Tourette's syndrome: causes, symptoms, diagnosis and treatment

Tourette's syndrome is a serious neurological disorder. It is usually observed in children and adolescents under the age of 20 years. Boys suffer from this pathology much more often than girls. The disease is accompanied by involuntary movements, tics and cries. A sick person is far from always able to control these actions. Pathology does not affect the mental development of the child, but serious deviations in behavior significantly complicate 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 violation. It has been established that the basal ganglia of the frontal subcortex are involved in the pathological process. and frontal lobes. These are parts of the brain that are responsible for motor function. It is their defeat that leads to the appearance of ticks and uncontrolled movements.

In addition, in people with Tourette’s syndrome, increased dopamine production is detected. This substance is considered a "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, short temper, emotional instability.

Causes of the disorder

The exact etiology of this syndrome has not been established. There are only hypotheses about the origin of the disease. The following assumptions about the probable causes of pathology are most common among medical scientists:

1. Genetic factor. Patients are often interested in the question of whether Tourette’s syndrome is inherited. It was established that if one of the parents suffers from this ailment, 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 determined. Sometimes the pathology is detected not in parents, but in other close relatives of sick children. When transmitting a gene in a child, Tourette’s syndrome does not necessarily occur. However, as a person grows up, other forms of tics or an obsessive state syndrome may appear.
2. Autoimmune pathologies. If a person has a hereditary predisposition to this disease, then streptococcal infections can become the cause of Tourette's syndrome. After scarlet fever or pharyngitis, autoimmune complications often occur that have a negative effect on the nervous system and can provoke tics.
3. The pathological course of pregnancy in the mother of the child. Oxygen starvation of the fetus, toxicosis, as well as birth trauma can lead to the development of Tourette's syndrome in the baby. A child’s disease can also occur if the expectant mother takes some medications in the early stages of pregnancy.
4. The use of antipsychotics. Antipsychotics have an unpleasant side effect, these drugs can cause hyperkinesis - a condition 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 complete code for Tourette’s syndrome in the ICD 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 in the patient of several motor tics and at least one vocalism.

Motor disorders

The first manifestations of the disease are noted at the age of 2-5 years. Often, parents and others take these symptoms for behavioral patterns of the child. The following symptoms should be noted:

1. The kid often blinks, grimaces, builds faces. These movements are repeated constantly and are of an involuntary nature.
2. The child often stretches his lips and folds them in the form of a tube.
3. Frequent and involuntary movements of the shoulders and hands (shaking, twitching) are noted.
4. The child periodically frowns his forehead, scratches himself, shakes his head.

Such movements are called simple motor tics. Usually one muscle group is involved in them. Ticks are repeated periodically in the form of seizures. The movements are intrusive, and a small child cannot stop them with volitional efforts.

As the disease progresses in pathological movements, several muscle groups are involved at once. Attacks become more severe. Complex motor tics appear that affect not only the face, but also the limbs:

1. The child begins to constantly squat.
2. The kid often bounces.
3. Hands clapping or obsessive fingers touching various objects are noted.
4. With severe ticks, the child bumps his head against the walls or bites his lips before the blood.

Tourette's syndrome is always accompanied by changes in the behavior of the child. The kid becomes overly emotional, restless and moody. He avoids communication with peers. There are mood swings. The child has frequent depression, which is then replaced by increased energy and aggressiveness. Children become inattentive; it is very difficult for them to concentrate on perceiving information or completing a school assignment.

Children with this syndrome often sniff. This is also a kind of teak, but parents can take this symptom of the disease as a symptom of a cold.

Voice Disorders

Along with involuntary movements, voice disturbances are also observed. They also occur in the form of seizures. Suddenly, the child begins to make strange noises: howling, hissing, rumbling, mooing. Often children during an attack shout out meaningless words.

In older children, the following voice disorders are noted:

1. Echolalia. The child repeats the surrounding parts of words or entire words and sentences.
2. Palilalia. Children repeat the same phrases many times.
3. Coprolalia. This is an obsessive shouting of insults or curses. This symptom makes life very difficult for patients. Not everyone around knows what this disease 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 symptoms of this disease subside by 18-20 years. However, this does not always happen, 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.

Stages of the disease

In medicine, several stages of Tourette's syndrome are distinguished. The less a person is able to control involuntary movements and vocalisms, the more severe the disease:

1. At the first stage of the disease, tics are almost invisible. 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.
2. In the second stage, the patient still retains the ability to self-control. But he does not always manage to stop the manifestations of the disease by volitional effort. Voice and motor tics become noticeable to others, the periods between attacks are reduced.
3. The third stage of the disease is characterized by frequent attacks. The patient controls the tics with great difficulty.
4. At the fourth stage, the signs of the disease are pronounced, and the person is not able to suppress them.

Often people 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 has an uncomfortable state with an irresistible desire to make one or another movement. This can be compared with the need to sneeze or scratch the skin with severe itching.

Diagnostics

A neuropathologist or psychiatrist is involved in the diagnosis and treatment of Tourette’s syndrome. A specialist may suspect a disease by the following symptoms:

• occurrence of ticks under the age of 18 years;
• the duration of symptoms for a long time (at least 1 year);
• the presence in the clinical picture of at least one voice tick.

It is important to remember that involuntary movements are also observed with organic lesions of the central nervous system. Therefore, it is important to conduct differential diagnosis of Tourette’s syndrome. For this purpose, MRI and CT of the brain are prescribed. A blood test for copper should also be taken. Ticks can be observed with an increased content of this element in the body.

Psychotherapy

Psychotherapy plays a major role in treating Tourette’s syndrome. It is impossible to completely get rid of this disease, but its manifestations can be significantly mitigated.

Psychotherapeutic exercises 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 ticks 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. Patients often feel guilty and ashamed of the manifestations of their illness. This exacerbates anxiety and exacerbates symptoms. During psychotherapeutic sessions, the specialist teaches the patient the correct behavior during motor and voice tics. Usually the patient always feels the approach of an attack. At this point, it is important to shift your attention from involuntary movements to another action. With a mild illness, this helps prevent an attack.

Drug treatment

In advanced cases, psychotherapy alone is not enough to improve the patient's condition. For moderate to severe illness, medication is required. In the treatment of Tourette’s syndrome, the following drugs are used:

• antipsychotics: Haloperidol, Truxal, Risolept;
• 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 these funds are strictly prescription and are not intended for independent use.

Teaching a sick child

If Tourette’s syndrome is mild, the child can study at school with healthy peers. However, teachers must be warned about its features. Ticks usually increase 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.

In severe forms of Tourette’s syndrome, home-based training is indicated. 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 ticks should be especially protected from stress and excessive mental overload.

Forecast

Tourette's syndrome does not affect the patient's lifespan. Most often, the manifestations of the disease disappear or significantly decrease in the post-puberty period. If the symptoms of the pathology persist even in 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 the baby, since the defective gene that provokes this syndrome has not been identified.

You can only reduce the likelihood of seizures in the patient. To do this, take the following measures:

• eliminate stressful situations as much as possible;
• attend classes with a psychotherapist;
• observe the daily routine.

It is important for pregnant women to eat right, to avoid taking medications and to be constantly observed by an obstetrician-gynecologist. This will help reduce the risk of having a baby with neurological problems.