What Are the Different Types of Tic Disorders?

Tic disorder is a complex disorder that starts in children and adolescents and is characterized by rapid, involuntary, sudden, repetitive, arrhythmic, stereotyped, single or multi-site muscle movement tics or (and) vocal tics. And chronic neuropsychiatric disorders. According to the age of onset, course of disease, clinical manifestations, and whether or not accompanied by vocal tics, it is divided into three clinical types of transient tic disorder, chronic motor or vocal tic disorder, and Tourette syndrome.

Basic Information

Also known as

Tic disorder

English alias

ticdisorders

Visiting department

Pediatrics

Multiple groups

Children, adolescents

Common symptoms

Motion twitch

Causes of tic disorder in children

The etiology of tic disorder is unclear, and its occurrence is mainly related to the following factors.

Heredity

Studies have confirmed that genetic factors are related to the occurrence of Tourette syndrome, but the genetic pattern is unclear. A family survey found that 10% to 60% of patients had a positive family history. Twins studies confirmed that the rate of homozygous twins (75% to 90%) was significantly higher than that of single twins (20%). The incidence of tic disorder in foster relatives was significantly lower than in blood relatives.

2. Neurochemical abnormalities

There may be neurotransmitter disorders such as DA, NE, and 5-HT in tic disorders. Most scholars believe that the occurrence of Tourette syndrome is related to the excessive release of striatum dopamine or the hypersensitivity of post-synaptic dopamine D ₂ receptors. The dopamine hypothesis is also an important hypothesis of the etiology of Tourette syndrome. Some scholars believe that this disease is related to central noradrenergic system hyperfunction, endogenous opioid peptides, and 5-HT abnormalities.

3. Abnormal brain structure or function

Cortical-striatal-thalamic-cortical (CSTC) loop structure and dysfunction are related to the occurrence of tic disorders. Structural MRI studies found that the volume of the caudate nucleus in the basal ganglia of children and adults with tic disorder was significantly reduced, and the local gray matter volume in the left hippocampus increased. Functional MRI studies of vocal tics revealed abnormal activation of the basal ganglia and hypothalamus in patients with tic disorders. It is speculated that the occurrence of vocal tics is associated with abnormal regulation of subcortical neural circuit activity.

4. Psychological factors

Various psychological factors encountered by children at home, school, and society, or the causes of children's nervousness and anxiety, may induce or make the tics worse.

5. Immune factors

Studies have shown that the onset of patients is related to the immune response of hemolytic streptococcal infection, and immunosuppressive therapy is effective in some patients.

Clinical manifestations of tic disorder in children

Basic symptoms

Mainly manifested as motor tics and / or vocal tics, which can be divided into two types: simple tics and complex tics. The simple forms of motion twitches are blinking, nose blowing, crooked mouth, shrugging, turning shoulders or oblique shoulders, etc., tics can occur in a single part or multiple parts of the body. Complex forms of motor tics include bouncing, running, spinning, bending, slapping yourself, and obscene behavior. The simple forms of vocal tics are clearing the throat, roaring, blowing your nose, dog barking, etc. The complex forms are repeated words, imitating words, dirty words (uncontrollable swearing), and so on.

The characteristics of tics are involuntary, sudden, rapid, repetitive, and non-rhythmic. They can be controlled by the will and do not occur for a short time, but they cannot control the symptoms for a long time. Attacks are more frequent under psychological stimuli, emotional stress, stressful learning, physical illness or other stressful conditions, and symptoms alleviate or disappear during sleep.

2. Clinical type

(1) Transient tic disorder is the most common. It is mainly manifested as simple motor tics symptoms, which are mostly on the head and face, and can be manifested in blinking, nose-bending, wrinkle, mouth opening, side view, shaking head, torticollis and shrugging symptom. A few manifestations are simple vocal tics, such as throat clearing, coughing, roaring, nose blowing, dog barking or monotonous sounds like "ah" and "ah". Complex motion twitches at multiple locations can also be seen. In some patients, the tics are always fixed in one area, while in others, the tics are variable. The onset of this subtype occurs early in school age, and is most common in children aged 4 to 7 years, with most males. Symptoms occur multiple times in a day, lasting at least 2 weeks, the US diagnostic standards require at least 4 weeks, and the course of this subtype requires no more than one year.

