Treatment of sound and vocal tics in Saratov, Russia. How to treat nervous tics in children Treatment of motor vocal tics

– sudden, repetitive movements that occur due to involuntary contraction of various muscle groups. They are manifested by obsessive facial, motor and vocal actions: blinking, closing their eyes, twitching the nose, mouth, shoulders, fingers, hands, turning the head, squats, jumping, shuddering, coughing, noisy breathing, pronouncing sounds and words. Comprehensive diagnostics includes examination by a neurologist, consultation with a psychiatrist, and psychodiagnostic examination. Treatment is based on adherence to a daily regimen, psychotherapy, psychocorrection, and medication.

General information

Synonymous names for tics are tic hyperkinesis, nervous tics. The prevalence is 13% in boys, 11% in girls. Tics in children occur between the ages of 2 and 18 years. Peak periods are 3 years and 7-10 years, the epidemiological indicator reaches 20%. The onset of the disease is least likely after the age of 15; the highest risk of development is observed in first-graders - the seven-year crisis and the beginning of schooling become provoking factors for “September 1st tics.” In boys, the disease is more severe and less responsive to treatment. A significant proportion of patients experience seasonal and daily exacerbations of symptoms, hyperkinesis intensifies in the evening, autumn and winter.

Causes of tics in children

Hyperkinesis develops as a result of the complex influence of biological and external factors. From birth, a child has a certain predisposition (biological basis) to this pathology, which is realized under the influence of diseases, stress and other negative influences. The causes of hyperkinesis in children can be divided into the following groups:

• Disorders of intrauterine development. The result of hypoxia, infection, and birth trauma is an imbalance of cortical-subcortical connections. When exposed to unfavorable factors, it manifests itself as tics.
• Burdened heredity. The disease is transmitted in an autosomal dominant manner. Since boys get sick more often, a dependence on the gender of patients is assumed.
• Stressful situations. A provoking factor may be school maladjustment, increased study load, passion for computer games, family conflicts, parental divorce, hospitalization. The incidence increases during age crises.
• Traumatic brain injuries. Tics can be long-term consequences of traumatic injury to the central nervous system. The most typical are hyperkinesis of the motor type.
• Some diseases. Often, long-term illnesses with symptoms that include a motor component lead to the formation of tics. For example, after respiratory infections, coughing, sniffing, and throat sounds are observed.
• Psychoneurological pathologies. Tics develop in children with attention deficit hyperactivity disorder, cerebrasthenic syndrome, and anxiety disorders. Hyperkinesis debuts against the background of exacerbations of the underlying disease.

Pathogenesis

The pathogenetic basis of tics continues to be investigated. The central place is given to the functions of the basal ganglia. The main ones are the caudate nucleus, globus pallidus, subthalamic nucleus, and substantia nigra. Normally, they are in close interaction with the frontal lobes of the cerebral cortex, limbic structures, visual thalamus and reticular formation. The connection between the subcortical nuclei and the frontal regions responsible for controlling actions is provided by the dopaminergic system. A decrease in the level of dopamine and disturbances in neural transmission in the subcortical nuclei are manifested by a deficit of active attention, insufficient self-regulation of motor acts, and a disorder of voluntary motor skills. The functioning of the dopaminergic system is disrupted as a result of intrauterine damage to the central nervous system, hereditary changes in dopamine metabolism, stress, and head injury.

Classification

Tics in children are classified based on several factors. According to etiology, hyperkinesis is divided into primary (hereditary), secondary (organic) and cryptogenic (occurring in healthy children). According to symptoms – local, widespread, vocal, generalized. Depending on the severity of the disease, single and serial tics and tic status are distinguished. In accordance with the International Classification of Diseases, according to the nature of their course, the following are distinguished:

• Transient tics. They are in the nature of local and widespread hyperkinesis. Manifest as winks, facial twitches. Completely disappear within a year.
• Chronic tics. Represented by motor hyperkinesis. They are divided into three subtypes: remitting - exacerbations are replaced by complete regression or local single tics during exercise; stationary – persistent hyperkinesis for 2-4 years; progressive – absence of remissions, formation of tic status.
• Tourette's syndrome. Another name is combined vocal and multiple motor tics. The disease begins in childhood, and the severity of symptoms decreases towards the end of adolescence. In mild form, tics continue into adults.

Symptoms of tics in children

Local (facial) tics are hyperkinesis that involve one muscle group. Among the manifestations, frequent blinking is observed in 69% of cases. Less common are squinting, twitching of the shoulder, wings of the nose, corners of the mouth, and tilting of the head. Blinking is persistent and periodically combined with other facial tics. In squinting, the dystonic component (tone) predominates. A distinctive feature of facial tics is that they are practically unnoticed by children and do not interfere with their daily activities. According to the severity of the clinical picture, local tics are often isolated.

With widespread hyperkinesis, pathological movement involves several muscle groups: facial, muscles of the head and neck, shoulder girdle, upper limbs, abdomen, back. Typically, tics debut with blinking, later followed by opening the gaze, twitching the mouth, closing the eyes, tilting and turning the head, and raising the shoulders. The course and severity of symptoms vary - from single transient to chronic with the development of tic status in exacerbation. Children experience difficulties performing tasks that require increased concentration and cause emotional stress (anxiety, fear). Problems arise when writing, assembling small parts of a construction set, or reading for a long time.

Simple vocal tics often involve coughing, sniffing, or noisy inhalation and exhalation. Less common are squeals, whistling, and pronouncing simple high-pitched sounds - “a”, “u”, “ay”. During periods of exacerbation of nervous tics, vocal symptoms may change, which is mistakenly regarded as a new debut. Example: a child coughed, no vocal symptoms were observed in remission, but later noisy breathing appeared. Complex vocalisms occur in 6% of patients with Tourette's disease. Represent the involuntary pronunciation of individual words.

Voicing swear words is called coprolalia. Continuous repetition of whole words and fragments is called echolalia. Vocalisms are manifested as single, serial and status tics. They intensify with fatigue, after emotional and mental stress, and negatively affect the child’s social adaptation - uttering words that do not correspond to the situation, swearing, limits activity in communication, and prevents the establishment of new contacts. In severe cases, the patient is unable to attend school or public places.

In Tourette's disease, the clinical picture is determined by the age of the child. The disease debuts between the ages of 3 and 7 years. Facial tics and shoulder twitching occur primarily. Hyperkinesis spreads to the upper and lower extremities, turning and throwing back the head, extension/flexion of the hands and fingers, tonic contractions of the muscles of the back, abdomen, squats, and jumping are noted. After 1-2 years, vocalisms join. Rarely do vocal tics precede motor tics. The peak of symptoms is observed from 8 to 11 years. Serial, status hyperkinesis develops. During exacerbations, children cannot go to school and need help and household services. By the age of 12-15 years, the disease enters the residual stage with local and widespread tics.

Complications

Severe forms of hyperkinesis lead to complications - serial tics, tic status, chronic progressive course. Children develop perceptual disturbances, a decrease in the functions of voluntary attention, and difficulty coordinating movements and developing motor skills. School failure develops - patients have difficulty mastering writing, do not perceive new material well, and have problems with memorization. The educational lag is complemented by social maladaptation - muscle twitching, involuntary movements, vocalisms become the cause of ridicule and detachment from peers.

Diagnostics

Diagnosis of tics in children is carried out by a group of specialists - a neurologist, psychiatrist, psychologist. The scope of diagnostic measures is determined individually at the first medical consultation. The data obtained is used for differential diagnosis, prognosis of the course of the disease, and selection of the most effective treatment methods. A comprehensive examination includes:

• Questioning, examination by a neurologist. The doctor clarifies the medical history (complications of pregnancy, childbirth, hereditary burden), asks about the onset of the disease, the progression, frequency, severity of symptoms, and the presence of concomitant neurological pathologies. During examination, assesses general condition, motor functions, reflexes, sensitivity.
• A conversation with a psychiatrist. The specialist focuses on the mental development and psychological characteristics of the child. Determines the connection between the onset of hyperkinesis and a stressful situation, excessive emotional stress, educational methods, and family conflicts.
• Psychodiagnostic study. A psychologist conducts a study of the child’s emotional, personal and cognitive sphere using projective methods (drawing tests), questionnaires, tests of intelligence, attention, memory, and thinking. The results allow us to predict the course of the disease and identify provoking factors.
• Instrumental research. Additionally, a neurologist may prescribe an EEG and MRI of the brain. The resulting data are necessary for differential diagnosis.

