Tics are the unexpectedly occurring, violent, stereotyped, involuntary, irregular, repetitive, abrupt and short-term movements of an individual muscle, muscle group, or body parts of the .It can also be sound anomalies, represented by shouting out sounds, syllables or words. Ticks differ from other hyperkinesis in that they are not completely involuntary and unconscious. In practice, there is always a beginning of the onset of a violent and irresistible desire to make some kind of movement. This feeling can be braked or broken by strong-willed effort, which will lead to discomfort and internal tension.
- 1 Epidemiology
- 2 Reasons for ticks
- 3 Pathogenesis
- 4 Classification of ticks
- 5 Clinical manifestations
- 6 Treatment of tics in children
- 7 Forecast
Frequency of occurrence in childhood is about 10%, ticks predominate among boys .Most often this pathology is first manifested in a child aged from five to ten years, 99% of cases are realized by fifteen years.
Reasons for ticks
All the etiological factors that cause tics can be divided into two groups.
Psychological, among which distinguish:
- Stressful external factors( tics are their consequence);
- Hyperactivity of the child( tics are a normal stage of its development);
- Triggers in which tick is evaluated as the initial period of the formation of behavioral disorders.
Biological: genetic predisposition, the presence of autoimmune pathology, injuries in the prenatal and perinatal periods, traumas of the nervous system( brain damage most often), the transferred neuroinfection.
The state of the psychological climate of the family is of great importance. For example, with constant remarks and shouts, the child's free physiological activity is contained, which is different for all and depends on temperament, and is replaced by tics and obsessions.
Maternal and child relationships also play an important role in the formation of this pathology. Excessive custody of the baby leads to the development of low self-esteem, lack of self-confidence, anxiety syndrome and infantilism. All these characteristic features cause the formation of a tick. In addition to all of the above, a significant contribution to the development of the disease makes available problems in communicating with peers( in school or kindergarten).
At the heart of the pathogenetic mechanism of the disease is the violation of the normal ratio of catecholamines - substances that are neurotransmitters, and control the course of processes in the brain.
Classification of ticks
Depending on the etiology of the pathological mechanism, the following are distinguished:
- Primary tics that exist as a separate pathology. Generally, they most often occur in children with a genetic predisposition of .Inheritance of this form of tick occurs according to the autosomal dominant type. Such children are characterized by poor tolerance of transport and stuffy spaces, fast fatigue, exhaustion from games and occupations, anxiety in a dream. Very often, before the appearance of this type of tick, there is an episode of an acute viral infection or some other disease( for example, tick of the in the form of blinking occurs as a result of conjunctivitis, after an illness of the throat, an obsessive cough appears).
- Secondary, a manifestation of a different disease. They arise in the background:
- Anomalies in the mental sphere - the presence of asthenoneurotic syndrome, obsessive-compulsive disorder, child hyperactivity disorder and attention deficit disorder, depression, schizophrenia, mental retardation, early childhood autism;
- Anomaly of brain development and hereditary degenerative pathology( with cerebellar hemispheres dysplasia, torsion dystonia, Huntington's chorea);
- Neurogenic infectious diseases, traumas of the skull and brain, suffered strokes;
There are also cryptogenic, in which the cause is not clear.
Depending on the nature and degree of severity, the following types of ticks are distinguished.
Motor, among which distinguish:
- simple( involves the involvement of one muscle group) - tick face , shrugging, coughing, turning the head, sniffing;
- complex( which is characterized by a longer movement in several muscle groups, reminiscent of arbitrary acts) - bouncing;
- ritual( when walking in a circle);
- is dystonic;
Vocal, subdivided into:
- simple, which consist in shouting sounds( barking, coughing, etc.);
- complex - the child cries out words, parts of words. Characteristic echolalia( repetition of certain dictionary sequences), polylalia( repetition of the latter in the sentence of the word), coprolalia( repetition of abusive words);
Sensory, in which the internal desire for movement is transformed into a sensory phenomenon( in the same place, there are repeated sensory sensations - cold, heat, pressure).
