tics in children
Introduction
Introduction to pediatric tic disorder Pediatric tic disorder, also known as habitual spasmsyndrome, ticsyndrome, transient tic disorder, etc., is a muscle twitching disease that occurs in childhood. The incidence rate is high, ranging from 1% to 7%, and reported to be 4% to 23%. More common in preschool and early school age children. Men are clearly dominant, with a male to female ratio of 3:1 to 4:1. More benign, there are also refractory patients. basic knowledge The proportion of illness: 0.001% Susceptible people: children Mode of infection: non-infectious Complications: Child anxiety disorder Pediatric epilepsy
Cause
Causes of pediatric tic disorder
(1) Causes of the disease
The cause of childhood tic disorder has not yet been fully clarified. Children with special qualities are expected to develop abnormal motor conditioning when they have various mental factors or imitate other people's movements.
(two) pathogenesis
During the development of children, the brain motion analyzer is highly excitatory and prone to ticatory reactions, especially in children with special qualities. When there are various mental factors or imitating other people's movements, such sports conditional reflexes are easy to form. Becoming a pathologically inactive reaction may begin with a patient's response to certain stimuli and become habitual tics for a long time.
Genetic factor
Transient tic disorder can have family aggregation, and tic disorder is more common in family members, so it is thought to be related to genetic factors.
2. Physical factors
At the beginning, twitching is often caused by local irritation, such as ocular membranous inflammation, trichiasis irritations cause blinking, rhinitis or upper respiratory tract infections, nasal aspiration, facial muscle twitching, and when local disease factors are removed, tics still persist.
3. Constitutional factors
Children with tic disorder, generally not quiet, sensitive to people, nervous, demanding, stubborn, and often combined with some psychological symptoms, such as headache, abdominal pain, unexplained fever, constipation, asthma, enuresis Wait.
4. Emotional factors
Often related to the family, common factors such as parents' excessive learning requirements for children, excessive blame, mothers are often neurotic, mentally unquiet, excessive intervention causes children to have emotional disorders, especially anxiety and tension, etc. Emotions and tics are the reaction of psychological conflicts in the sports system, family disputes, parental divorce, death of relatives, etc. In addition, some people think that the child has had a history of restrictions on sports activities, such as parents. Child safety is too much or some early illnesses limit children's activities, mental stimulation can also be an incentive, or children have recently been exposed to accidents such as illness, hospitalization, danger, etc., or children watching nervous TV, video shows Twisting games such as playing games, twitching becomes a manifestation of psychological stress, which plays a major role in transient tic disorder.
5. Learning theory
The initial twitch may be due to conditional escape response, such as blinking in the eyes, or learning other physiological defects or morbidity of others, and later enhanced by external causes, resulting in habitual tics.
6. Drug-induced factors
Central nervous stimulants such as methylphenidate, long-term use of antipsychotics may cause adverse reactions to tic disorder.
Prevention
Pediatric tic disorder prevention
Because children's ability to imitate is very strong, for some disease states, to avoid the child's imitation of any bad habits, so as not to cause a habitual action in the later period, can not be changed. At the same time, avoid mental stimulation and let the children play with other children. This can distract the child's attention and prevent children from developing anxiety and other adverse conditions.
Complication
Pediatric tic disorder complications Complications, childhood anxiety, pediatric epilepsy
Can cause children to feel inferior, anxiety, affect social and other psychological barriers.
Symptom
Symptoms of pediatric tic disorder Common symptoms Paroxysmal or tonic convulsions nod signs Tired shaking heads and neck biting lips or tongue blinking more than tic disorder
Most of the boys who are 5 to 10 years old, for a sudden, short, repeated, rigid group of muscles or two groups of muscles twitching, manifested as blinking, eyebrows, cavities, strange, shrug, neck , nodding, body twisting, arm shaking or kicking, lower limb twitching, etc., increased when emotional stress, decreased when concentrated, lost during sleep, in a period of a group of muscles twitching, showing the same symptoms; In another period, another group of muscles twitched, that is, the variability of symptoms, the duration of the disease lasted for several months to one year, the frequency and severity of tics were different, and the lighter had no effect on the learning and living environment of the child. It affects learning, disrupts the environment, and can't even go to class in the classroom.