Experts differentiate tics from dyskinesias, stereotypies, and compulsive actions. Distinctive signs of tic hyperkinesis: the child is able to repeat, partially control movements, symptoms rarely occur with voluntary, purposeful action, their severity intensifies in the evening, with fatigue, exhaustion, emotional stress. When the patient is engaged, the tics almost completely disappear.

Treatment of tics in children

Therapy of hyperkinesis is implemented within the framework of a comprehensive differential approach. The selection of treatment methods is determined by the form of the disease, the severity of symptoms, and the age of the patient. The main goals are to reduce the frequency and severity of symptoms, improve the child’s social adaptation, and correct cognitive functions. The following methods are used:

• Maintaining a daily routine. Provides for the prevention of hunger, fatigue, mental and emotional exhaustion, physical and intellectual activity, adherence to the schedule of eating, going to bed and waking up. The time spent watching TV shows and computer games is reduced to a minimum.
• Family psychotherapy. The cause of tics may be a chronic traumatic situation or parenting style. Psychotherapy sessions include analysis of family relationships and elaboration of negative attitudes towards tics. Participants are taught methods to help cope with anxiety, tension, and child problems.
• Individual and group psychotherapy. Alone with the psychotherapist, the patient talks about his experiences, fears, and attitude towards the disease. Using the methods of cognitive behavioral therapy, complexes are worked out, methods of relaxation and self-regulation are mastered, allowing one to partially control hyperkinesis. At group meetings, communication and conflict resolution skills are trained.
• Psychocorrection. aimed at developing lagging cognitive functions. Exercises are performed to correct spatial perception, attention, memory, and self-control. As a result, the child experiences fewer difficulties in school.
• Drug treatment. Medicines are prescribed by a neurologist. The selection of funds, duration of treatment, dosage are determined individually. Basic therapy is based on the use of anti-anxiety medications (anxiolytics, antidepressants) and medications that reduce the severity of motor symptoms (antipsychotics). Additionally, nootropics, vascular drugs, and vitamins are indicated.
• Physiotherapy. The sessions have a calming effect, normalize the processes of excitation and inhibition in the nervous system, and reduce the symptoms of the disease. Electrosleep, galvanization of segmental zones, therapeutic massage, electrophoresis of the collar zone, ozokerite applications to the cervical-collar zone, aerophytotherapy, and pine baths are used.
• Biofeedback therapy. The biofeedback method is represented by a set of procedures that allow the patient to feel and master the control of a certain physiological function. With hyperkinesis, the child receives information about the state of the muscles through a computer program, and during the training process masters voluntary relaxation and contraction.

Prognosis and prevention

The prognosis of tics is determined by the severity of the disease and the age of onset. A favorable outcome is more likely in children who become ill at 6-8 years of age; with proper treatment, hyperkinesis disappears within 1 year. Early onset with the first symptoms at 3-6 years is typical for the course of the pathology until the end of adolescence. Prevention consists of organizing the correct regimen, alternating rest and work, reducing the time spent playing on the computer, watching movies, and TV shows. It is important to prevent situations of stress, to treat somatic diseases in a timely manner, preventing them from becoming chronic.

Every mother dreams of her little miracle growing up as a strong and healthy child. Alas, no matter how hard she tries, sooner or later the baby gets sick. While many are prepared for viral infections and various acute respiratory infections, a nervous tic in a child can frighten even the most experienced parents. To provide timely assistance, avoid complications and simply save your own nerves, it is enough to know basic information about the disease: symptoms, causes, types and treatment.

Nervous tics can occur not only in adults, but also in children - parents should pay special attention to the symptom

What is a nervous tic and how to distinguish it from other similar disorders?

A nervous tic can be described as a sudden and involuntary brief movement of the face or limbs caused by muscle contraction. In certain cases it is accompanied by sounds. Externally you can observe in a child:

• blinking;
• twitching of the corners of the mouth or cheeks;
• wincing and shrugging;
• raising eyebrows;
• head throwing and more.

Tics can appear in children between the ages of 2 and 18, but most often they can be found in children aged 3 and 7-11 years. According to statistics, 20% of children under 10 years of age suffer from a tic disorder - this is every fifth child.

It is important to be able to distinguish a nervous tic from convulsive muscle contractions that may accompany another disease. These signs include:

1. A child's ability to produce, partially control, and temporarily suppress tics.
2. The dependence of the frequency of tics on the child’s mood, activity, time of year and even time of day.
3. Absence of tics during voluntary movements (drinking from a cup, eating with a spoon, etc.).
4. Change of localization. For example, twitching of the corners of the mouth over time can turn into a shrug or blinking. You need to understand: most likely, this is a new attack of an old disease, and not another disease.

When a child is focused and highly engaged in an interesting activity, nervous tics may weaken and sometimes stop completely. After finishing playing, drawing, reading or other activity, the symptoms return with renewed vigor. Also, the child’s prolonged stay in the same position can intensify the manifestation of tics.

Children susceptible to this disorder have noticeable impairments in attention and perception. Their movements cease to be smooth and coordinated; difficulty in performing habitual motor acts can be noted. In particularly severe cases, the child may suffer from impaired spatial perception.

When a child draws or does something else that interests him, the tic often temporarily recedes

Classification of nervous tics

Firstly, there are two types of tics:

• simple;
• complex.

The first type includes tics that affect only one specific muscle group: the eyes or head, arms or legs. Complex tics are a combined contraction of several different muscle groups at once.

Secondly, tics are divided based on their external manifestation:

• motor;
• vocal;
• rituals;
• generalized forms.

The first type includes: blinking, shrugging shoulders, throwing back the head, twitching the corners of the mouth or cheeks and other involuntary body movements. Vocal tics get their name from the sound they produce - sniffing, sniffling or coughing. Constantly repeating actions of the same type - walking back and forth or in a circle - are referred to as so-called rituals. With the latter form of tics, the child exhibits several variants of them at once.

The literature describes the classic path of symptoms: first blinking, then sniffling, coughing, then shoulder movements and complex repetitive movements of the arms and legs, plus speech stereotypes that arise several years after the disease (“say no” - “no, no, no”) "). However, in practice such a picture is rare. So, if the onset of a tic coincides with a cold, then during this period overstimulation of the nasopharynx will lead to coughing or sniffling, and blinking will join later. In this case, one symptom can transform into another, single signs are replaced by their combinations. In the absence of qualified help and delay in treatment, a severe form of tic disorder may develop - de la Tourette's syndrome - a combination of voice and multiple movement disorders, plus hyperactivity with attention deficit and obsessive fears.

From a medical point of view, the following forms of nervous tics are distinguished:

• transient, in other words transitional;
• chronic.

In the first case, the child develops complex or simple varieties of tics, which are repeated every day for a month, but not longer than a year. It is very difficult for a child to control such mannered and rapidly repeating movements. The chronic form of the disorder can last more than a year with almost daily, but not simultaneous, repetition of different types of nervous tics.

Causes of the disease

Before you begin to treat a disorder in your baby, you need to find out its cause. These could be:

1. Hereditary predisposition. The likelihood of the disorder occurring in children increases in a family where one of the close relatives suffers from a similar disease.
2. Parental behavior and family atmosphere. Of course, genetics and the environment play an important role in the formation of a child’s personality, his character traits and the ability to adequately respond to external stimuli, but the family and its internal state play a primary role in this. A pronounced violation in the ratio of verbal and nonverbal communication between parents and children and among themselves provokes unnatural behavior and anomalies in the child’s character. Constant prohibitions and comments, strict control and tension, endless screams can lead to inhibition of physiological activity, which, in turn, can result in one of the forms of nervous tics in the future. The situation with permissiveness and connivance can end in a similar way, so in raising children it is necessary to find a middle ground, which is individual for each child, depending on his temperament and personal qualities.

