Tourette's syndrome is a neurological and psychiatric disorder that occurs in children or adolescents, characterized by involuntary, recurrent, sudden, rapid, repetitive, and non rhythmic motor and/or vocal tics in one or more parts of the body. The age of onset is 5-10 years old, with more boys than girls, and a male to female ratio (3-5:1). A small number of children with this disease can self relieve during adolescence, while some may continue into adulthood. Clinical investigations have found that this disease often coexists with various mental and/or behavioral disorders, such as attention deficit hyperactivity disorder, compulsive behavior/disorder, anxiety disorder, depression disorder, and sleep disorder.
The pathogenesis of tic disorders is not yet clear, as it is a neurodevelopmental disorder. Currently, some scholars speculate that its pathogenesis may be related to the combined effects of genetic, immune, psychological, and environmental factors. The connection mechanism between pathophysiology and clinical symptoms may lie in the disinhibition of the cortical striatal thalamic cortical loop. But it can be confirmed that Tourette's syndrome has a high degree of heritability.
Tic refers to sudden, aimless, rapid, and rigid muscle contractions, which are divided into motor tics and vocal tics. Movement tic refers to the rapid contraction movement of fingers, face, neck, shoulders, trunk, and limbs; Vocal twitching refers to the contraction of the mouth, nose, throat, and respiratory system, which produces sound through the airflow of the nose, mouth, and throat. Children with both motor tics and vocal tics can also be seen clinically. Tourette can transform from one form to another and new forms of tics may appear during the course of the disease, but typically manifest as a specific stereotype during a specific time period. The frequency and intensity of tics also fluctuate significantly during the course of the disease, and tics symptoms increase and decrease during the course of the disease.
The treatment of this disease mainly involves a preliminary assessment of tics to establish a treatment plan, determining whether there are concurrent psychological, social, and behavioral problems, and identifying the damage caused by each problem. If tics do not affect daily life or school activities, many children do not need intervention or treatment for tics. In China, there are differences in the applicability of cognitive-behavioral therapy (CBT) and drug therapy, and the experience of clinical physicians in different places and situations also reflects the rationality of clinical guidelines. Therefore, treatment should be based on individualized needs, expert consensus and clinical guidelines, and guided by the specific symptoms of the child.
From a clinical perspective, the treatment of Tourette's syndrome in children must start from the source. Doctors should establish the correct concept of "finding and solving the pathogenic factors from the source". Parents, teachers, and even children themselves should scientifically understand and recognize Tourette's syndrome, avoid falling into misunderstandings, and increase the harm of Tourette's syndrome to children. At the same time, close cooperation from multiple aspects, actively, seriously, and meticulously searching for and discovering psychological pathogenic factors in the family and school environment, taking corresponding measures, and removing pathogenic factors from the source, is expected to fundamentally cure children's tic disorders, curb the development of comorbidities, avoid causing greater functional damage, and do not blindly scold, beat and scold in an attempt to make children "obedient". This will only make children more nervous, anxious, and insecure. Therefore, it is very important to create a relaxed and pleasant environment for children. Many children are under pressure from the environment while taking medication, and some treatment methods may exacerbate their tension, making the treatment effect very unsatisfactory. It is suggested that parents should not rush to medication, acupuncture and moxibustion, massage, etc. when finding problems. The most important thing is to find the inducing factors and eliminate them.