Gilles de la Tourette syndrome is a congenital mental and neurological disorder that first manifests itself in childhood. Pathology is characterized by echo-symptoms and obsessive movements in the form of ticks.
The peak of the clinical picture is observed in children in adolescence. When the pubertal period ends, the symptoms gradually subside and completely withdrawn in adults. In mature people, full Tourette syndrome is rare. Most often these are separate symptoms that do not need to be treated. In adults, the symptoms of the disease are rare, it is difficult to diagnose the syndrome. For the poet, doctors diagnose other tick neurological disorders, such as chronic motor tics or vocalisms.
The disease is named after the French neurologist Gilles de la Tourette, who first published 9 clinical cases in a 1885 report.
In the Middle Ages, people with this pathology were considered possessed demons. The priest, the central figure in the treatise on demonology, received the first status of "obsessed". It was the work of Kramer and Sprenger. In the book, the priest had voice and motor tics.
With the development of humanism in the 19th century, patients were no longer considered obsessed. They began to study doctors. Over the course of a century, G. Itar, Trusso and other doctors tried to systematize knowledge and combine individual symptoms into a single syndrome. However, it was not until the end of the 19th century that Tourette himself succeeded.
Tourette syndrome occurs in about 10 children out of a thousand. More than 10 children have a mild form of the disorder. The disease often affects boys (1 to 3 ratio).
Tourette syndrome can be combined with other diseases. 75% of patients were diagnosed with attention deficit hyperactivity disorder, 40% had anxiety disorders.
The specific cause of spontaneous ticks, researchers have not yet identified. Doctors believe that heredity and environmental factors play a role in the mechanism of disease development. However, the gene and molecular mechanism of transmission of the defect are not defined.
In favor of the genetic theory, there are cases of family transmission. So, a patient with Tourette syndrome will transmit the disease to his child with a 50% probability. However, the inherited gene does not mean that the child will develop a complete syndrome. These may be individual neurological symptoms: vocalisms, motor tics, obsessions. But in the clinical picture of Tourette syndrome it does not add up. There are cases of sporadic syndrome: the disease occurs in children whose relatives did not suffer from pathology, but no other reason was found.
An exacerbation of the disease and individual symptoms, or autoimmune diseases can provoke their development. Studies were conducted in 1998 at the National Institute of Mental Health. Doctors have determined that the patient’s neurological condition worsens after postponing a post-streptococcal autoimmune process.
Ecological and social factors influence the course and severity of the disease, but do not provoke its development. Such factors include hypo-or hypertext, malnutrition in children, physical or sexual abuse.
In the journal Medical Hypotheses in 2002, it was suggested that magnesium and vitamin B6 deficiencies are caused by vocal and motor tics. Due to the lack of these substances, metabolic disorders occur in the body, including in the brain. These disorders can provoke neurological disorders. The hypothesis is explained as follows: in the treatment of magnesium and vitamin B6, the patient's condition improves.
Pathophysiologically, abnormalities are observed in the cortex and subcortical structures of the brain — in the thalamus, frontal lobes and the ball ganglia. Violation of the function of structures arises due to a failure in interneuronal connections. Magnetic resonance imaging - the method of neuroimaging - confirms morphological changes in the basal ganglia and the frontal cortex.
In the pathophysiological mechanism such theories are noted:
- Disruption of the metabolism of neurotransmitters - acetylcholine, dopamine and serotonin. Dopamine plays the largest role in the development of ticks. Researchers note that with Tourette syndrome, it is produced in a normal amount, but its transport to brain cells is impaired. In nature, vocal tics play a role in violation of serotonin.
- Theory of oxidative stress with simultaneous deficiency of superoxide dismutase. The accumulation of free radicals in the innate deficiency of the antioxidant system violates the sensitivity of the receptors. This leads to the fact that neurotransmitters can not fully affect the caudate nucleus of the thalamus, motor and sensory parts of the cortex.
- Defect relationship between the frontal and temporal cortex of the left hemisphere of the brain. This theory explains dyspraxia, dysphasia and dispersal of attention.
Tourette syndrome is characterized by such neurological disorders:
- Local tics.
- Common tics.
- Vocalisms or vocal tics.