The causes of tics refute the widespread myth that only restless and excitable children are susceptible to this nervous disorder, because at a certain period of their lives absolutely all children are nervous, capricious and uncontrollable.

Factors that provoke tics

What exactly can trigger the appearance of tics? The answer is obvious - psychological stress caused by the child’s inability to independently cope with a problem or a difficult situation for him.

Quarrels or strained relationships between parents are acutely felt by the child, even if he does not see confirmation of his guesses. This may be one of the causes of tic condition

For parents, the situation may remain mundane and they may well not notice that their child has suffered psychological trauma. As a result, the baby begins to demand more attention, does not want to stay and play alone, then facial expressions change, unconscious movements and gestures begin to appear, which are especially noticeable when the baby is emotionally excited or worried. It is they who subsequently turn into nervous tics. Also, severe long-term ENT diseases such as tonsillitis, ARVI or eye diseases can also cause tics.

Diagnosis of the disease

You should start treatment immediately after your doctor makes a diagnosis. This will require an examination by a neurologist and a mandatory examination of the mental and emotional state of the little patient. The latter will help to find out the causes and factors that caused the appearance of tics, find out their nature and adjust future treatment.

Sometimes additional measures may be required to make a diagnosis: consultation with a psychiatrist, magnetic resonance imaging, electroencephalography. They should only be prescribed by a doctor.

Stages of treatment

First, you need to eliminate the influence of factors that cause tics. At the same time, it is important to follow sleep and nutritional schedules and ensure that the baby’s physical activity is adequate. There are several stages of treatment for such a nervous disorder:

1. Family psychotherapy. First of all, it is necessary for families in which the internal tense situation directly affects the psychological state of the child. This practice would also be useful for families in which the child grows up in a favorable and harmonious atmosphere - this will only bring benefits to relationships within the family and prevent possible mistakes in the future.
2. Correction with a psychologist. In individual lessons, using a variety of psychological techniques, the child is helped to cope with internal feelings of anxiety and discomfort and increase self-esteem. With the help of conversations and games, they stimulate the development of lagging areas of mental activity: memory, self-control, attention (see also:). Group classes include children with similar diseases or disabilities, and the main idea of ​​the classes is to create conflict situations in a playful way. Thus, the child learns to behave in conflicts, look for possible solutions and draw conclusions. Additionally, the sphere of communication and communication with others is developing.
3. Drug treatment. You should resort to the last method of treatment only if all the previous ones did not have the desired effect. A pediatric neurologist prescribes medications based on data from all examinations.

You should be seriously concerned about this disease if symptoms appear before the age of three - this may indicate the presence of another mental illness. If tics appear later, then you should not panic ahead of time, as Dr. Komarovsky often recommends. Tics that appear at the age of 3-6 years decrease over time, and those that appear at the age of 6-8 years can be completely cured without consequences.

Nervous tics in children are a neurological disorder that manifests itself in twitching of the eye, cheeks, shoulders or other parts of the body, which the child himself does not notice. A parent observing a “strange habit” from the side often panics. However, this syndrome is usually not a serious problem and can be treated.

External manifestations

Twitching eye syndrome most often occurs in children between 7 and 10 years of age. Less commonly observed during the transition period from 11 to 13, and sometimes from 3 to 6 years.

Manifestations of nervous tics in children can be of a motor or vocal nature. Among the motor tics, eye twitches are the most common. In other cases, the child exhibits other symptoms:

rhythmic shaking of the head

shoulder elevation

cheek twitch

lip trembling

frequent blinking or raising eyebrows

causeless shuddering.

Vocal signs of a nervous tic include the following manifestations:

the child grunts involuntarily

sniffles

snoring all the time

produces other, constantly repeating sounds.

Symptoms, both motor and vocal, increase when the child is agitated. Often a nervous tic appears when there is increased attention to it. For example, when there are many guests in the house, and strangers ask the child to recite a poem.

Children in such situations experience severe embarrassment, which can provoke non-stop nose sniffing or uncontrollable eye twitching. But as soon as the child can be calmed down, the nervous tic goes away on its own and does not require treatment.

What distinguishes the syndrome from a more serious nervous disorder is that the attacks do not last long and the symptoms never appear at night. If a child sleeps calmly, with relaxed facial muscles, and does not make repetitive sounds, then the causes of a nervous tic that happens during the day are shallow and completely removable.

Causes

Treatment of a nervous tic begins with finding out the reasons for its occurrence. They can be:

psychological

physiological

hereditary.

If parents had a similar syndrome in childhood, then it is likely that the children inherited their sensitivity and tendency to nervous disorders.

Physiological causes may include the following factors:

1. Infectious diseases.

If a child has suffered any viral disease (chicken pox, jaundice and even the common flu), not only does his immunity decrease, but normal processes in the autonomic nervous system may also be disrupted.

1. Intoxication.

Long-term exposure to toxins can cause neurological pathologies. This happens after long-term treatment with antibiotics or other potent drugs. Polluted air in the child’s place of residence, as well as the general environmental climate, also have a significant impact. And sometimes parents themselves create unfavorable conditions, for example, by allowing themselves to smoke indoors. The tobacco smoke that a child breathes in causes persistent eye twitching or very rapid blinking.

1. Magnesium deficiency.

One of the common causes of nervous tics in children is an insufficient amount of microelements in the body, such as potassium and especially magnesium. Deficiency of these substances occurs after inflammatory processes, long-term infectious diseases, intoxication, or due to poor absorption of vitamins and minerals by the child.

The psychological causes of the syndrome include the following factors:

1. Emotional stress.

As a child develops, he encounters new experiences every day, meets new people and learns to adapt to new circumstances. Sensitive children sometimes become too emotional about transferring to another school or moving. Not to mention the usual problems and conflicts: quarrels with classmates, fear of tests, etc. If a child does not express emotions openly and tries to hide them, internal stress accumulates and manifests itself in the form of a twitching eye, flinching, etc.

This is one of the most common causes of tics in children. A child can be frightened by a strong thunderstorm, a bad dream, a scary movie, etc.

1. Mental stress.

Tics in the form of a twitching eye often appear due to overwork. The nervous system of children can be depleted by stresses beyond their age, especially mental ones. If after school a child sits down at his desk again to do his homework, and after that he still goes to a tutor, then it is not surprising that he will develop nervous tic syndrome.

1. Lack of attention or excessive care.

Eye twitching often occurs in children whose parents are either very strict or, conversely, pay little attention to the child. In both cases, children worry too much about trifles, because they are afraid of punishment or because they strive to earn love.

Nervous tic in a child: treatment

Treatment of a nervous tic, as already noted, depends on the cause:

1. Psychological help.

If a child experiences a lack of attention from his parents, then simply taking the time to talk to him for at least half an hour before bedtime is enough:

ask about how the day went (provoke the child to express all the fears, doubts, and disappointments accumulated during the day)

reassure the child, assuring that such troubles can happen to anyone and that they quickly pass and are forgotten

remind them of your love (for children it is not always obvious from the fact that you take care of them, feed them and clothe them; they need to hear words of love and support from you).

1. Calming procedures.

To calm the nervous system, it is useful to drink decoctions of mint or valerian root before bed, take baths with essential oils and do a relaxing massage.

1. Providing microelements.

If a child has suffered an infectious disease, care must be taken to replenish vitamins and minerals in the body. You can ask your doctor to immediately prescribe a complex containing B vitamins or including elements such as potassium and magnesium.

Or you can think over the menu in such a way that it contains a lot of beans, peas, buckwheat and oatmeal, black currants and cherries, and nuts. These products contain enough essential microelements to restore the child’s nervous system.

1. Prevention of overwork.

If there is really a need for additional classes with tutors, distribute the schedule in such a way that mental stress alternates with physical activity. Gymnastics and swimming are very helpful for nervous tics. Do not force your child to sit down for homework immediately after school. Let him take a walk on the street, or go dancing (if it brings him pleasure). And be sure to make sure your child goes to bed on time. In the end, health is much more important than one unlearned lesson.

