Tourette syndrome is a serious neurological disorder. It usually occurs in children and adolescents under 20 years of age. Boys suffer from this pathology much more often than girls. The disease is accompanied by involuntary movements, tics and cries. A sick person is not always able to control these actions. Pathology does not affect the mental development of the child, but serious deviations in behavior significantly impede his communication with others.
Pathogenesis
What kind of disease is Tourette's syndrome? At first glance, the manifestations of pathology look like oddities in behavior, and sometimes like ordinary bad manners. However, the disease is a serious disorder of the nervous system and psyche.
Currently, there are different theories about the mechanism of development of this disorder. It has been established that in the pathological processthe basal ganglia of the frontal subcortex are involved. and frontal lobes. These are areas of the brain that are responsible for motor function. It is their defeat that leads to the appearance of tics and uncontrolled movements.
In addition, people with Tourette's syndrome have an increased production of dopamine. This substance is considered the "hormone of pleasure", it is responsible for the mood of a person. However, an excess of dopamine leads to excessive nervous excitement. Therefore, children suffering from this disease are often hyperactive. Tourette's syndrome in adults is often accompanied by increased impulsivity, irascibility, emotional instability.
Causes of disorder
The exact etiology of this syndrome has not been established. There are only hypotheses about the origin of the disease. Among medical scientists, the following assumptions about the probable causes of the pathology are most common:
- Genetic factor. Patients are often interested in the question of whether Tourette's syndrome is inherited. It has been established that if one of the parents suffers from this disease, then the probability of having a sick child is about 50%. To date, the gene responsible for the development of the syndrome has not been identified. Sometimes pathology is detected not in parents, but in other close relatives of sick children. When a gene is passed on, a child does not necessarily develop Tourette's syndrome. However, as a person ages, other forms of tics or obsessive-compulsive disorder may develop.
- Autoimmune pathologies. If a person has a hereditary predisposition to this disease, then the causeTourette's syndrome can become transferred streptococcal infections. After scarlet fever or pharyngitis, autoimmune complications often occur that have a negative effect on the nervous system and can provoke tics.
- Pathological course of pregnancy in the mother of the child. Oxygen starvation of the fetus, toxicosis, and birth trauma can lead to the development of Tourette's syndrome in a baby. The disease in a child can also occur if the expectant mother takes certain medications in the early stages of pregnancy.
- Use of neuroleptic drugs. Antipsychotics have an unpleasant side effect, these drugs can cause hyperkinesis - conditions accompanied by chaotic involuntary movements. This syndrome also refers to hyperkinetic disorders.
ICD classification
According to the International Classification of Diseases of the tenth revision, this pathology refers to ticks and is indicated by the code F95. The full ICD code for Tourette's syndrome is F95.2. This group includes diseases accompanied by multiple motor tics in combination with voice disorders (vocalisms). A sign of this type of pathology is the presence of several motor tics and at least one vocalism in the patient.
Motor disorders
The first manifestations of the disease occur at the age of 2-5 years. Often, parents and others take these symptoms for the characteristics of the child's behavior. Look out for the following signs:
- The baby often blinks, grimaces, makes faces. Thesemovements are repeated constantly and are involuntary.
- Child often pulls out lips and folds them into a tube.
- There are frequent and involuntary movements of the shoulders and hands (shaking, twitching).
- The child periodically frowns, scratches, shakes his head.
Such movements are called simple motor tics. Usually they involve one muscle group. Tics recur periodically in the form of seizures. The movements are compulsive, and a small child cannot stop them by willpower.
As the disease progresses, several muscle groups are involved in pathological movements at once. Seizures become more severe. Complex motor tics appear that affect not only the face, but also the limbs:
- Child begins to squat constantly.
- Baby bounces often.
- Clapping hands or obsessive finger touching of various objects are noted.
- In severe tics, the child hits the head against the walls or bites the lips until it bleeds.
Tourette syndrome is always accompanied by changes in the behavior of the child. The kid becomes overly emotional, restless and capricious. He avoids contact with peers. There are mood swings. The child has frequent depressions, which are then replaced by increased energy and aggressiveness. Children become inattentive, it is very difficult for them to concentrate on the perception of information or completing school assignments.
Children sufferingthis syndrome, often sniffle. This is also a type of tic, but parents may mistake this sign of illness for a symptom of a cold.
Voice disorders
Along with involuntary movements, voice disturbances are also observed. They also come in the form of seizures. Suddenly, the child begins to make strange sounds: howling, hissing, rumbling, lowing. Often children shout out meaningless words during an attack.
At older age, children have the following voice disorders:
- Echolalia. The child repeats parts of words or whole words and sentences after others.
- Palilalia. Children repeat their own phrases over and over again.
