Tic is a type of hyperkinesis. Represents involuntary stereotyped movements that resemble arbitrary. In most cases, it occurs in childhood. It is provoked by neuroses, residual organic insufficiency due to harmful effects in the prenatal period and early childhood. Seen in Tourette's syndrome. Sometimes it occurs secondary to other CNS lesions. The cause is determined on the basis of a survey, examination, data from a psychodiagnostic examination, CT, MRI, and other procedures. Treatment - psychotherapy, psychocorrection, drug therapy, physiotherapy. Operations are sometimes shown.
Tics are non-rhythmic movements or sounds that occur unexpectedly and are stereotyped over and over again. In most cases, they are observed in childhood, weaken or disappear after the completion of puberty. There are the following variants of tic acts:
1. Motor:
2. Vocal.
Motor tics are also divided into clonic and tonic. In the first case, the movements are short-term, fast, sudden, in the second - slower, with a relatively prolonged muscle contraction. They can be local (involving the muscles of one area, such as the eye area), multiple (spreading over several areas, such as the face and shoulder), and generalized.
Taking into account the cause of the occurrence, tics are primary (neurosis-like, neuropathic, neurotic, in patients with Tourette's syndrome) and symptomatic (in other diseases). The circumstances of the development of seizures depend on the cause of the tics. With residual organic pathology, the symptom occurs due to overexcitation. In patients with early neuropathies, overwork plays a decisive role. In neurosis, the main factors are fear, anxiety and anxiety.
Primary tics, which are of residual organic origin, confirmed by the corresponding changes in the EEG. They develop under the influence of negative factors during pregnancy (bad habits and diseases of the mother, fetal hypoxia, preeclampsia, prematurity, complications in childbirth) or in the first years of life (neuroinfection, TBI, intoxication). They usually make their debut at 7-1 years old.
Characterized by a steady course, the presence of a clear "tic focus" with a tendency to spread tics. They do not decrease during periods of rest (on vacation), on the contrary, they often appear for the first time in a favorable psychological environment. Most often, they begin with blinking, in the absence of treatment they spread to other parts of the face (grimacing), shoulders, sometimes the upper body, less often legs.
Pathology is genetically determined, more often transmitted through an autosomal dominant, less often through an autosomal recessive or polygenic pathway. As a rule, it manifests at 5-6 years of age by grimacing, winking, blinking, twitching the shoulder girdle, clapping the palms, and other movements in the face and upper half of the body. Motor tics are complemented by sound tics. Then hyperkinesis spreads to the lower part of the body and legs, and becomes more complicated. Echopraxia, copropraxia, accidental self-harm are possible.
Develop against the background of early childhood neuropathy. They first appear at the age of 3-8 years. Children are anxious, restless, prone to stereotypical movements, mobile, but with insufficiently developed coordination, which causes an increased likelihood of injury. Often suffer from vegetative disorders and meteorological dependence. Tics, as a rule, are local, sometimes spreading over several zones, appear or become more frequent with overwork, an excess of impressions.
Teak
They can develop at any age, starting from 3 months, provoked by mental trauma and emotional upheaval: sudden fear, expectation of bad things, unusual circumstances of communication, external conflicts and internal contradictions. Often they are part of the clinical picture of obsessive-compulsive disorder. Rarely develop with other neuroses in children.
Tics are realized, briefly give in to conscious control, followed by "return" in the form of increased tic movements. Arise or become more frequent in a state of passive attention, overwork, strong excitement. Characterized by instability, frequent change of one tick by another. Children with obsessive-compulsive disorder try to overcome the "bad habit". Attempts to delay on the part of the child or parents (remarks, prohibitions) worsen the psycho-emotional state, provoke aggressiveness, irritability, headaches.
Secondary tics are observed in diseases and pathological conditions accompanied by damage to the extrapyramidal system. Distinctive features are constancy (a rare change in localization, strength and frequency), the impossibility of conscious suppression, a combination with other neurological disorders and pathopsychological disorders. The main provoking factors are:
In addition, secondary tics are sometimes found after streptococcal infections (eg, tonsillitis) and other infectious diseases. Occur or worsen during the recovery period or some time after the normalization of the condition.
With neuralgia, special tic movements are noted - painful tics, which are muscle twitches against the background of intense pain. Detected in the following diseases:
Diagnostic measures are carried out by a neurologist. If a neurotic character of tics is suspected, patients are referred to psychotherapists and psychiatrists. With neuralgia, consultations with a dentist and an otolaryngologist are recommended to identify diseases that can provoke nerve compression. During the conversation, the time of occurrence and the dynamics of the development of ticks are established.
As part of a neurological examination, the localization, severity and prevalence of tic movements, the patient's ability to conscious control are assessed. Neurological abnormalities are identified that may indicate the cause of tics. The program of additional examination includes such procedures as:
Electroencephalography
The treatment program for primary tics is compiled according to general principles with slight variations due to the etiology of the symptom:
The selection of drugs for secondary tics is carried out taking into account the type of causative pathology. With neuralgia, anticonvulsants, antispasmodics, antihistamines are used. Perform therapeutic blockades. Physiotherapeutic procedures are prescribed to reduce pain and inflammation.
If the conservative therapy of the trigeminal nerve is not effective enough, microsurgical decompression is performed or the sensory nerve root is destroyed by gamma radiation using stereotaxic techniques. Perhaps the intersection of the branches of the nerve trunk by percutaneous radiofrequency destruction.
Patients with lesions of the ear node may be shown sanitizing operations on the middle ear, removal of stones or neoplasms of the salivary gland, other otolaryngological and dental interventions. Adult patients with Tourette's syndrome perform deep brain stimulation, however, the technique is still considered experimental, it is not used in children.