Treatment of nervous tics often involves the listed actions. But if eye twitching or other symptoms still do not go away, contact a neurologist. He will select appropriate sedative medications and, if necessary, prescribe sessions with a psychotherapist to help the child get rid of obsessive fears and cure tics.

Classification, causes and treatment of hyperkinesis

A tic is a sudden, jerky, repetitive movement that involves individual muscle groups. This symptom can be observed in both adults and children.

Nervous tics in children occupy a leading place among childhood diseases, diagnosed in 13% of boys and 11% of girls. According to statistics, in Russia every fifth child under the age of 10 has this symptom.

There are two “crisis” periods: 3.5–7 years and 12–15 years; it is during these age intervals that “jumps” in the maturation of the cerebral cortex and the appearance of the first tic attack occur. A nervous tic manifests itself in the form of a contraction of a certain muscle group or one muscle as a result of its reflex excitation.

It is necessary to differentiate tics from convulsive contractions of skeletal muscles, which appear as a result of any acute and chronic diseases (with this pathology, a person can reproduce and partially control muscle contraction).

The origin of tics is based on an imbalance between the processes of excitation and inhibition in the subcortical areas of the brain.

Causes

Consequences of traumatic brain injury

Viral and infectious lesions of the central nervous system

Long-term inflammatory diseases in the facial area

Deficiency of B vitamins and magnesium

Vegetovascular dystonia

Taking psychotropic medications (for example, antipsychotics, psychostimulants)

Past stress

Hereditary predisposition

Authoritarian parenting in the family

ADHD.

Nervous tics in children - treatment

Despite the fact that the symptoms of nervous tics in children are very frightening for parents, treatment of this disease is successful in 90% of cases. This panic is justified, because obsessive involuntary muscle contractions, which appear with lightning speed, distort the child’s face beyond recognition, forcing an arm or leg to make absurd movements. While teenagers can still control tics (albeit for a short time), two-year-olds cannot do this.

Types of ticks

There are three types of ticks:

vocal (sniffling, grunting, sniffling, coughing, etc.)

motor (the child blinks frequently, shrugs his shoulders, his cheeks twitch)

ritual (specific walking, swaying from side to side, moving in a circle).

Each of these types can manifest itself in a simple form, when a tic affects one muscle, complex (in a group of muscles) and generalized (a combination of several types of tics). Often, children do not notice oddities in their own behavior and well-being, but it is immediately apparent to those around them. More sensitive kids can sense that a certain muscle is about to start twitching, so they can overcome the tic on a subconscious level. And some children, anticipating an attack, panic and become nervous, which leads to increased muscle contractions. It is worth noting that this disease is always accompanied by decreased attention, deterioration of memory and performance. The child becomes restless, capricious, and may become depressed.

Why do tics occur in children? Do they go away on their own? Only a doctor can give a definite answer, since each case is individual. But common reasons still exist. They are divided into psychogenic (primary) and symptomatic (secondary). The first include:

emotional impact

psychological trauma

loneliness

lack of love and attention.

Symptomatic causes can be both hereditary and acquired as a result of diseases:

birth injury

brain tumor

brain hypoxia

infection.

To cure tics in a child, as practice shows, it is necessary to accurately determine their cause. Often it is enough to create a friendly and calm environment around the baby. Consulting a psychotherapist wouldn't hurt either. Moreover, parents too!

How to treat tics in emotional children prone to overexcitement? Most doctors tend to use homeopathic remedies. The fact is that long-term use of classic sedative sedatives can worsen the situation. And homeopathy treatment for tics in children is absolutely harmless. However, in this case, you need to consult an experienced homeopath, because there are dozens of similar drugs!

Nervous tic in a child: treatment, causes

Nervous tics are commonly called involuntary, sudden and repeated muscle contractions. This disease is familiar to many people, but most often it affects children under ten years of age. Parents do not immediately notice a nervous tic in their child, and treatment is delayed because of this. Over time, frequent blinking or coughing alerts adults, and the baby is taken to a specialist. Since usually all indicators are normal, he advises contacting a neurologist. Only then do parents begin to deal with the problem. Diagnosing the disease takes a lot of time, so don’t hesitate. It is better to seek help as soon as alarming symptoms appear.

How does tic manifest itself and when does it occur?

Contractions are often most noticeable on the face and neck. They can be manifested by blinking, sniffling, movements of the head or shoulders, twitching of the lips and nose. Sometimes a child has several symptoms.

Neurologists say that the most dangerous age, when the occurrence of the disease is most likely, is 3-4 years and 7-8 years. This is explained by the peculiarities of the development of the body: at this age, children face various crises and move on to new life stages.

Symptoms

It is not easy to identify this disorder, since for a long time neither the child nor the parents realize that the movements are involuntary. The most important criterion that should alert you is the inability to control muscle contractions. When a nervous tic is observed, the child's eyes may blink and twitch rapidly. This is one of the most common symptoms.

Types of nervous tics

Depending on how long the disease lasts, tics are usually classified as follows:

Transistor. In this case, symptoms appear for less than a year.

Chronic. It lasts for more than a year.

Gilles de la Tourette syndrome. It is diagnosed when a child has extensive motor tics and at least one vocal tic.

If a nervous tic is detected in a child, treatment will depend on which muscle groups are involved. Therefore, the disease is usually divided into types:

Local (one muscle group)

Common (several groups)

Generalized (almost all muscles contract).

Why does this disorder occur?

When nervous tics occur in children, the reasons for this phenomenon are very worrying for their parents. To make the picture more clear, experts recommend remembering what events preceded these manifestations. As a rule, the disease is caused by a complex of reasons.

Hereditary factor

Neurologists say that it is of primary importance. But there are a number of caveats.

If one of the parents suffers from this condition, it is not necessary that the child also be diagnosed with tics. This indicates a predisposition, but does not guarantee this disorder.

It is impossible to determine from external factors whether a genetic predisposition is present. Perhaps the parents had psychological problems that, through upbringing, were passed on to the child through uncontrolled emotions. In this case, it is worth talking about the method of response, and not genes.

Experiences and stress

Parents are very worried when a nervous tic is detected in a child. They begin treatment immediately, but sometimes it is first necessary to think about the triggering factors and eliminate them. If a specialist says that stress may be the cause, parents are skeptical. But it is worth remembering that for adults and children the reasons for worry can be completely different. In addition, even positive emotions, if they are particularly vivid, can excite the nervous system of an impressionable child.

TVs and computers

Childhood neurology affects many children, so parents should take timely measures. Watching TV for a long time brings big problems. This is due to the fact that flashing light affects the intensity of the brain's nerve cells. When this happens very often, the natural rhythm that is responsible for calm is disrupted.

Insufficient physical activity

Parents need to figure out how to get rid of nervous tics, because they affect the child’s mental health and can change from one type to another and grow over time. Their main mistake is that they attach great importance to the child’s mental stress and completely forget about the physical one. Children also need it so that their energy finds a way out. Otherwise, reflex muscle contractions may occur.

Errors of education

Child neurology can be affected by parental personality traits that they have no control over. The following factors can lead to this disorder.

Mom's anxiety. Children intuitively feel her mood and inner experiences, even if outwardly she is calm. This leads to the child losing his sense of security and being in constant anxiety.

Restraint in showing emotions. A lack of affection and warmth can manifest itself in involuntary movements.

Total control. Many mothers like their child’s actions and the events that happen around him to be under their complete control. Only then can they be calm.

Excessive demands. Every parent wants their child to be the smartest. Often they endow him with qualities that he does not possess, so the baby does not live up to their expectations. For a long time, the child lives in constant fear of disappointing mom and dad, so tics may arise as a reaction to experiences.

Psychogenic and symptomatic tics

To understand how to get rid of nervous tics, you need to know that they are primary (psychogenic) and secondary (symptomatic). The first ones occur most often between the ages of five and seven years, since this period is the most critical for the child. The causes of their occurrence can be stress and psychological trauma, which are divided into acute and chronic.

