Description of generalized tics in children and the main etiological factors of its development. The clinical picture of manifestations and varieties of symptoms that occur in this nosology. The main approaches to the treatment of Tourette's syndrome in a child. Generalized tics in children (Tourette's syndrome) is an inherited neurological disorder that manifests itself in the presence of tics, both motor and vocal. Often in the structure of nosology, coprolalia is distinguished - the uncontrolled shouting of obscene words and expressions. Most often, the first symptoms appear in early childhood. By the time of puberty, the full picture of Tourette's syndrome unfolds.
Description and development of generalized tics in a child
At the heart of this disease is a neurochemical failure, which entails the corresponding symptomatology. It is known that mental processes in the human body are regulated by the hormone system - dopamine, norepinephrine and serotonin. All emotions that can be expressed are formed by the ratio of different levels of these substances. Also, many other important functions of the body depend on them. Tourette's syndrome is caused, in fact, by a failure of the ideal balance between these neurotransmitters. That is why the first symptomatology arises, which is manifested by changes in behavior, emotional response and dysregulation of motor functions. Statistics show that boys get sick on average 4 times more often than girls. The disease occurs between the ages of 4 and 15. Depending on the severity of the symptoms, the adaptation of a particular person in adulthood is manifested. Existing treatments only relieve symptoms and make you feel better. Unfortunately, it is not yet possible to completely cure generalized tics.
Causes of generalized tics in children
This disease is considered to be hereditary, since it is transmitted from generation to generation in an autosomal manner, both in a dominant and a recessive manner. That is, it is impossible to predict the 100% probability of having a child with Gilles de la Tourette's syndrome for sure.
Although statistics show that boys are much more likely to suffer from this nosology, studies have not yet confirmed the connection of the gene with the Y chromosome at the moment. Even the presence of a predisposition or changes in DNA does not guarantee the development of this disease. To start, provoking factors are needed. That is, even if a child has inherited the Tourette's gene, he will not necessarily be sick, but may remain just a carrier for life. The predisposing factors can be divided into several groups:
- Infection … The development of an inflammatory process in the body with an aggressive pathogen significantly weakens the child's immune system, depletes resources and requires a long recovery period. Against this background, an imbalance in the neurotransmitter system easily arises, which can trigger a genetic predisposition to Tourette's syndrome. Most often, it is streptococcal infection that provokes the manifestation of the gene. It specifically affects the neurochemical balance and can cause the development of clinical symptoms of the disease.
- Intoxication … This refers to both long-term exposure to potent substances and acute poisoning with poisons. That is, any intake of toxins that negatively affect the central nervous system will easily provoke the development of Tourette's syndrome if a certain gene is determined in the child's DNA. Neurotoxins directly destroy the balance between dopamine, norepinephrine and serotonin, thereby causing the primary symptoms of intoxication. After some time, the symptoms of this disease join.
- Hyperthermia … Febrile conditions and fevers, when the temperature exceeds 38 ° C, are especially dangerous for the child and his central nervous system. If these figures go beyond 40 ° C, the danger to the child's life increases several times. Fever, in addition to direct negative effects, can provoke the development of various symptoms, which are determined by DNA, including generalized tics.
- Emotional stress … Severe psychological stress, which does not go away for a long time, can leave traces behind for many years. Basically, the shattered children's psyche is supplemented by various diseases that have not manifested themselves before. The tendency to develop Tourette's syndrome turns into a full-fledged disease.
- Taking psychotropic drugs … The presence of various psychological problems and diseases in children in some cases requires the prescription of drugs that affect the balance of neurotransmitters. Thus, external intervention with pharmacological drugs allows you to correct the existing mental disorder and achieve better health. In addition, exposure to psychotropic drugs can trigger a cascade of reactions that manifest Tourette's syndrome.
The main signs of a generalized tic in a child
The first manifestations of this disease can be noticeable already at the age of 4 years. The main symptoms that make up Tourette's syndrome are involuntary actions (generalized tics), including verbal expressions that occur unconsciously. The person does not control them at all, despite the emotional coloring in the form of coprolalia. It can also be sounds, movements and other stereotypical manifestations of an involuntary nature.
General characteristics
Children with Tourette's syndrome are quite visible in society due to the characteristic tics:
- Monotony … Each child develops his own individual set of movements, expressions, which is repeated from time to time in the form of an attack.
- Transience … Each tick takes a few seconds and stops. A single seizure can be characterized by a variety of different motor and vocal tics that have a distinct beginning and ending.
- A period of calm … A relatively small amount of time a child suffering from this disease spends without seizures. Most often this happens in the absence of any kind of stimuli in complete rest.
- Rhythm … Attacks can be of different duration, and also occur more often at one time and less often at another.
- Dominant … Each tick in Tourette's syndrome is accompanied by a characteristic onset. The child feels an irresistible desire to perform an action or express it verbally. In this case, the sensations are similar to itching, which will decrease, only by satisfying the need.
Motor tics
A kind of spontaneous actions, which are based on the movement of body parts into meaningless and even strange postures. In most cases, they bring at least physical discomfort and pain. Most often, this is a tension of a muscle group, a jump, a clap, a stereotypical action with the help of facial muscles, tapping, clinking.
Motor tics often duplicate obscene expressions in the form of characteristic gestures. Naturally, the child has absolutely no control over his own body at the moment, and all actions should be perceived as a manifestation of the disease. It is customary to divide motor tics into two main groups:
- Simple tics … This includes activities that involve only one muscle group. They are stereotypical and short-lived. Most often, such a tic is perceived as a one-time twitching of a limb or other part of the body and causes much less trouble than the next group.