Local tics are detected as hyperkinesis - an increase in the tone of the muscles of one group. Most often it is the facial muscles. Local mimic tics are manifested by private blinking, violent movements of the corner of the mouth or the wings of the nose, and frequent squeezing of the eyes. Local tics are the first signs of a disease.
Frequent blinking is caused by the load on the organs of vision. More often, this is triggered by prolonged watching TV or working at a computer. Blinking is usually followed by squinting and pulling the wings of the nose along with the corners of the mouth.
The common tics are raising the tone of several muscle groups at once. More often, the muscles of the face, neck, head, shoulders, back and rectus muscles of the abdomen contract simultaneously.
With common ticks, muscles tighten up gradually. The patient forcibly blinks and squeezes his eyes, after which the muscles of the neck contract: the head turns to the side or falls back. The most common patterns are observed: a combination of blinking and raising the gaze to the eyelids, blinking and contraction of the shoulder muscles, the establishment of the gaze and the tilting of the head back.
Vocal tics are a characteristic symptom that manifests Tourette syndrome. Vocal tics are simple and complex.
Simple vocalisms are coughing, chuckling, noisy breathing, or grunting. In some patients, simple sound tics are manifested by involuntary pronunciation of sounds “aaaa” or “and-and”. Such tics are prognostically favorable - the disease will not become a disability.
Chronologically, vocalisms appear after local and then complex motor tics. The first vocal tics occur 2-3 years after the debut of the disease. Vocalisms intensify in the late afternoon when the patient is tired.
Difficult vocalisms are echo-symptoms, coprolalia and palilalia. The echo-symptoms include echolalia - the violent repetition of someone else's words. This symptom is unstable: in the clinical picture it is not present for weeks to 1-2 months.
Coprolalia is swear words that involuntarily shout out to patients. In children, coprolalia is rare, but this complex vocalism is the reason for the child's transition from school to home. Swearing is predominantly sexual and vulgar content. In adults, coprolalia occurs in 40%.
Palilalia is a rehearsal tick. A patient with palilalia involuntarily repeats his own word or sentence several times.
To diagnose Tourette syndrome, doctors are guided by the diagnostic criteria from DSV-IV (American Mental Disorders Guide):
- There are multiple local or common motor tics, there is one or more vocalisms. The simultaneity of these symptoms is optional.
- During the day, vocalisms and / or motor tics appear repeatedly and serially for at least 1 year. At the same time, remissions with a length of not more than 3 months should be absent.
- Motor and / or vocal tics affect social adaptation: a child moves to home schooling, an adult is fired from work. There is a psychological discomfort requiring the intervention of a psychotherapist.
- The first signs of Tourette syndrome occurred before the age of 18.
- Motor tics and vocalisms are not caused by another neurological and mental illness, they are not caused by alcohol or drugs.
Neurological examination is required for diagnosis. On examination, the doctor assesses the neurological status and records motor tics and vocalisms. The clinical picture can also be manifested by distraction of attention, loss of memory and impaired coordination.
To determine the organic basis of the disease, instrumental methods of research are assigned:
- Electroencephalography. The predominance of delta waves is noted in the frontal lobes, and bilateral phenomena of the type “discharge → tick” are also noted.
- Magnetic resonance or computed tomography. There are structural disorders of the corpus callosum, aneurysm. The pictures also show small cysts in the parietal and temporal cortex.
The Tourette syndrome test is a functional test. The patient is asked to blink 10 times. In patients with the syndrome, during the test or after a blink, tics of the facial muscles are noted. In this case, it is considered positive.
The goals of treatment are to eliminate the clinical picture and adapt the patient to social life. Local hyperkinesis and rare manifestations of the disease do not need to be treated. Therapy is prescribed in the case when the vocalisms and motor tics interfere with the patient himself. Standards of therapy - neuroleptics: haloperidol or eperapasin. Doses of пера eperapine and haloperidol - 4 mg / day and 4–8 mg / day 2-3 times a day for 12 months under the supervision of a physician. The operation is not shown.
Among the complications of Tourette syndrome in children can be:
- prolonged stress due to difficult communication and ridicule by peers,
- violation of the child's adaptation in social areas,
- low self-esteem of the child,
- sleep disturbance,
- constant anxiety and irritability,
- hysterical seizures.
Since the symptoms are less pronounced in older age, then the complication for this group of people is not observed.