Symptomatic disorders are caused by birth injuries, tumors and metabolic disorders of the brain. Sometimes the cause is a viral infection that causes short-term hypoxia.

How to treat the disorder?

Parents who have identified a nervous tic in their child should not put off treatment. First of all, you need to contact a neurologist, and then a psychologist. If the tics last for quite a long time, the baby will be prescribed medication, but in order to get good results, pills alone are not enough. It is necessary to correct all factors that can cause the disorder.

Parents must:

Reduce time spent watching TV

Provide physical activity

Develop an optimal daily routine and stick to it

Minimize worries and stress

If possible, conduct sand therapy or sculpting sessions

Do exercises to tense and relax your facial muscles

Do not focus the child’s attention on the problem so that he does not try to control the contractions.

Do not despair if your child is diagnosed with a nervous tic. Causes and treatment may vary in each case, but you need to know the general rules. It is not recommended to give your baby strong drugs, as there is a high probability of side effects. If the disorder is a consequence of another disease, then comprehensive treatment is necessary.

Prevention

When a nervous tic is present in children, the symptoms can be either pronounced or completely invisible. But it is better not to wait until the disease begins to progress and take preventive measures. The baby should have enough rest, walk in the fresh air, and it is also very important to surround him with care and love, to provide a comfortable and calm environment.

Attention, TODAY only!

Noticing that the child is making involuntary obsessive movements, twitching or making strange sounds, parents begin to worry.

This is a nervous tic in a child, the symptoms of which will be discussed in this article. Most often, they do not pose a serious threat to health, other than psychological discomfort. But the reasons for this condition may be different.

Tics can be both muscular and auditory. The general thing is that movements and sounds are made involuntarily, uncontrollably and intensify during the period of greatest nervous excitement. Often children, especially young ones, do not notice these manifestations and do not experience much discomfort.

Older children are aware of the deviation and may try to control it, which is not always successful and, as a result, causes even greater anxiety in the baby. Teenagers can achieve control, but it requires a lot of effort. In any case, nervous tics in children worry parents much more and attract unnecessary attention from others.

Tics affect far more boys than girls (6:1 ratio). They can appear at any age, but the peak occurs at 3.5-7 years and 12-15 years, when the child’s nervous system is most actively rebuilt. By the age of eighteen, in most cases, all manifestations of tics disappear. Only in exceptional cases does the tic continue after reaching maturity.

If a tic is not a symptom of more serious disorders of the nervous system, then it makes itself felt during the daytime and in moments of particularly strong excitement in the child. At night the patient relaxes and sleeps peacefully. This disorder usually goes away on its own. However, if involuntary movements continue for more than a month, are accompanied by grinding teeth during sleep and urinary incontinence, this is a serious symptom that should definitely be addressed by a doctor.

Consultation with a specialist will be useful even with mild manifestations of tics. A neurologist will help determine the causes of the disorder and reassure parents. And for known reasons, it is possible to adjust the child’s life so that nervous abnormalities will remain a thing of the past.

Classification of ticks

All ticks are divided into four categories.

• Motor tics. These include involuntary movements. In children, most often this is a contraction of the facial muscles: blinking, twitching eyebrows, winking, lip movements. Less often - movements with arms or legs, fingers: fiddling with folds of clothing, twitching a shoulder, sharply tilting the head, retracting the stomach, repeating gestures, jumping and even “beating” oneself. They, in turn, are divided into simple and complex. The former involve movements of one muscle, the latter involve muscle groups.
• Vocal tics involve the involuntary production of sounds. They, just like motor ones, can be simple and complex. Simple vocalisms include snorting, grunting, whistling, sniffling, and coughing. When difficult, the child repeats the words, phrases and sounds that he heard. Including obscene language - this condition is called coprolalia.
• Ritual tics are accompanied by the repetition of peculiar “rituals”. For example, drawing circles, an unusual walking style.
• Generalized tics include combined forms of this deviation. For example, when a motor tic is combined with a vocal tic.

In different children, tics manifest themselves in different ways and in different combinations.

Tourette's syndrome

Generalized tics include Tourette's syndrome, a pathology of the nervous system. Most often occurs between the ages of 5 and 15 years. The peak occurs in adolescence. In some cases, the disease goes away on its own, less often it persists for life. However, over the years the symptoms weaken.

The development of the syndrome begins with the appearance of facial muscle tics, then they move to the limbs and torso. Involuntary movements are accompanied by vocalizations, these can be either meaningless sounds or shouting curse words.

Other manifestations of the disease are absent-mindedness, restlessness, and forgetfulness. The child becomes overly sensitive, vulnerable, and sometimes aggressive. At the same time, 50 percent of children and adolescents develop unreasonable fears, panic, obsessive thoughts and actions. These symptoms are uncontrollable, and only a competent specialist can alleviate the condition.

Causes

The causes of nervous tics in a child can either lie on the surface (the situation in the family, at school) or be deeply hidden (heredity). Tics are most often caused by three types of causes in children.

Heredity. If one of the parents suffered from tics in childhood, then their child has a predisposition to their occurrence. However, heredity does not guarantee that a child will certainly get sick.

Physiological reasons

• Past infections. It could be chickenpox, jaundice, flu, herpes. After this, not only the child’s immunity is lowered, but also the nervous system is most vulnerable.
• Long-term poisoning. With prolonged intoxication of the child's body, the child's nervous system also suffers. This may include taking medications, antibiotics, or living in an unfavorable environmental environment. A blow to a child's health is caused by parents smoking in his presence.
• Lack of vitamins and microelements. Occurs with a poor, monotonous diet. The nervous system suffers most from a lack of B vitamins, potassium, and magnesium.
• Lifestyle. Lack of sufficient physical activity, rare exposure to fresh air, and sitting for many hours at the computer or in front of the TV can cause disturbances in the functioning of the nervous system.
• Brain diseases. This includes tumors, benign and malignant, injuries, including birth injuries, encephalitis, trigeminal neuralgia, and vascular pathologies.

Psychological reasons

• Stress. Problems with family, at school, with peers, especially if the child tries to suppress them and keep them to himself, often lead to the appearance of tics in children. Changing educational institutions, moving to another district or city, parental divorce, bullying or rejection from classmates are the most severe emotional stresses for a child. There is even such a thing as “tick September 1”.
• Fright. Most often, it is this that becomes the impetus for the appearance of tic. Anything can scare a child: a scary movie, a nightmare, a thunderstorm or storm, even a sharp sound. A deviation can occur if a child witnesses a major quarrel, scandal, fight, or is attacked by a large animal, for example, a dog.
• Increased loads. Often parents try to give their child comprehensive development and education. And they forget that the child’s psyche is not always able to cope with such an intense load. The child goes to school, then to a tutor, then to language courses or to an art school. At some point, the child’s body cannot withstand the constant pressure. Tick ​​is the least terrible manifestation of an unbearable load.
• Attention deficit. If parents do not pay due attention to their child, spend little time together, rarely talk and praise, then the child tries to earn this attention. As a result, he is constantly in nervous tension.
• Overprotectiveness or authoritarian parenting style. In this case, frustration may also arise as the child is stressed due to increased parental interference in his life. Especially if the mother or father is too strict. Then the child’s companion becomes the fear of making a mistake and being guilty.

Often parents are skeptical about the presence of psychological problems in their child. Firstly, many do not believe that children can experience stress at all. Secondly, almost everyone is sure that this will definitely not affect their children.

Diagnostics

Only a doctor - a pediatric neurologist - can determine for sure nervous tics in a child, symptoms and treatment. The symptoms are often frightening for parents. Of course, the child sometimes changes beyond recognition, performing strange and even frightening obsessive actions. However, in 90% of cases the disease is successfully treated.

You should consult a doctor if the nervous tic is generalized and lasts longer than a month, causes psychological or physical discomfort to the child, or is severe. The initial diagnosis is made based on a survey. The doctor needs to find out how the disease manifests itself, when it began, whether the patient experienced severe stress before it, whether he received a head injury, what medications he took.