- Complex tics … These involve the muscles of several groups, which work together to express some rather complex movements. The child can purposefully bang his head against the wall, grimace, touch himself or others. Complex tics take longer and look like the person is aware of what they are doing. In fact, this is not the case.
Sound tics
This includes not only verbal unconscious expressions, but also all kinds of sounds. The child may whisper, hiss, cough, and even whistle. Such short sound tics are most often seen in conversation when the patient is trying to explain something important. Speech defects often occur during an emotionally charged conversation or just excitement. Similar to motor tics, sound tics are also divided into simple (hiss, whistling, whispering) and complex (words and phrases). In addition, there are several of the most common types of vocal tics:
- Coprolalia … This symptom is observed in almost one third of all patients with generalized tics. It is characterized by the appearance in the conversation of phrases and words with obscene expressions. It also arises, like other symptoms, completely involuntarily and does not depend on the situation in which the child is at the moment. That is, he can swear both on the street, at home, at a party, and in a concert hall.
- Echolalia … Obsessive repetition of the last words spoken by the interlocutor. The child takes a separate phrase out of context and repeats it all the time. Most often, it does not carry any semantic meaning.
- Palilalia … Obsessive repetition of your own words. The child seems to get stuck on the phrase he said and is not able to continue the thought. Usually, after several repetitions, the manifestations of palilalia diminish.
Features of the treatment of generalized tics in children
It is generally accepted that this disease cannot be cured to the end. Existing techniques are aimed at reducing the number of symptoms that appear, as well as adapting patients in society. After all, Tourette's syndrome is a big social problem. Nearly healthy children cannot adapt to life due to tics, which make it difficult to communicate with others. Therefore, first of all, the treatment of generalized tics in children is aimed at helping in the socialization of patients and their adaptation to a normal lifestyle.
Support from relatives
This is an extremely important aspect in terms of adapting a child to a lifestyle where illness takes up most of it. First of all, parents need to create conditions where the child will be perceived as an ordinary average statistical one.
The characteristics of the disease should be explained to teachers at school or educators. Children with Tourette's syndrome may well study on an equal basis with everyone, they do not have to be sent to a separate closed boarding school for the "special". This will only aggravate the situation and the child's confidence in his own inferiority. It is important to explain to him the essence of his illness so that he does not consider tics to be something shameful or extremely undesirable. He should be convinced that the symptoms remain symptoms, both in bronchial asthma, diabetes mellitus, other somatic diseases, and in Tourette's syndrome. When others, parents, friends, and teachers begin to ignore the symptoms and focus on something really important, the child will feel much easier emotionally. Consequently, the frequency of ticks may decrease over time. In no case should you shout and scold him for the manifestations of the disease, he is completely innocent of his actions / expressions and does not even deserve a raised tone. If family and friends fail to create a favorable environment for the development of a child with Tourette's syndrome, the effectiveness of pharmacotherapy will be much lower than expected.
Drug therapy
The use of pharmacological drugs should take place under the strict supervision of a physician, because only a specialist understands how to treat Tourette's syndrome correctly. The use of psychotropic drugs requires increased control and careful selection of the dosage in each case. Most drugs used for generalized tics have many side effects. The doctor weighs the probable benefits of the use and the possibility of undesirable manifestations of each drug, taking into account the individual signs of the disease, and prescribes therapy.
Features of pharmacotherapy for Tourette's syndrome in a child:
- Dosage … The amount of psychotropic drug should be minimal for a day at the beginning of treatment and gradually increase to the required therapeutic dose that will have the expected effect.
- Duration … Pharmacological agents are prescribed for this disease for a long time. The body gets used to the new substance and includes it in the metabolism. Abrupt withdrawal of the drug can cause a number of side effects, including worsening of the symptoms of the disease.
- Dose support … An increase in a single or daily dosage of the drug occurs until the first signs of its effectiveness. It is called minimally effective or supportive. The doctor stops at this dosage and prescribes for a long time.
- Correction … Any changes in the treatment regimen occur gradually with increasing or decreasing the dosage of the drugs.
Non-drug treatments
Every year, a lot of research is carried out, which are aimed at finding new ways to treat generalized nervous tics in children. Some of them are focused on the use of non-drug methods. Their use does not cause side effects and can be prescribed in more cases.
The following techniques are most commonly used:
- Psychotherapy … An experienced specialist will help the child to disassemble in detail all their complexes associated with the disease, as well as gradually get rid of them. With the help of psychotherapy, patterns of behavior in society are developed that minimize the chances of rejection and rejection, and also teach you how to cope with everyday tasks.
- Behavioral therapy … With the help of special trainings with specialists, the child learns to identify a future attack and extinguish it through conscious setting movements, and not unconscious tics. If you can form a clear connection between the conscious movement and the rolling seizure, you will be able to suppress your symptoms. Naturally, the method requires constant training on yourself.
- Electrostimulation … This method is used in extreme cases, when the symptoms are not eliminated with the help of pharmacological drugs (even in large doses) and psychotherapy. Such persistent forms of Tourette's syndrome are treated with the implantation of an electrostimulator into the parts of the brain. It acts directly on those zones that are responsible for the manifestations of tics.
How to treat generalized tics in children - watch the video:
Gilles de la Tourette's syndrome is a huge problem of our time. Beginning in childhood, the disease complicates the entire process of growing up, leaving its mark on the character and personality of a person. That is why early diagnosis and treatment will help the child to adapt to a normal life in the future. When the first generalized tics appear, you should definitely consult a doctor.