Depending on the distribution, ticks also are distinguished:
- local, which capture only one group of muscles( usually face, neck and shoulders);
- multiple, for which the involvement of several muscle groups is characteristic;
- generalized - they represent a combination of motor and vocal tics( Tourette's syndrome).
Complemented etiologic classification:
- idiopathic tic tics in which no specific or suspected cause of the disease is identified, an exception is hereditary predisposition;
- organic, the cause of which are transferred or ongoing organic brain damage;
- are psychogenic, among which tics of intrusive and neurotic characters are distinguished. They are caused by the transferred situation, traumatic psyche, which the person deeply worries;
- is cryptogenic or neurotic like. They are based on some unidentified brain disorder, they are conditionally organic;
- is reflex, the occurrence of which is associated with the local tissue irritation present. For example, the appearance of blinking after inflammation of the mucous membrane of the eye;
- tics in other pathological processes and conditions. They are in two versions:
- in the first case, tick is an involuntary manifestation of some particular disease or pathological process( tics in case of pain, movement of hands when stuttering);
- in the second version of tick is not a sign of this disease, which is very rare.
Depending on the duration of the process,
- is allocated with transient patterns that are observed in the child every day for four weeks but less than one year;
- chronic - these are those that last more than a year.
Clinical manifestations of
Tics resemble natural gestures, which are extremely inappropriate in this situation. All varieties are characterized by intensification during anger, fear, excitement or excitement. Most often, children develop facial tics: blinking of the eyes, sniffing of the nose, stirring of the ears, twitching of the corners of the mouth, etc.
For such children psychologically it is characteristic: violation of attention, change in perception of space, delay in the development of motor skills and the ability to control oneself, awkwardness in movements, violation of their smoothness, slow fulfillment of movement acts. These children in the process of writing duplicate words and letters( "domasmashnyaya"), when answering a teacher's question they shout out from behind the desk( instead of raising their hand), which is why they are often called "upstarts".Also, they often do not understand the task, the solution of tasks is carried out unintelligently.
Depending on the clinical manifestations, frequency and spread of pathology, there are two degrees of severity of the disease: medium and heavy. The process of this disease is very variable, ticks can last up to tens of years. Also, the frequency of the pathology and its nature changes throughout the day: from rare jerking in the morning until frequent in the evening. In addition to the above, for teak typical unequal response to therapy: they can both quickly stop drugs, and remain resistant to treatment for many years. The motor type of pathology is characterized by an increase in the winter period( November-February).
Treatment of tics in children
The main thing in treatment is the exclusion of contributing factors. In the presence of chronic stress in family family sessions of family psychotherapy are shown. To correct the disturbances of the mental sphere and reduce the symptoms of anxiety, psychological correction classes are used in a playful form, using conversations and drawings. Also effective are group sessions with other children, which promote the development of communication skills and the reproduction of possible situations of conflict. Thanks to this, the child gets the opportunity to rehearse the probable variants of the development of events and choose the most optimal one.
Drug treatment is indicated when all alternative therapies have proved ineffective. The principle of treatment is that it begins with safer drugs and, in the absence of positive dynamics, shifts to heavier means. Initially, the therapy uses the lowest effective dose, which is gradually increased until it receives a positive dynamic( it is believed to reduce ticks to a minimum level).The effect of the drug taken is evaluated two weeks after the onset of the disease.
Baseline therapy of disorders includes two main drugs:
- phenibut from the group of antidepressants, which has anti-anxiety activity. Apply in a daily dose of up to 1000 mg;
- tiapridal in a dose of 100 mg per day.
Also in the treatment complex include nootropic drugs, vascular and vitamins. The admission of medications lasts up to six months after the disappearance of tics, then the dose slowly decreases until they are canceled.
In case of occurrence of ticks in 6-8 years the forecast favorable. In the case of development after 8 years, as a rule, they persist for life.