In medicine, cases of disease are described within the same family: brothers, sisters, fathers. In addition, hyperkinesis of varying severity occur in close relatives of children with Tourette symptom.
Scientists suggest that Tourette's symptom is transmitted by an autosomal dominant mode of inheritance with incomplete penetrance. However, the autosomal recessive mode of inheritance should not be excluded either, as well as polygenic inheritance.
It is assumed that a person with Tourette syndrome in 50% of cases passes the genes to one of his children. However, such reasons as variable expression and incomplete penetrance explain the appearance of symptoms of varying severity in close relatives, or their complete absence. However, only a small proportion of children inherit genes that lead to serious violations and require careful medical supervision.
In men, tics are more pronounced than in women. Therefore, it is believed that sex has an effect on gene expression. Sons whose mothers suffered from Tourette syndrome are at the greatest risk of developing the disease. Women who carry the gene are more prone to the neurosis of obsessive states. (read also: Neurosis - types and symptoms)
Autoimmune processes in the body (PANDAS)
Thus, scientists from the National Institute of Mental Health in 1998 put forward the theory that tics and other behavioral disorders occur in children against the background of a developed autoimmune post-streptococcal process.
Experts point out that the transferred streptococcal infection and the autoimmune process that developed on this background may even provoke tics in children in whom they have not previously been observed. However, research on this matter has not yet been completed.
The emergence of Tourette syndrome is explained by a change in the structure and functionality of the basal ganglia, neurotransmitter and neurotransmitter systems. At the same time, scientists point out that tics occur either because of an increase in dopamine production, or because the receptors become more sensitive to dopamine.
At the same time, both motor and vocal tics become less pronounced when patients take dopamine receptor antagonist drugs.
In addition, scientists note a number of factors that can trigger the development of the syndrome
Tourette, among them:
Toxicosis and stress experienced by a pregnant woman.
Taking anabolic steroids, drugs and alcohol-containing beverages during the child's birth.
Intrauterine hypoxia of the fetus with impaired functioning of the central nervous system.
Received during childbirth intracranial injuries.
Transferred intoxication of the body.
Hyperactivity syndrome and psychostimulants taken on this background.
Increased emotional stress.
Symptoms of Tourette syndrome
Most often, the first symptoms of Tourette syndrome manifest in a child aged 5 to 6 years.
In general, the signs and symptoms of Tourette syndrome are as follows:
Parents begin to notice certain oddities in their behavior in their children. Children make grimaces, stick out their tongues, wink, often blink, clap their hands, etc.
As the disease progresses, the muscles of the trunk and legs are involved in the process. Hyperkinesias become more complex and begin to manifest themselves in jumping, throwing out lower limbs, squats.
From an early age, children are capricious, restless, inconsiderate, very vulnerable. Due to such high emotionality, it is difficult for them to establish contact with their peers.
Patients are prone to depression, irritability. Depressive disorders are replaced by bouts of rage and aggression. After a short time, aggressive behavior is replaced by a cheerful and energetic mood. The patient becomes active and at ease.
Often there are ecopraxia and cyproxraxia. The first are expressed in copying the movements of other people, and the second in offensive gestures.
Tics can pose a certain danger, as patients can bump their heads, put pressure on their eyes, bite their lips hard, etc. As a result, patients themselves cause quite serious injuries to themselves.
Voice or, as they are also called, vocal tics are very diverse with Tourette syndrome. They are expressed in the repetition of nothing meaningful sounds and words, in whistles, puffing, mooing, hissing, shouting. When voice tics are introduced into the process of a person's monologue, an illusion of stuttering, hesitations and other problems with the patient's speech is created.
Sometimes patients cough non-stop, sniffle. Such manifestations of Tourette syndrome can be mistaken for symptoms of other diseases, such as rhinitis, tracheitis, sinusitis, etc.
Patients are also characterized by speech disorders such as:
Coprolalia - the expression of obscene words (is not
Pathognomonic symptom, as observed in only 10% of cases),
Echolalia - repetitions of phrases and words uttered by the interlocutor,
Palilalia - repeated repetitions of the same word.
Speech rate, tone, volume, tone, accents, etc. can be changed.
