Tourette's syndrome (disease) is a disorder of the central nervous system (brain) that manifests itself as involuntary motor and / or vocal tics (twitching).
Typically, Tourette's syndrome occurs in children and adolescents under 20 years of age. Despite the fact that the disease is 4 times more likely to be diagnosed in boys, the manifestations of Tourette's syndrome in girls appear earlier.
Not so long ago, Tourette's disease was considered a rare pathology, but today it has been established that this disease occurs in 0.05% of cases among 10,000 children.
The degree of the syndrome
Tics are repetitive, repetitive, and involuntary movements and expressions. In this regard, motor tics and sound tics are distinguished. According to the duration of tics, transient and chronic tics are distinguished, respectively, lasting from 4 to 12 months or more than a year.
There are also 4 degrees of severity of Tourette's syndrome:
- Easy degree. External manifestations (tics) are practically invisible, patients can control them in society. Symptoms may be absent for a short period of time.
- Moderately pronounced degree. Vocal and motor tics are noticeable, the possibility of self-control remains. There is no period without manifestations.
- Pronounced degree. Tics are pronounced, patients control them in society with great difficulty.
- Severe degree. Pronounced manifestations of Tourette's syndrome, there is no ability for self-control.
Causes
The exact causes of Tourette's syndrome have not been established. It is assumed that the disease has a genetic predisposition and is associated with a violation the exchange of neurotransmitters (substances that communicate between nerve cells), in particular dopamine.
Also, the impact of poor ecology in the early stages of pregnancy is not excluded, which leads to genetic abnormalities.
In some cases, Tourette's syndrome develops as a result of taking medications (antipsychotics).
Also, infectious factors (post-streptococcal autoimmune process) and autoimmune diseases affect the course and severity of the disease.
Symptoms of Tourette's Disease
The main manifestation of Tourette's syndrome is motor and vocal tics, which first appear in children aged 2 to 5 years. In turn, ticks can be simple or complex.
Motor tics
Simple motor tics do not last long and are performed by one muscle group. It can be involuntary frequent blinking, sniffing, pulling the lips into a tube, the appearance of grimaces, shrugging, hand twitching, scratching, frowning, head twitching, teeth clicking, and other.
Difficult motor tics include jumping up, touching an object or person or parts of your body, hitting your head against a wall, pressure on the eyeballs, a sharp throwing of the leg forward, hand claps, biting the lips to blood, indecent gestures, etc. like that.
Vocal tics
Vocal simple tics are characterized by sudden sounds from the patient (barking, coughing, grunting, howling, hissing, rumbling).
Complex vocal tics appear as whole words or phrases that are meaningless in their essence. For example, each sentence begins with a definite and incomprehensible phrase ("it's okay, you know, shut up").
A characteristic, but not obligatory symptom of Tourette's syndrome is coprolalia - the sudden shouting of obscene or offensive words.
Echolalia - multiple repetition of one or more words after the interlocutor.
Palilalia is the repetition of one's own words or phrases.
Also, vocal tics include a change in tone, rhythm, accent and intensity of speech, sometimes speech becomes very fast that it is impossible to make out a word.
Tourette's syndrome can occur in waves, with the disappearance or diminution of symptoms, or constantly, when there are no periods of improvement.
Typically, Tourette's disease begins to subside after puberty.
Also, in addition to motor and vocal tics in Tourette's syndrome, there are behavioral disorders and learning difficulties, although the intellect in patients with this disease does not suffer:
- Obsessive-compulsive thinking syndrome. With this syndrome, the patient is haunted by fear for the health of loved ones, the fear of contracting an infection (frequent washing of hands and washing), a sense of guilt for the misfortunes that relatives have experienced.
- Attention deficit disorder. This syndrome is associated with an inability to concentrate, increased activity and learning difficulties.
- Emotional lability, aggressiveness and impulsivity. It is manifested by emotional instability, screaming threats, pugnaciousness, attacks on others.
Diagnostics
Diagnosis of Tourette's disease is based on the collection of anamnesis (the presence of relatives with this disease), characteristic symptoms that occur for a year or more.
At the first visit of a patient with Tourette's syndrome, a neurological examination is performed, the purpose of which is to exclude organic damage to the brain (tumor). For this, the patient undergoes computed tomography, nuclear magnetic resonance and electroencephalography. A biochemical blood test is also examined to exclude metabolic disorders.
Differential diagnosis is carried out with many diseases (Wilson-Konovalov disease, Huntington's chorea, juvenile Parkinson's disease, rheumatic chorea and others).
Treatment for Tourette's syndrome
Patients with Tourette's are treated by a psychiatrist. Since the disease makes its debut in childhood, a pediatrician, a neuropathologist, an ophthalmologist (according to indications) and a speech therapist (with difficulties with speech) are involved in the treatment.
Medical treatment for Tourette's disease is carried out taking into account the tics, their number and frequency.
The most commonly used drugs are antipsychotics (haloperidol). However, due to severe side effects, haloperidol is rarely prescribed for a short period of time. Antihypertensive drugs (clonidine and guanfocine) are also used to treat tics (side effect - sedation).
The main role in the treatment of Tourette's syndrome is played by psychotherapy, both with the child and with his parents. The patient needs to be instilled with an adequate attitude to his condition and the absence of impairment. They use special games, therapeutic communication with animals, active physical rest.
Forecast
The prognosis for Tourette's syndrome for life is favorable.
In most cases, Tourette's syndrome disappears or decreases after puberty. Despite the fact that the disease is lifelong, no degenerative disorders of the brain are observed, therefore, mental capacity is not affected.
Over time, the patient learns to control his tics and behave appropriately in society.