In addition, the child may need to see other specialists. Psychotherapist - if a young patient has recently experienced stress. An infectious diseases specialist if there is a suspicion of infectious diseases. A toxicologist if the body has been exposed to toxins. If you suspect a brain tumor, you need to consult an oncologist, and if you have nerve damage in your family, you need to consult genetics.

Therapy for the disorder

If the disorder has serious causes, such as brain diseases, tumors and injuries, treatment is aimed primarily at eliminating these causes. The tic as a consequence will disappear when the child recovers completely.

If children's tics are primary, that is, they exist on their own, getting rid of them involves, first of all, creating a favorable environment.

Psychotherapy will not be superfluous. And not only for children, but also for parents. Not everyone will be able to independently notice, admit their own mistakes in behavior and upbringing and correct them. Therapy for a young patient can be carried out either individually or in a group with children who have similar disorders.

Parents must establish contact with their child. Adjust your pastime so that you can be together more often, find common activities. Heart-to-heart conversations are also necessary. During them, the child will be able to express all the emotions accumulated during the day and calm down. You need to speak words of love to your child and praise him more often.

We need to establish a daily routine. Adequate sleep, regular moderate physical activity, alternating mental and physical work, reducing time spent at the computer or TV can significantly improve the condition of the nervous system. It's a good idea to adjust your diet.

A growing body must receive enough proteins, vitamins and microelements. In the case of teak - B vitamins, potassium and magnesium. These elements are found in animal foods, grains and cereals, especially oatmeal and buckwheat, and fresh vegetables. Bananas and dried apricots are rich in potassium and magnesium.

Treatment with drugs

In severe cases, treatment of nervous tics in children can be done with medication. First of all, sedatives are prescribed. To calm the baby, light herbal preparations based on extracts of valerian, motherwort, and chamomile are enough. In more severe cases, antidepressants and antipsychotics may be prescribed.

Vitamins - complex or magnesium with vitamin B6 - are prescribed as auxiliary agents, as well as vascular drugs that improve metabolic processes in the brain. To avoid unpleasant consequences for a fragile body, homeopathic preparations are preferable, or remedies in which the proportion of the healing substance is negligible.

Physiotherapy

Tics can be treated using physiotherapeutic methods. They also imply a calming effect on the nervous system.

These include:

• electrosonotherapy (the child sleeps during a special electric shock) reduces nervous excitability and accelerates metabolic processes;
• galvanization of the brain activates inhibition processes;
• therapeutic massage stimulates blood circulation;
• acupuncture improves blood flow to the brain;
• medicinal electrophoresis of the neck and shoulders has a calming effect;
• ozokerite applications on the neck and shoulders reduce excitability;
• aerophytotherapy reduces susceptibility to stress, improves mood;
• baths with pine extracts relax and restore healthy sleep.

Based on the doctor's opinion, other treatment methods may be prescribed.

The healing power of creativity

In children, nervous disorders can be treated through creativity. Such methods arouse genuine interest in the child, calm him down and lift his spirits. If parents come up with a creative activity for themselves and their offspring, it will be doubly valuable. A child’s excellent mood after such activities is a sure sign of a speedy recovery.

Dancing is useful, especially rhythmic and fiery. For example, tectonic, in which the dancer makes movements reminiscent of teak. It is important that the child finds it interesting, so that during classes he “dances” all bad emotions, relieves nervous and muscle tension, and improves his mood.

All types of needlework and creativity that involve hands, fingers and fine motor skills are also useful. This is modeling, classes with sand. Drawing will help you free yourself from fears, especially if you draw their cause and then destroy it.

Quick tick removal

Muscle twitches often cause discomfort to the baby, especially if he tries to suppress them. When a tic appears, you can try to alleviate this condition. Distraction will help: offer to do something interesting that will occupy the child’s full attention. And it’s better that it’s not a computer or TV.

For eye tics, acupressure relieves the attack. You need to consistently press on points in the center of the brow ridge and in the corners of the eyes for several seconds. Then the child should close his eyes tightly several times for a few seconds. Among the traditional methods, a compress of geranium leaves helps, which in crushed form should be applied to the affected area (not to the eyes).

However, such methods can only relieve the attack for a while, and not cure the tic completely. After some interval (from several minutes to several hours) everything will return, especially if the baby is nervous.

Prevention

The rhythm of life, especially in the city, is accelerating, which cannot but affect children. They are especially vulnerable to stress. Therefore, it is important not only to know how to treat nervous disorders, but also how to prevent their occurrence.

Prevention of tics is the correct daily routine, adequate sleep and nutrition, physical activity, fresh air and lack of overexertion, a favorable environment at home, good and trusting relationships with parents.

In order for children to be calm, parents must be calm. After all, even if mom or dad don’t outwardly show nervousness, the baby will still feel it. Therefore, anyone who wants their children to be healthy and happy should start with themselves.

We hope that our article helped you understand the causes of tics in children (including generalized type tics) and the features of treating nervous tics in children of different ages.

Tics, or hyperkinesis, are repeated, unexpected short stereotypical movements or statements that are superficially similar to voluntary actions. A characteristic feature of tics is their involuntary nature, but in most cases the patient can reproduce or partially control his own hyperkinesis. With a normal level of intellectual development in children, the disease is often accompanied by cognitive impairment, motor stereotypies and anxiety disorders.

The prevalence of tics reaches approximately 20% in the population.

There is still no consensus on the occurrence of tics. The decisive role in the etiology of the disease is given to the subcortical nuclei - the caudate nucleus, globus pallidus, subthalamic nucleus, and substantia nigra. Subcortical structures interact closely with the reticular formation, thalamus, limbic system, cerebellar hemispheres and the frontal cortex of the dominant hemisphere. The activity of subcortical structures and frontal lobes is regulated by the neurotransmitter dopamine. Insufficiency of the dopaminergic system leads to disturbances of attention, lack of self-regulation and behavioral inhibition, decreased control of motor activity and the appearance of excessive, uncontrolled movements.

The effectiveness of the dopaminergic system can be affected by intrauterine developmental disorders due to hypoxia, infection, birth trauma, or hereditary deficiency of dopamine metabolism. There are indications of an autosomal dominant type of inheritance; However, it is known that boys suffer from tics approximately 3 times more often than girls. Perhaps we are talking about cases of incomplete and sex-dependent penetration of the gene.

In most cases, the first appearance of tics in children is preceded by external unfavorable factors. Up to 64% of tics in children are provoked by stressful situations - school maladjustment, extracurricular activities, uncontrolled watching of TV shows or prolonged work on the computer, conflicts in the family and separation from one of the parents, hospitalization.

Simple motor tics can be observed in the long-term period of a traumatic brain injury. Vocal tics - coughing, sniffing, expectorating throat sounds - are often found in children who often suffer from respiratory infections (bronchitis, tonsillitis, rhinitis).

In most patients, there is a diurnal and seasonal dependence of tics - they intensify in the evening and become aggravated in the autumn-winter period.

A separate type of hyperkinesis includes tics that arise as a result of involuntary imitation in some highly suggestible and impressionable children. This happens in the process of direct communication and under the condition of a certain authority of the child with tics among his peers. Such tics go away on their own some time after the cessation of communication, but in some cases such imitation is the debut of the disease.

Clinical classification of tics in children

By etiology

Primary, or hereditary, including Tourette's syndrome. The main type of inheritance is autosomal dominant with varying degrees of penetration; sporadic cases of the disease are possible.

Secondary or organic. Risk factors: anemia in pregnant women, maternal age over 30 years, fetal malnutrition, prematurity, birth trauma, previous brain injuries.

Cryptogenic. They occur against the background of complete health in a third of patients with tics.

According to clinical manifestations

Local (facial) tic. Hyperkinesis affects one muscle group, mainly facial muscles; frequent blinking, squinting, twitching of the corners of the mouth and wings of the nose predominate (Table 1). Blinking is the most persistent of all local tic disorders. Closed eyes are characterized by a more pronounced disturbance of tone (dystonic component). Movements of the wings of the nose, as a rule, are associated with rapid blinking and are among the unstable symptoms of facial tics. Single facial tics practically do not interfere with patients and in most cases are not noticed by the patients themselves.