(2) Chronic motor or vocal tics disorders Most patients present with simple or complex motor tics, and a few patients present with simple or complex vocal tics. Generally, only one form of motor twitch or vocal tics appears in the same patient. In addition to the head, face, neck and shoulder muscles, tics often occur in the muscles of the upper and lower limbs or trunk, and the symptoms are generally persistent. The frequency of tics may occur daily or intermittently, but the interval between attacks will not exceed 2 months. Chronic tic disorder lasts for more than a year.

(3) Tourette syndrome is also called Tourette syndrome, vocalization combined with multiple motor tics, tic disorder, and multiple tics. The clinical features are progressive multi-site motor tics and vocal tics. The general first symptom is simple motor tics, with facial muscles being the most frequent, intermittent. The first symptom in a few patients is simple vocal tics. As the course of the disease progresses, the number of twitches increases, which gradually affects the shoulders, neck, limbs, or trunk, etc., and the form of expression also develops from simple tics to complex tics, from single motor tics or vocal tics to both. The frequency also increases. About 30% of them have profanity or obscenity. Most patients have tics every day, and a few patients have intermittent tics, but the interval between attacks does not exceed 2 months. The course of the disease has continued for more than one year, which has a great impact on the social function of patients.

3. Other performance

Some patients are accompanied by attention deficits, anxiety, depression, and obsessive-compulsive symptoms. Such as Tourette syndrome with 50% to 60% combined with ADHD, 40% to 60% combined with compulsive personality and compulsive symptoms, a small number of patients have symptoms of emotional instability or irritability, disruptive and aggressive behavior, sleep disorders and other symptoms.

Treatment of children with tic disorder

Choose different treatment strategies and methods according to clinical type and severity. For patients with transient tic disorder or mild symptoms, only psychological treatment can be used. Chronic motor or vocal dysfunction, Tourette syndrome, or tic symptoms severely affect daily life and learners, drug treatment is the main, combined with psychotherapy. If the patient develops due to psychological factors, they should be actively removed.

Drug treatment

(1) Haloperidol Effectiveness is 60% to 90%. 1-2 times a day, observe 3 days to 7 days, if the side effects are not obvious, increase the dose. In the process of increasing the dosage, the dosage should be adjusted according to the treatment effect and side effects. The drug has mainly sedative and extrapyramidal side effects.

(2) Telebilli The effective rate is 76% to 87%, which is characterized by fewer extrapyramidal side effects and is suitable for patients over 7 years old. 2 to 3 times a day. Common side effects are drowsiness, fatigue, dizziness, gastrointestinal upset, excitement, and insomnia.

(3) clonidine can improve tics, with an effective rate of 50% to 86%. The drug can also improve symptoms of attention deficit and hyperactivity, and it is the first choice for patients with combined ADHD or induced tics due to the use of central stimulants for ADHD. At present, transdermal patches are mainly used in China. Side effects include drowsiness, hypotension, dizziness, and dry mouth.

(4) Risperidone It has been reported that risperidone is effective in treating this disease. The drug has mainly sedative and extrapyramidal side effects.

2. Psychotherapy

There are mainly psychological support therapy, cognitive therapy and behavioral therapy. The purpose of psychological support and cognitive therapy is to adjust the family system, let patients and family members understand the nature of the disease, the causes of the fluctuations in symptoms, eliminate the adverse factors that may have an effect on the occurrence or maintenance of symptoms in the school and home environment, and reduce the patient's tics Symptoms of anxiety and depression are secondary to improving social function in patients. There is evidence to support that behavioral therapy such as habit reversal training has a positive effect on correcting tics.

3. Other treatments

For refractory cases that are ineffective with multiple medications, transcranial magnetic stimulation, deep brain stimulation (DBS), or neurosurgery stereotactic surgery, such as putamen cystectomy, can be tried. However, the consensus of experts in this field is that DBS treatment is still in the early stages of research, and rigorous controlled studies need to be designed to further verify its efficacy and safety. It is only suitable for adult patients, patients with difficult treatment and affected patients, not recommended for childhood.