- Coprolalia. This is a compulsive shouting of insults or curses. This symptom greatly complicates the life of patients. Not everyone around knows what kind of disease it is. Tourette's syndrome interferes with normal communication and life in society. Coprolalia is most often perceived as rudeness and bad manners. For this reason, patients are often closed and avoid contact with people. However, coprolalia occurs in only 10% of patients.
Most often, the signs of this disease subside by the age of 18-20. However, this is not always the case, sometimes motor and voice disorders persist throughout life. At the same time, severe forms of pathology in adults are rare, since the manifestations of the disease decrease with age.
Stagesdisease
In medicine, there are several stages of Tourette's syndrome. The less a person is able to control involuntary movements and vocalisms, the more severe the disease:
- Tics are almost invisible in the first stage of the disease. A person is able to control them when he is in the company of other people. Symptoms of pathology may be absent for some period of time.
- In the second stage, the patient still retains the ability of self-control. But he does not always manage to stop the manifestations of the disease by an effort of will. Voice and motor tics become noticeable to others, the periods between attacks are reduced.
- The third stage of the disease is characterized by frequent attacks. Patient controls tics with great difficulty.
- At the fourth stage, the signs of the disease are clearly expressed, and the person is not able to suppress them.
Often people around are interested in the question: "Can the patient independently stop the emerging tics and cries?". As the disease progresses, it becomes more and more difficult for the patient to control his actions. Usually, before an attack, the patient experiences an uncomfortable state with an irresistible desire to make one or another movement. This can be compared to the need to sneeze or scratch the skin when itching.
Diagnosis
Tourette's syndrome is diagnosed and treated by a neurologist or psychiatrist. A specialist may suspect the disease by the following signs:
- onset of tics before the age of 18;
- duration of symptoms throughoutlong time (at least 1 year);
- presence of at least one vocal tick in the clinical picture.
It is important to remember that involuntary movements are also observed in organic lesions of the central nervous system. Therefore, it is important to conduct a differential diagnosis of Tourette's syndrome. For this purpose, MRI and CT of the brain are prescribed. You should also take a blood test for copper content. Tics can be observed with an increased content of this element in the body.
Psychotherapy
Psychotherapy plays a major role in the treatment of Tourette's syndrome. It is impossible to get rid of this disease completely, but its manifestations can be significantly mitigated.
Psychotherapeutic sessions should be carried out for a long time. It is important to find out in which situations seizures most often occur. Typically, the appearance of tics is preceded by stress, a feeling of anxiety and excitement. The work of a psychotherapist should be aimed at calming the patient's psyche. It is necessary to develop the patient's ability to cope with anxiety and excitement.
The task of the psychotherapist is the maximum adaptation of the patient to life in society. Often, patients experience feelings of guilt and shame for the manifestations of their disease. This increases anxiety and leads to aggravation of symptoms. During psychotherapeutic sessions, the specialist teaches the patient the correct behavior during motor and vocal tics. Usually the patient always feels the approach of an attack. At this point, it is important to shift your attention frominvoluntary movements to another action. In mild illness, this helps prevent an attack.
Medicated treatment
In advanced cases, psychotherapy alone is not enough to improve the patient's condition. For moderate to severe disease, medication is required. In the treatment of Tourette's syndrome, the following drugs are used:
- neuroleptics: Haloperidol, Truxal, Rispolept;
- antidepressants: Amitriptyline, Azafen.
- antidopamine drugs: Eglonil, Bromoprid, Metoclopramide.
These drugs calm the central nervous system and normalize the metabolism in the brain. Only a doctor can prescribe such medicines. All of these products are strictly prescription and are not intended for independent use.
Teaching a sick child
If Tourette's syndrome is mild, then the child can go to school with he althy peers. However, teachers must be warned about its features. Tics usually get worse with excitement. An attack of involuntary movements can happen at the moment when the child answers at the blackboard. Therefore, it is useful for a student to visit a psychotherapist in order to learn how to cope with excitement and anxiety.
For severe forms of Tourette's syndromehome training is shown. It is very important to provide the child with a good rest, especially in the afternoon. Often, attacks occur after overwork and excessive fatigue. Children with tics need to be especially protected from stress and excessive mental overload.
Forecast
Tourette's syndrome does not affect the patient's life expectancy. Most often, the manifestations of the disease disappear or significantly decrease in the post-pubertal period. If the symptoms of pathology persist into adulthood, then they do not affect mental abilities and do not lead to organic changes in the brain. With adequate treatment and psychotherapy, the patient can adapt well to life in society.
Prevention
Special prevention of this disease does not exist. It is impossible to prevent the occurrence of pathology in an infant, since a defective gene that provokes this syndrome has not been identified.
You can only reduce the likelihood of a patient having seizures. To do this, take the following steps:
- eliminate stressful situations as much as possible;
- attend classes with a psychotherapist;
- observe daily routine.
It is important for pregnant women to eat right, avoid taking medications and be constantly monitored by an obstetrician-gynecologist. This will help reduce the risk of having a baby with neurological problems.
