The exact mechanism of onset of symptoms has not yet been determined, but there are several hypotheses.
According to statistics, up to 10 children out of 1000 suffer from involuntary movements or sounds, up to 5 adults out of 10,000 try to hide tics from other people, are afraid to go out in public, to communicate with new people. Uncontrolled movements, shouting of incomprehensible words, insults, various sounds were combined as signs of Tourette syndrome in the 19th century.
In 1885, French neurologist Gilles de la Tourette published a report on 9 patients with the same symptoms. Previously they were described, including in fiction, but it was he who made the classification and analysis.
The first signs of Tourette syndrome appear most often in children between the ages of two and five years, and later their intensity decreases somewhat. In adolescence, however, they can manifest with new force. After 20 years, tics remain with a small number of people. Their intensity and frequency decreases markedly.
The disorder often affects boys – it occurs about 3 times more often in them than in girls.
Tics can occur in a variety of diseases. They are transient, which are characterized by changes in location and intensity, only chronic vocal or only motor. However, Tourette syndrome is said if tics:
- appear before the age of 18;
- arise as a primary phenomenon and are not directly related to any disease;
- persist without remission for more than a year;
- they appear as vocal and as motor, and some may appear first, others after some time.
However, sometimes tics that arise as a result of certain pathologies are also attributed to Toure-tta syndrome and are called turrettizm. Such involuntary movements occur on the background of encephalopathy, idiopathic dystonia, schizophrenia, psychogenic pathologies.
The main symptoms of Tourette syndrome are involuntary motor and voice disorders. They differ in duration, arise and increase under the influence of stressful situations, do not have rhythm.
Researchers note that before the start of a tick, a child has a strong arousal, tension. There is a desire to scratch the skin, sneeze, remove the mote from the eye, cough. Thus, he feels the approach of a tic. The involuntary movement itself is perceived as helping to eliminate an unpleasant sensation.
Tourette syndrome is often manifested by involuntary sounds, cries that appear either by themselves or with uncontrolled movements. Small children suddenly cry out, howl, hiss, moo, purr, cough. Sometimes cry out incomprehensible, non-existent words, syllables.
Older children have 3 types of vocal disorders. With echolalia, they repeat the words heard from the side, parts of words, phrases. With palilalia, words and sentences invented by themselves are aimlessly repeated. The most severe manifestation are coprolalia. In this disorder, the child shouts curses, insults, including obscene. It is observed not more often than in 10% of cases.
Motor disorders are manifested mainly in the form of involuntary winks, facial movements, grimaces, lip pulling, forehead wrinkling. A child may shake his head, shrug, jerk his hands, sniff his nose.
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In some cases, motor tics are more complex. The child involuntarily crouches, jumps, claps his hands, touches objects, hits his head on various surfaces, bites sponges to blood.
Degrees of severity
Scientists identified 4 severity of Tourette syndrome. With a mild degree, tics are hardly noticeable. The patient can control them. With a moderate degree of control is not always possible to maintain control. Involuntary movements are noticeable to others and appear more often.
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For the pronounced, frequent attacks of tics are characteristic, it is extremely difficult for the patient to restrain them with will power. When severe, he shouts curses. In this case, the other disorders are expressed very clearly, it is impossible to suppress them.
Tourette syndrome is characterized by some other signs. In particular, it is restlessness – a child cannot sit in one place for a long time and be engaged in one business. Poor concentration of attention is connected with this – the kid is constantly distracted, his attention switches from one object to another.
Often children with Tourette syndrome can not control their actions, make them under the influence of the moment, can not explain them, find the reason for them.
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. 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, the effects of toxicosis, 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.
When an involuntary movement occurs in a child, a consultation with a neuropathologist is indicated. The doctor will collect anamnesis, find out all the details regarding the appearance of ticks, clarify their presence with relatives and prescribe research. Their main goal is the differential diagnosis of the syndrome from other pathologies: rheumatic chorea, the occurrence of tumors, the juvenile form of Parkinson’s disease.
Electroencephalography, MRI, biochemical and complete blood count are assigned to the child.
To completely cure Tourette’s syndrome is impossible. Complex therapy, which would allow to cure tics, currently does not exist. The main role in the treatment is psychotherapy. Classes are held regularly and for a long time. Their goal is to find out what causes the seizures, how the child feels when they are. The psychiatrist teaches him to recognize the approach of a tick, to switch to other actions in order to avoid its occurrence.
Classes are also aimed at reducing mental stress and developing the ability to cope with anxiety, tension and anxiety. An important part is to assist in the adaptation to school, to society. Not only children can participate in the classes, but also their parents.
The main methods used for the correction of the violation or their prevention are fairy tale therapy, art therapy.
In addition to psychotherapy, applied treatment with the use of drugs. Antidepressants (Azafen), neuroleptics (Rispolept, Haloperidol), dopamine-lowering drugs (Metoclopramide, Eglonil) are used. Sometimes prescribed antihypertensive drugs, for example, Guangfotsin.
If a child has a speech disorder, speech therapy classes are conducted.
The consequences of Tourette syndrome relate primarily to the psycho-emotional sphere. Because of the constant ridicule in school, the child becomes anxious, nervous, withdraws into himself, often experiences depression and stress. Sometimes such a child becomes prone to aggression. Emotional distress leads to sleep disorders, prevents to adapt in society, meet new people, have friends.
Over time, the constant repetition of adverse and difficult situations leads to the formation of personality traits, which further hinder further adaptation. They remain with the person even after the tics have disappeared, become rare and insignificant.
In general, the disorder does not affect lifespan, mental or physical development.
The effect of genetic predisposition cannot be excluded in any way. To reduce the risk of neurological disorders in a child during pregnancy, it is important for the expectant mother to be seen by a doctor. You need to eat right, take medications only as prescribed by a doctor, do not smoke or drink alcohol.
Reduce the frequency and intensity of attacks can, if:
- avoid stressful situations;
- love the child and give him to make sure his feelings;
- avoid conflict situations, including those in which the child is not involved;
- engage with a psychologist or psychotherapist;
- help him adapt to children’s groups;
- develop artistic or musical abilities.
Tourette syndrome – it is not a sentence, it does not affect mental and physical development. Impacts on the emotional sphere can be avoided by creating favorable conditions in the family, visiting a psychologist, and helping the child with everything. Most often, the symptoms disappear after 18-20 years.