If boys are characterized by coprolalia, then girls are obsessive-compulsive traits.Coprolalia is a serious symptom of the disease, as it contributes to social maladjustment. A person utters swear words loudly, sometimes even shouts out. Phrases abrupt.
The behavior of the patient during the attack can be very eccentric. They can grunt, crack their fingers, sway from side to side, rotate around their axis, etc.
Patients are able to anticipate the beginning of the next attack, as it is accompanied by the appearance of a certain aura. Perhaps the appearance of a coma in the throat, pain in the eyes, skin itching, etc. As the patients explain, it is these subjective sensations that force them to reproduce one or another sound or phrase. The voltage goes away immediately after the tick is complete. The stronger the emotional experience of the patient, the more often and more intense will be the tics, both voice and motor.
Intellectual development of patients does not suffer. But motor and speech tics influence his learning and behavior.
Other symptoms of Tourette syndrome are behavioral reactions, expressed in excessive impulsiveness, aggression, and emotional instability.
The disease is gaining its peak by adolescence, and as it reaches maturity, it declines or disappears altogether. However, it is possible that symptoms of the disease persist throughout a person’s life. In 25% of cases, the disease is hidden and sharpens after a few years. Complete remission is rare.
Depending on how severe the patient’s symptoms are, there are several degrees of Tourette syndrome:
Mild degree The patient is able to control all vocal and motor abnormalities without problems. Sometimes these disorders remain unrecognized by other people. In addition, asymptomatic periods are possible, although they are fairly short-term.
Moderate degree The patient is able to control the existing violations, but it is not possible to hide them from the environment. At the same time, asymptomatic periods are absent altogether.
Pronounced degree. Man cannot control the symptoms of the disease, or does it with great difficulty. The symptoms of the disease are obvious to everyone around.
Heavy degree. Tiki vocal and motor tics are pronounced vividly. The muscles of the trunk and limbs are involved in the process. Man cannot control the symptoms of the disease.
Features of tics in Tourette syndrome
Tiki with Tourette syndrome has its own characteristics. So, motive disturbances are always monotonous, for a while the patient can suppress them. Rhythm is absent.
Another distinctive feature of tics is that they are preceded by an impulse that a person cannot overcome. It occurs just before the start of the tick. Patients describe it as an increase in tension, an increase in the feeling of pressure, or an increase in energy that must be eliminated. This needs to be done in order to normalize one’s condition, to restore the former “good” state of health.
Patients indicate that they have a lump in their throats, discomfort in the shoulder girdle. This causes them to shrug their shoulders or cough. In order to get rid of the unpleasant sensation in the eyes, people often blink. Prodromal sensory phenomena, or prodromal urges - these are the names of these impulses that patients experience before tics.
At the same time, not every patient, especially in childhood, is able to assess this heralding urge. Sometimes children do not even notice that they have tics and are surprised if they are asked a question about a particular condition.
Treatment of Tourette syndrome
Treatment of Tourette syndrome is an individual process. The specific scheme is suggested based on the condition of the patient, and also largely depends on the severity of the pathological manifestations. Mild and moderate degree of the disease is well amenable to correction using such psychological techniques as art therapy, music therapy, animal therapy. Psychological support, a favorable emotional background in which it exists is extremely important for the child.
Therapy can be optimal only if it is selected for a specific child:
With a mild degree of Tourette syndrome, only additional support is provided to the child. Adaptation of its environment, changes in the school process are possible (for example, providing an opportunity for a child with Tourette syndrome to perform control work not in a general class, but in a separate room and without limiting it in time). Often this is enough to reduce the symptoms of the disease. Well, when the teacher is going to meet their parents. So, in the classroom you can show children a scientific film about people with the disease.
If tics affect the patient's quality of life, then he is shown drug treatment, which will minimize the manifestations of the disease. The main drugs used in this case are neuroleptics (Pimozide, Haloperidol, Fluorophenazine, Penfluridol, Risperidone) adronomimetics (Clonidine, Catapress), benzodiazepines (Diazepam, Fenozepam, Lorazepam). Drugs are used only in extreme cases, since their reception threatens with the development of various side effects. A positive effect from the use of neuroleptics can be expected in about 25% of cases.