classification
Some people have classified children with tic disorder as follows:
1. Acute simple (or transient) children with tic disorder tics beginning with the symptoms are mostly simple, involuntary exercise tics, very few are simple vocal twitching, common eyes, facial twitching is blinking, squeeze Eyebrows, eye-opening, biting lips, opening mouth, nodding, shaking his head, stretching his neck, shrugging his shoulders, etc. A few simple vocal tics are repeated coughing, clearing the scorpion, snoring, symptoms can fluctuate and metastasize within weeks or months. Most cases occur before the age of 12, the most common is blinking, the symptoms will continue to disappear after 2 weeks to 1 year, physical examination including neurological examination, usually no abnormal findings.
2. Chronic simple children with tic disorder before the age of 15 years old, rare in adults, manifested as one or two groups of muscle twitching, no excessive changes, long duration, can exist for life.
3. Subacute or persistent simple or multiple twitching can be seen in childhood, adolescence, simpleness, one or two groups of muscle twitching lasts for more than 1 year, until the puberty naturally disappears, multiple ticks have vocal, to adolescence Whether the symptoms disappear or not is necessary, and this is to be differentiated from multiple tics-speaking syndrome (Tourette syndrome).
4. Multiple tics - Syll syndrome (Tourette syndrome) The above classification is not complete, especially between Type 3 and Type 4, so there will still be "multiple tics - slang syndrome" alone Discuss it.
Examine
Pediatric tic disorder check
Blood, urine, stool and other routine examinations are normal. EEG should be checked, and some children may have abnormal patterns.
Diagnosis
Diagnosis and diagnosis of pediatric tic disorder
diagnosis
Behavioral appointment
For children with transient tic disorder, they should communicate with the children and parents separately to understand the children's learning and living environment, hobbies, personality traits, and accidents and major conflicts before and after tic disorder, and obtain information on the cause. Observe the performance of the child's tics, communicate with the parents to understand the living environment of the child, especially the family and school, the relationship between family members, family function, family conflict or major changes; children and peers in the school and The relationship between the teacher, the academic achievement, the parents' expectations of the child's learning, the activities the child likes and the TV programs they watch, so as to find the environmental factors of the child's twitching.
2. History collection
In addition to the description of the current clinical manifestations, the medical history should also know the past illness of the child, whether there is tics, duration, treatment, etc., and ask about the occurrence of tics in the family.
3. Diagnostic criteria
According to the CCMD-3 criteria, the diagnosis of transient tic disorder is as follows:
(1) Children have repeated, involuntary, stereotypical, untargeted single or two groups of muscle twitches. Some patients have symptoms of variability, often manifested as blinking, with single or multiple motion twitches or vocal tics.
(2) twitching occurs every day, many times a day, the course of the disease is often more than 1 month, the child can consciously control for a few minutes without twitching with his own will, but then there are often more frequent tics.
(3) The onset of illness before the age of 18 is most common among children aged 4 to 7.
(4) No other physical or mental illness, not due to Tourette syndrome, small chorea, drugs or other diseases of the nervous system.
Differential diagnosis
1. tics - slang syndrome
This disease is often twitched by multiple groups of muscles. At the same time, there are various involuntary movements, accompanied by involuntary throat or slang (slang), so the multiple twitches and their accompanying proverbs are the symptoms. Characteristics.
2. Attention deficit hyperactivity disorder
Hyperactivity and twitching muscle twitching are completely different, accompanied by attention deficit and impulsivity, and identification is not difficult.
3. Epilepsy
Some types of epilepsy, such as temporal lobe epilepsy, may occur such as pouting; myoclonic epilepsy has local muscle twitching, but seizures tend to be seizures, while tic disorder is more frequent, seizures are generally not Controlled by the will, and tic disorder can be controlled by the will for a short period of time, epilepsy is more conscious, EEG has special changes, and tic disorder does not have this change.
4. chorea
This is caused by rheumatoid lesions involving the extrapyramidal system. It may have involuntary unconscious movements of the extremities and the face. In addition, there may be changes in body temperature, erythrocyte sedimentation rate, C-reactive protein and ASO, and infection with streptococcus before onset. These help to distinguish from tic disorder.
