age, has multiple causes, is a type of epilepsy, each episode lasts for a short time, often accompanied by disturbance of consciousness, EEG is highly abnormal. Anticonvulsant medications can control seizures.
4. Delayed discinesia is mainly seen in involuntary movement disorders that occur during the application of antipsychotics or after sudden withdrawal.