There is evidence that forms of Tourette syndrome that are resistant to conservative therapy are amenable to surgical correction using deep brain stimulation (DBS). However, at this point in time, this technique is at the testing stage, therefore it is forbidden to use it for treating children. The method boils down to the fact that using surgical manipulations, electrodes are inserted into certain parts of the brain. The apparatus with which the electrodes are connected is placed in the chest. It, at the right time, transmits a signal through the electrodes to the brain, preventing or preventing the development of the next tick.
Non-drug methods such as segmental reflex massage, exercise therapy, acupuncture, laser reflexotherapy, etc. are also widely used.
In the perspective of the treatment of Tourette syndrome are techniques such as BOS-therapy, injecting botulinum toxin in order to rid the patient of vocal tics. Positive effects have shown treatment with the help of Cerucal, however, to be able to use the drug in pediatric practice, it is necessary to conduct additional, more extensive tests.
At this point in time, Haloperidol remains the drug of choice. Its action is aimed at blocking dopamine receptors in the zone of the basal ganglia. Children are advised to begin administering a dose of 0.25 mg per day with a weekly increase of 0.25 mg. In 24 hours, a child can receive from 1.5 to 5 mg of the drug, depending on his age and body weight. Such a drug as Pimozit has fewer side effects than Gadloperidol, however, it is forbidden to use it for violations in the functioning of the heart.
A doctor who needs to be treated if there are symptoms of Tourette syndrome is a psychiatrist.
Against the background of the treatment, the improvement of well-being can be achieved in 50% of patients after they enter adolescence or adulthood. If tics are not amenable to complete elimination, then lifelong therapy is possible.
Although the disease does not affect a person’s longevity, it is capable of disrupting its quality, and sometimes quite severely. Patients are prone to depression, panic attacks and need constant psychological support from people around them.
Practical advice to parents with children with Tourette syndrome
Own education and enlightenment environment. Understanding what constitutes Tourette syndrome provides an opportunity to delve deeper into the problems of a child. The source of knowledge should be the attending physician, as well as information resources such as medical textbooks, journals and articles on this topic.
It is important to understand the mechanism that causes the launch of the next tick. Build a logical chain and establish the jerk factor will help record what preceded the next vocal and behavioral violation.
Making adjustments. If you make appropriate changes in the environment of the sick child, in the routine of his life, you can reduce the number of ticks. Often help breaks in homework, the possibility of additional rest at school, etc.
The restructuring of the existing skills. The child should try to learn to control tics. This should be done by a qualified specialist. To restructure the skill, the child will need to have a clear understanding of ticose behavior in order to subsequently learn how to correct it.
Regular meetings with the attending doctor. A qualified psychiatrist is obliged to conduct conversations and activities with a child, who have as their goal not only psychological support, but also assistance in coping with his thoughts, behavior, feelings. Members of the family where the child grows up with this problem can also take part in the consultation.
Sometimes a child with motor tics should be given the opportunity to spend more time typing on the keyboard than writing by hand. It is mandatory to notify the school teachers. Also, do not forbid the child to move or leave the class if he needs it. Sometimes these children should be given the opportunity to be alone.
If necessary, you can practice classes with a tutor or go to home schooling.
Education: In 2005, he completed an internship at the First Moscow State Medical University named after I. M. Sechenov and received a diploma in the specialty “Neurology”. In 2009, graduate school in the specialty "Nervous Diseases".
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Tourette syndrome what is it
Psychoneurological disorder, which is accompanied by involuntary movements, shouting sounds - Gilles de la Tourette syndrome. This brain pathology is also called a disease in which a person swears. The processes begin in childhood, mainly in boys. Often, by mature years, symptoms are reduced. Tourette's disease is characterized by the presence of generalized ticks, including voice and motor symptoms.
Tourette syndrome - causes
It is believed that one of the main reasons - genetic. People with a specific gene get sick. Often the causes of Tourette syndrome lie in the waiting period of the child. The disease can occur if during pregnancy:
- was taking anabolic steroids, drugs,
- there was a strong toxicosis,
- there was a stressful situation
- suffered a disease with a high fever,
- there was a pathology caused by staph.
To provoke Gilles Tourette's syndrome can:
- intracranial trauma at birth,
- side effects of medication
- diseases caused by microbes - sore throat, scarlet fever, rheumatism,
- alcohol intoxication,
- psychological problems,
- toxic poisoning
- diseases with fever,
- reception for the treatment of psychotropic drugs in childhood.