Common tic. Several muscle groups are involved in hyperkinesis: facial muscles, muscles of the head and neck, shoulder girdle, upper limbs, abdominal and back muscles. In most patients, a common tic begins with blinking, which is accompanied by opening the gaze, turning and tilting the head, and lifting the shoulders. During periods of exacerbation of tics, schoolchildren may have problems completing written assignments.

Vocal tics. There are simple and complex vocal tics.

The clinical picture of simple vocal tics is represented mainly by low sounds: coughing, “clearing the throat,” grunting, noisy breathing, sniffing. Less common are high-pitched sounds such as “i”, “a”, “oo-u”, “uf”, “af”, “ay”, squealing and whistling. With an exacerbation of tic hyperkinesis, vocal phenomena may change, for example, coughing turns into grunting or noisy breathing.

Complex vocal tics are observed in 6% of patients with Tourette syndrome and are characterized by the pronunciation of individual words, swearing (coprolalia), repetition of words (echolalia), and rapid, uneven, unintelligible speech (palilalia). Echolalia is an intermittent symptom and may occur over several weeks or months. Coprolalia usually represents a status condition in the form of serial utterance of swear words. Often, coprolalia significantly limits the child’s social activity, depriving him of the opportunity to attend school or public places. Palilalia is manifested by obsessive repetition of the last word in a sentence.

Generalized tic (Tourette's syndrome). Manifests itself as a combination of common motor and vocal simple and complex tics.

Table 1 presents the main types of motor tics depending on their prevalence and clinical manifestations.

As can be seen from the table presented, as the clinical picture of hyperkinesis becomes more complex, from local to generalized, tics spread from top to bottom. Thus, with a local tic, violent movements are noted in the facial muscles; with a widespread tic, they move to the neck and arms; with a generalized tic, the torso and legs are involved in the process. Blinking occurs with equal frequency in all types of tics.

According to the severity of the clinical picture

The severity of the clinical picture is assessed by the number of hyperkinesis in the child during 20 minutes of observation. In this case, tics can be absent, single, serial or status. Severity assessment is used to standardize the clinical picture and determine the effectiveness of treatment.

At single ticks their number in 20 minutes of examination ranges from 2 to 9, more often found in patients with local forms and in remission in patients with widespread tics and Tourette's syndrome.

At serial ticks During a 20-minute examination, from 10 to 29 hyperkinesis are observed, after which there are many-hour breaks. A similar picture is typical during exacerbation of the disease and occurs in any localization of hyperkinesis.

At tic status serial tics follow with a frequency of 30 to 120 or more per 20 minutes of examination without a break during the day.

Similar to motor tics, vocal tics can also be single, serial and status, intensifying in the evening, after emotional stress and overwork.

According to the course of the disease

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), there are transient tics, chronic tics and Tourette's syndrome.

Transient , or transient The course of tics implies the presence of motor or vocal tics in a child with complete disappearance of symptoms of the disease within 1 year. Characteristic of local and widespread tics.

Chronic Tic disorder is characterized by motor tics lasting more than 1 year without a vocal component. Chronic vocal tics in isolated form are rare. There are remitting, stationary and progressive subtypes of the course of chronic tics.

In a remitting course, periods of exacerbation are replaced by complete regression of symptoms or the presence of local single tics that occur against the background of intense emotional or intellectual stress. The relapsing-remitting subtype is the main variant of the course of tics. With local and widespread tics, exacerbation lasts from several weeks to 3 months, remissions last from 2-6 months to a year, in rare cases up to 5-6 years. With drug treatment, complete or incomplete remission of hyperkinesis is possible.

The stationary type of the disease is determined by the presence of persistent hyperkinesis in various muscle groups, which persist for 2-3 years.

The progressive course is characterized by the absence of remissions, the transition of local tics to widespread or generalized ones, the complication of stereotypes and rituals, the development of tic status, and resistance to therapy. A progressive course predominates in boys with hereditary tics. Unfavorable signs are the presence of aggressiveness, coprolalia, and obsessions in the child.

There is a relationship between the localization of tics and the course of the disease. Thus, a local tic is characterized by a transient-remitting type of course, a widespread tic is characterized by a remitting-stationary type, and Tourette's syndrome is characterized by a remitting-progressive type.

Age dynamics of tics

Most often, tics appear in children aged 2 to 17 years, the average age is 6-7 years, the frequency of occurrence in the child population is 6-10%. Most children (96%) develop tics before age 11. The most common manifestation of a tic is blinking the eyes. At the age of 8-10 years, vocal tics appear, which make up approximately a third of the cases of all tics in children and occur both independently and against the background of motor ones. Most often, the initial manifestations of vocal tics are sniffing and coughing. The disease is characterized by an increasing course with a peak of manifestations at 10-12 years, then a decrease in symptoms is noted. By age 18, approximately 50% of patients become free of tics spontaneously. At the same time, there is no relationship between the severity of the manifestation of tics in childhood and in adulthood, but in most cases in adults the manifestations of hyperkinesis are less pronounced. Sometimes tics first appear in adults, but they are characterized by a milder course and usually last no more than 1 year.

The prognosis for local tics is favorable in 90% of cases. In the case of common tics, 50% of children experience complete regression of symptoms.

Tourette's syndrome

The most severe form of hyperkinesis in children is, without a doubt, Tourette's syndrome. Its frequency is 1 case per 1,000 children in boys and 1 in 10,000 in girls. The syndrome was first described by Gilles de la Tourette in 1882 as a “disease of multiple tics.” The clinical picture includes motor and vocal tics, attention deficit disorder, and obsessive-compulsive disorder. The syndrome is inherited with high penetrability in an autosomal dominant manner, and in boys, tics are more often combined with attention deficit hyperactivity disorder, and in girls - with obsessive-compulsive disorder.

The currently generally accepted criteria for Tourette's syndrome are those given in the DSM III revision classification. Let's list them.

• A combination of motor and vocal tics that occur simultaneously or at different intervals.
• Repeated tics throughout the day (usually in series).
• The location, number, frequency, complexity and severity of tics changes over time.
• The onset of the disease is before 18 years of age, duration is more than 1 year.
• Symptoms of the disease are not associated with the use of psychotropic drugs or central nervous system disease (Huntington's chorea, viral encephalitis, systemic diseases).

The clinical picture of Tourette's syndrome depends on the age of the patient. Knowledge of the basic patterns of disease development helps to choose the right treatment tactics.

Debut The disease develops between 3 and 7 years of age. The first symptoms are local facial tics and shoulder twitching. Then hyperkinesis spreads to the upper and lower extremities, shuddering and turning of the head, flexion and extension of the hand and fingers, throwing the head back, contraction of the abdominal muscles, jumping and squats appear, one type of tics is replaced by another. Vocal tics often join motor symptoms for several years after the onset of the disease and intensify during the acute stage. In a number of patients, vocalisms are the first manifestations of Tourette's syndrome, which are subsequently joined by motor hyperkinesis.

Generalization of tic hyperkinesis occurs over a period lasting from several months to 4 years. At the age of 8-11 years, children experience peak clinical manifestations of symptoms in the form of a series of hyperkinesis or repeated hyperkinetic states in combination with ritual actions and auto-aggression. The tic status in Tourette's syndrome characterizes a severe hyperkinetic state. A series of hyperkinesis is characterized by the replacement of motor tics with vocal ones, followed by the appearance of ritual movements. Patients note discomfort from excessive movements, for example, pain in the cervical spine that occurs when turning the head. The most severe hyperkinesis is a throwing back of the head - in this case, the patient can repeatedly hit the back of the head against the wall, often in combination with simultaneous clonic twitching of the arms and legs and the appearance of muscle pain in the extremities. The duration of status tics ranges from several days to several weeks. In some cases, exclusively motor or predominantly vocal tics are noted (coprolalia). During status tics, consciousness in children is completely preserved, but hyperkinesis is not controlled by patients. During exacerbations of the disease, children cannot attend school and self-care becomes difficult for them. Characteristic remitting course with exacerbations lasting from 2 to 12-14 months and incomplete remissions from several weeks to 2-3 months. The duration of exacerbations and remissions is directly dependent on the severity of tics.

