ABSTRACT
Tics are sudden, repetitive, non-rhythmic movements and/or vocalizations. Generally, tics begin during childhood as a part of Tourette syndrome (TS) and rarely have an onset during adulthood. We describe a 30-year-old male who presented with multiple motor and vocal tics two weeks following a closed head injury with alteration of consciousness as a result of being crushed against the wall by a 4,100-pound air-conditioning unit. He started having motor tics that developed in a rostrocaudal distribution, followed by simple and complex vocal tics. His tics increased in severity over several months following the injury until presentation. He was started on pimozide and received hyperbaric oxygen treatment which improved both motor and vocal tics.
ABSTRACT
Tourette's Syndrome (TS), in which patients have sudden, repeated, involuntary twitches and movements, called tics, is a condition of the nervous system. They can be motor, vocal, simple, or complex tics. It can be physically, emotionally, mentally, and socially distressing and challenging for those suffering from it. Usually, it is accompanied by various comorbidities like attention-deficit hyperactivity disorder, obsessive-compulsive disorder, and sleep disorders. A variety of environmental and genetic factors are also associated with tics in TS like the first-degree relatives are more at risk of developing TS.TS is heterogeneous with complicated patterns of inheritance and phenotypic manifestations. There is a strong association between common single nucleotide polymorphisms (SNP, s) in the SLITRK1 gene and TS. Environmental factors like prenatal, postnatal, and perinatal factors directly influence tics in TS. These factors are low birth weight, intrauterine growth retardation (IGR), and various infections. The treatment of TS can be broadly classified into non-pharmacological and pharmacological treatment. Non-pharmacological therapy includes various behavioural interventions that can be helpful in situations when patients are tolerant of medical treatments. Psychoeducation and counselling play an essential role in the treatment of TS. It is vital to give a proper understanding to the patient and their family about the disease. Cognitive-behavioral intervention for tics, cognitive-behavioral therapy, exposure and response prevention, relaxation techniques, deep brain stimulation, and habit reversal training are the commonly used therapies for tics. These therapies have shown good efficacy because it improves the Yale Global Tic Severity Scale score (YGTSS) significantly. And they show effectiveness in patients who are irresponsive to medical treatment. The main lines of medical treatment are antipsychotics and alpha agonists. Typical (haloperidol, pimozide) or atypical (aripiprazole, risperidone, olanzapine) Antipsychotics differ in their side effects, efficacy, and tolerance in different age groups of children. Haloperidol was the first drug approved by the Food and Drug Administration for tics, but later on, new developments and improvements were made as far as drug therapy is concerned. The alpha-agonist most commonly used is clonidine which is also available in the form of adhesive patches. Another alpha agonist which is also widely used is guanfacine. Botulinum toxin and baclofen have also shown efficacy in dealing with tics in TS with other comorbidities. We will review in this article all the main lines of treatment and their effectiveness in TS.
ABSTRACT
BACKGROUND: Chronic tic disorders are neurodevelopmental disorders that can be treated with Habit Reversal Training (HRT) and Exposure Response Prevention (ERP). Intermediate and long-term effects have been examined after individual treatment with HRT, whereas evaluation of long-term outcome after an initial treatment with ERP, or a combination of HRT and ERP is lacking. The present study examines the long-term effect after a combined treatment with HRT and ERP delivered in an individual or a group setting METHODS: Fifty-nine children and adolescents diagnosed with a chronic tic disorder were randomised to manualised treatment combining HRT and ERP as individual or group training. Forty-seven were re-examined 1 year after acute outcome. Outcome measures included Total Tic Severity score (TTS) measured by the Yale Global Tic Severity Scale (YGTSS) and Beliefs About Tics Scale (BATS) RESULTS: In a mixed model, it was shown that the initial improvement with both individual and group treatment was maintained throughout the follow-up period. There were no significant differences between the two methods of treatment delivery. Of all participants completing the 12 months evaluation, 74.4% were considered responders. There was a significant positive association between the reduction of TTS and the reduction in BATS. In a latent class post-treatment trajectory analysis, two classes were identified, where high baseline severity increased the likelihood of being in the lesser responder class. Similar, but only as a trend, having ADHD, planning difficulties or hypersensitivity increased the risk of a lesser response. CONCLUSIONS: The present study compares the efficacy in individualised and group treatment of providing manualised therapy for child and adolescent tic disorders using two behavioural methods (combined HRT and ERP) both of which have been shown to have acute benefits but only one of which has been validated for longer term effectiveness. In the present study, both individualised and group treatments showed benefit throughout a 1-year follow-up period with several potential confounds affecting outcomes, while the relative benefits of either HRT and ERP were not addressed. Trial registration NCT04594044, 1-10-72-216-15, registered 19th October 2020, retrospectively registered, https://register.clinicaltrials.gov/prs/app/template/Home.vm?uid=U0005BW2&ts=9&sid=S000ABEY&cx=-wlx7vb The study is approved by the National Ethical Committee (1-10-72-216-15) and the Danish Data Protection Agency (1-16-02-490-15), registered 12 October 2015.