Tourette syndrome - symptoms
The disease is characterized by the main features - an irresistible urge to repeat movements or sounds, which are called tics. There are two types - vocal (voice), motor (motor). Generalized tics are possible, in which all signs appear simultaneously. Depending on the emotional state, the symptoms of Tourette syndrome can be:
Sounds with voice ticks are: moaning, in the form of coughing, grunting, grumbling. They appear when the muscles of the vocal cords are involved. To vocal tics, include:
- typical speech disorders - changes in tone, accent, rhythm, volume,
- repeated repetition of one own word - vocalism,
- coprolalia - spontaneous saying insults, mate, aggressive phrases,
- repeating hearsay
- echolalia - an imitation of sounds, the words of others,
- Palilalia - the repetition of their own phrases, syllables.
Before the appearance of a generalized tic, sensory phenomena arise - a foreign body sensation in the throat, limited discomfort in the shoulders, a strong impulse, an overflow of energy. The increase in tension provokes a person to action. A patient can shout out socially undesirable, forbidden words, swear, swear. Motor tics can spread throughout the body, accompanied by:
- obscene gestures
- twinkling eyes
- biting lips.
What is this disease?
Tourette syndrome is a neuropsychic disorder that is accompanied by involuntary vocal and motor tics, as well as deviations in human behavior.
And the most important sign of the disease, especially at an older age, is obscene language, which a person can cry out at any time without any reason. Unexpected laughter, sharp scratching, unnatural twitching of the facial muscles, spontaneous movements of the arms and legs - these are the main symptoms of the disease that are not controlled by the patient.
Usually, the first signs of the disease become noticeable already at a young age, about 3-5 years old. In most cases, the pathology affects boys. The disease can be inherited and passed on from generation to generation.
This syndrome in 1884 was first described by Gilles de la Tourette, who was at that time a student of a psychiatrist from France, Jean-Martin Charcot. The doctor based his conclusions on the description of observations of a group of patients consisting of nine people. Not much earlier, in 1825, the French doctor Jean Itard published an article in which he described the symptoms of seven men and three women, very similar to the symptoms described by Tourette. But the very first mention of a similar disease is found in 1486 in the book The Witch Hammer, which tells about a priest with vocal and motor tics.
Causes of development
The disorder is associated with impaired activity of the central nervous system. The exact causes of Tourette syndrome have not yet been clarified. There are several hypotheses:
- Genetic. According to the observations of scientists, the disorder occurs more often in children of those parents who themselves suffered from involuntary tics in childhood. This occurs in approximately 50% of cases. Uncontrolled movements often manifest themselves differently from those of parents or close relatives. Sometimes, instead of ticks, obsessive states arise. The severity of symptoms of the disorder in children and parents also varies.
- Autoimmune. Pathology occurs as a result of the disease caused by streptococci.
- Neuroanatomical. It is associated with a violation of the brain, in particular, pathology of the frontal lobes, thalamus, basal nuclei.
- Dopamine. According to one theory, the occurrence of involuntary disorders associated with high levels of dopamine.
- Metabolic disease. In accordance with this hypothesis, Tourette syndrome occurs due to magnesium deficiency. Replenishing the deficiency and taking vitamin B6 at the same time allows you to get rid of ticks.
- Unsuccessful pregnancy. During fetal development, the fetus experiences hypoxia, toxicity, alcohol or nicotine.Under the influence of these factors arise neurotic disorders.
- The effects of neuroleptics. A side effect of psychotropic substances is that they cause involuntary movements.
Symptoms and first signs
The first symptoms of Tourette syndrome are usually found by the relatives of the patient at a young age. From about three years old, the child suddenly begins to twitch, make frequent repetitions of sudden movements, and suddenly shouts. As the disease progresses, the baby may involuntarily repeat the movements of other people, mimic them, shout out offensive words.
Among vocal tics are especially common:
- echolalia (repeating phrases after other people),
- coprolalia (shouting of obscene words),
- palilalia (constant repetition of one word or sentence).
Before the start of a tick, the patient begins to feel emotional lift and excitement, the tension inside grows so much that he cannot cope with his body and either starts to twitch or make sounds. Then comes relief, after the completion of the attack, the person wakes up and calms down.