In most patients at 12-15 years of age, generalized hyperkinesis turns into residual phase , manifested by local or widespread tics. In a third of patients with Tourette's syndrome without obsessive-compulsive disorders in the residual stage, a complete cessation of tics is observed, which can be considered as an age-dependent infantile form of the disease.

Comorbidity of tics in children

Tics often occur in children with pre-existing central nervous system (CNS) conditions, such as attention deficit hyperactivity disorder (ADHD), cerebrasthenic syndrome, and anxiety disorders including generalized anxiety disorder, specific phobias, and obsessive-compulsive disorder.

About 11% of children with ADHD have tics. Mostly these are simple motor and vocal tics with a chronic recurrent course and a favorable prognosis. In some cases, the differential diagnosis between ADHD and Tourette's syndrome is difficult when hyperactivity and impulsivity appear in a child before the development of hyperkinesis.

In children suffering from generalized anxiety disorder or specific phobias, tics can be provoked or intensified by worries and worries, unusual surroundings, prolonged anticipation of an event and a concomitant increase in psycho-emotional stress.

In children with obsessive-compulsive disorder, vocal and motor tics are combined with compulsive repetition of a movement or activity. Apparently, in children with anxiety disorders, tics are an additional, albeit pathological, form of psychomotor discharge, a way of calming and “processing” accumulated internal discomfort.

Cerebrasthenic syndrome in childhood it is a consequence of traumatic brain injuries or neuroinfections. The appearance or intensification of tics in children with cerebrasthenic syndrome is often provoked by external factors: heat, stuffiness, changes in barometric pressure. Typically, tics increase with fatigue, after long-term or repeated somatic and infectious diseases, and increased educational loads.

Let us present our own data. Of the 52 children who complained of tics, there were 44 boys and 7 girls; the boys: girls ratio was 6:1 (Table 2).

So, the largest number of calls for tics was observed in boys aged 5-10 years, with a peak at 7-8 years. The clinical picture of tics is presented in Table. 3.

Thus, simple motor tics with localization mainly in the muscles of the face and neck and simple vocal tics imitating physiological actions (coughing, expectoration) were most often observed. Jumping and complex vocal expressions were much less common - only in children with Tourette syndrome.

Temporary (transient) tics lasting less than 1 year were observed more often than chronic (remitting or stationary) tics. Tourette's syndrome (chronic stationary generalized tic) was observed in 7 children (5 boys and 2 girls) (Table 4).

Treatment

The main principle of treatment for tics in children is an integrated and differentiated approach to treatment. Before prescribing medication or other therapy, it is necessary to find out the possible causes of the disease and discuss methods of pedagogical correction with parents. It is necessary to explain the involuntary nature of hyperkinesis, the impossibility of controlling them by willpower and, as a consequence of this, the inadmissibility of comments to a child about tics. Often the severity of tics decreases when the demands on the child from the parents are reduced, attention is not focused on his shortcomings, and his personality is perceived as a whole, without isolating “good” and “bad” qualities. Streamlining the regimen and playing sports, especially in the fresh air, have a therapeutic effect. If induced tics are suspected, the help of a psychotherapist is necessary, since such hyperkinesis can be relieved by suggestion.

When deciding whether to prescribe drug treatment, it is necessary to take into account factors such as etiology, age of the patient, severity and severity of tics, their nature, and concomitant diseases. Drug treatment must be carried out for severe, pronounced, persistent tics, combined with behavioral disorders, poor performance at school, affecting the child’s well-being, complicating his adaptation in the team, limiting his opportunities for self-realization. Drug therapy should not be prescribed if the tics only bother the parents but do not interfere with the child's normal activities.

The main group of drugs prescribed for tics are antipsychotics: haloperidol, pimozide, fluphenazine, tiapride, risperidone. Their effectiveness in the treatment of hyperkinesis reaches 80%. The drugs have analgesic, anticonvulsant, antihistamine, antiemetic, neuroleptic, antipsychotic, and sedative effects. The mechanisms of their action include blockade of postsynaptic dopaminergic receptors of the limbic system, hypothalamus, trigger zone of the gag reflex, extrapyramidal system, inhibition of the reuptake of dopamine by the presynaptic membrane and subsequent deposition, as well as blockade of adrenergic receptors of the reticular formation of the brain. Side effects: headache, drowsiness, difficulty concentrating, dry mouth, increased appetite, agitation, restlessness, anxiety, fear. With prolonged use, extrapyramidal disorders may develop, including increased muscle tone, tremor, and akinesia.

Haloperidol: the initial dose is 0.5 mg at night, then it is increased by 0.5 mg per week until a therapeutic effect is achieved (1-3 mg/day in 2 divided doses).

Pimozide (Orap) is comparable in effectiveness to haloperidol, but has fewer side effects. The initial dose is 2 mg/day in 2 divided doses; if necessary, the dose is increased by 2 mg per week, but not higher than 10 mg/day.

Fluphenazine is prescribed at a dose of 1 mg/day, then the dose is increased by 1 mg per week to 2-6 mg/day.

Risperidone belongs to the group of atypical antipsychotics. Risperidone is known to be effective for tics and related behavioral disorders, especially those of an oppositional defiant nature. The initial dose is 0.5-1 mg/day with a gradual increase until positive dynamics are achieved.

When choosing a drug to treat a child with tics, you should consider the dosage form that is most convenient for dosing. Optimal for titration and subsequent treatment in childhood are drop forms (haloperidol, risperidone), which allow you to most accurately select a maintenance dose and avoid an unjustified overdose of the drug, which is especially important when carrying out long courses of treatment. Preference is also given to drugs with a relatively low risk of side effects (risperidone, tiapride).

Metoclopramide (Reglan, Cerucal) is a specific blocker of dopamine and serotonin receptors in the trigger zone of the brain stem. For Tourette's syndrome in children, it is used in a dose of 5-10 mg per day (1/2-1 tablet), in 2-3 doses. Side effects include extrapyramidal disorders that occur when the dose exceeds 0.5 mg/kg/day.

In recent years, valproic acid preparations have been used to treat hyperkinesis. The main mechanism of action of valproate is to enhance the synthesis and release of γ-aminobutyric acid, which is an inhibitory neurotransmitter of the central nervous system. Valproates are the first choice drugs in the treatment of epilepsy, but their thymoleptic effect, manifested in a decrease in hyperactivity, aggressiveness, irritability, as well as a positive effect on the severity of hyperkinesis, is of interest. The therapeutic dose recommended for the treatment of hyperkinesis is significantly lower than for the treatment of epilepsy and is 20 mg/kg/day. Side effects include drowsiness, weight gain, and hair loss.

When hyperkinesis is combined with obsessive-compulsive disorder, antidepressants - clomipramine, fluoxetine - have a positive effect.

Clomipramine (Anafranil, Clominal, Clofranil) is a tricyclic antidepressant whose mechanism of action is inhibition of the reuptake of norepinephrine and serotonin. The recommended dose for children with tics is 3 mg/kg/day. Side effects include transient visual disturbances, dry mouth, nausea, urinary retention, headache, dizziness, insomnia, excitability, extrapyramidal disorders.

Fluoxetine (Prozac) is an antidepressant, a selective serotonin reuptake inhibitor with low activity in relation to the norepinephrine and dopaminergic systems of the brain. In children with Tourette's syndrome, it effectively eliminates anxiety, anxiety, and fear. The initial dose in childhood is 5 mg/day once a day, the effective dose is 10-20 mg/day once in the morning. The drug is generally well tolerated, side effects are relatively rare. Among them, the most significant are anxiety, sleep disturbances, asthenic syndrome, sweating, and weight loss. The drug is also effective in combination with pimozide.

Literature

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N. Yu. Suvorinova, Candidate of Medical Sciences
RGMU, Moscow