ABSTRACT
The purpose of this paper is to present the diagnosis and treatment of idiopathic hypersomnia comorbidity tics disorder. The client is 15 years old， female， a senior student， with frequent blinking and a crooked mouth since childhood， diagnosed with tics disorder. She previously had consistently good academic performance. Since the COVID-19 epidemic in 2020， the client has been sleeping more， averaging 12 hours per day， accompanied by increased daytime sleep with fatigue after waking up， and a significant decline in her studies. She was diagnosed with idiopathic hypersomnia comorbidity persistent （chronic） movement or tic disorder. It was suggested that she adopt a method of comprehensive biopsychosocial intervention. Biotherapy with methylphenidate can improve her arousal， enhance attention and improve drowsiness， meanwhile， changes to tic symptoms must be monitored. Cognitive behavioral therapy was used to help the client correct cognitive biases， reshape cognitive structure， and establish confidence in rehabilitation. Mindfulness therapy was adopted to help the client adjust her emotions. In terms of social resources， the client was encouraged to explore resources actively， seek social support， and build therapeutic alliances. Through coordinating multiple resources， the client reduced symptoms of sleepiness and enhanced her adaptability to continue with her studies.
ABSTRACT
Objective:To explore whether executive function (EF) deficits are specific to attention-deficit/hyperactivity disorder (ADHD) or whether such deficits are also associated with tics disorder (TD).Methods:A total of 112 ADHD comorbid TD (ADHD +TD) children,112 pure ADHD children and 112 normal controls were selected.The diagnosis was according to the criteria of Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition (DSM-Ⅳ).The groups were matched by sex,age (less than 6 months) and IQ.The Rey-Osterrieth complex Figure Test,the Trail Making Test,and Stroop Color Word Test were administered to assess working memory,shifting and inhibitory function respectively.The results of the comparison between groups used multivariate analysis of variance,and the statistically significant indicators were conducted with apost-test comparison.Results:Both pure ADHD group and ADHD + TD group performed worse (P ＜ 0.05) in the aspects of the delay recalling structure score,the immediate memory detail score,delay recalling detail score of Rey complex figure test,time of numberletter part and shifting time of trail making test,the time of Stroops2,4,the errors of Stroop 4 and word interference than normal controls.In the aspects of the score of the structure and detail forgetting,the pure ADHD group performed worse (P ＜0.05) than normal controls,but the ADHD + TD group didn't.The differences were significant (P ＜ 0.05).The other differences all weren't significant (P ＞ 0.05).Conclusion:It suggests that children with ADHD have executive function deficit,particular in the tests assessing working memory,shifting and inhibitory function,whether or not comorbid tics disorder.Comorbid tics disorders may not be the factor of aggravation.
ABSTRACT
A perturbação Gilles de la Tourette é um distúrbio neuropsicológico crónico, que resulta de anomalias ao nível dos neurotransmissores cerebrais. É caracterizada por fenómenos compulsivos, que originam tiques motores e vocais e origina problemas a nível social, emocional e particularmente na adaptação e integração no meio escolar. Este artigo procura promover um melhor conhecimento desta perturbação, da sintomatologia associada e essencialmente elaborar estratégias de intervenção educativa destinadas aos diversos agentes educativos, de modo a promover uma integração escolar e social mais eficiente.
Gilles de la Tourette syndrome is a neuropsychological condition, caused by multiple disorders in brain neurotransmitters. It is characterized by compulsive phenomena that give rise to motor and vocal tics, resulting in social and emotional problems, especially in integration and adaptation in school. The present article aims to improve knowledge of this disorder, including related symptoms, as well as to develop educational intervention strategies for various educational agents, so as to foster more efficient school and social integration.