According to the tick severity scale, there are 4 stages of the disease:
- A light degree is sometimes invisible to close surroundings. The patient copes well with emotional stress, controls his behavior and can fully live. Sometimes there are long periods without ticks.
- Moderate is more noticeable, the patient can not fully restrain himself.
- The expressed degree practically deprives a person of the ability to control his behavior, he hardly exists in society, work and daily affairs are given with difficulty.
- A severe degree is completely out of control, motor and vocal tics are strongly pronounced, the patient is incapacitated.
What to do and how to treat Tourette syndrome?
Treatment for Tourette syndrome is aimed at helping patients manage the most problematic symptoms. In most cases, Tourette syndrome is mild and does not require pharmacological treatment. Treatment (if required) is aimed at eliminating tics and related conditions, the latter often become more problematic when ticking occurs. Not all people with tics have associated conditions, but if they occur, the treatment focuses on them.
There is no treatment for Tourette syndrome and there are no drugs that would act universally for all people without significant side effects. Understanding patients of their disease allows you to more effectively manage tick disorders. Managing the symptoms of Tourette syndrome includes pharmacological therapy and psychotherapy, the right behavior. Pharmacological treatment is intended for severe symptoms; other treatments (for example, supportive psychotherapy and cognitive behavioral therapy) can help avoid or alleviate depression and social isolation. Educating the patient, family, and other people (eg, friends, schools) is one of the key treatment strategies, and maybe this is all that is required in mild cases.
Medications are used when symptoms interfere with the normal life of the patient. Classes of drugs with the most proven efficacy in treating tics — typical and atypical antipsychotics, including risperidone, ziprasidone, haloperidol, pimozide, and flufenazine — can cause long-term and short-term side effects. Antihypertensives clonidine and guanfacine are also used to treat tics, studies have shown variable efficacy, but the effect is lower than that of antipsychotic drugs. Studies on the use of metoclopramide (cerucala) in Tourette syndrome (generalized tics and vocalization in children) showed positive results, but doctors note that more extensive tests are needed for pediatric use.
For obsessions, problems with concentration and depression associated with Tourette syndrome, tricyclic antidepressants, SSRIs (for example, fluoxetine) and lithium preparations are used.
Practical advice to parents with children with Tourette syndrome
- The restructuring of the existing skills. The child should try to learn to control tics. This should be done by a qualified specialist. To restructure the skill, the child will need to have a clear understanding of ticose behavior in order to subsequently learn how to correct it.
- Regular meetings with the attending doctor. A qualified psychiatrist is obliged to conduct conversations and activities with a child, who have as their goal not only psychological support, but also assistance in coping with his thoughts, behavior, feelings. Members of the family where the child grows up with this problem can also take part in the consultation.
- Own education and enlightenment environment. Understanding what constitutes Tourette syndrome provides an opportunity to delve deeper into the problems of a child. The source of knowledge should be the attending physician, as well as information resources such as medical textbooks, journals and articles on this topic.
- It is important to understand the mechanism that causes the launch of the next tick. Build a logical chain and establish the jerk factor will help record what preceded the next vocal and behavioral violation.
- Making adjustments. If you make appropriate changes in the environment of the sick child, in the routine of his life, you can reduce the number of ticks. Often help breaks in homework, the possibility of additional rest at school, etc.
- Sometimes a child with motor tics should be given the opportunity to spend more time typing on the keyboard than writing by hand. It is mandatory to notify the school teachers. Also, do not forbid the child to move or leave the class if he needs it. Sometimes these children should be given the opportunity to be alone.
If necessary, you can practice classes with a tutor or go to home schooling.
Treatment of the syndrome usually brings positive results. Already a few months later, patients stabilize, and the first improvements become noticeable. To do this, a patient needs only a visit from a neurologist and a psychologist, as well as special classes aimed at relaxing the nervous system.
Only in severe cases, when the therapy was performed poorly or out of time, tics can become lifelong. At the same time, patients become prone to depression and antisocial behavior. Quite often they have panic attacks and inadequate reaction to surrounding events. But, despite the pronounced symptoms, Tourette syndrome does not affect the life expectancy of a person and his intellectual development.
Therefore, in most cases, people with a similar disorder live a long and happy life.