Tics can even happen when a person first falls asleep, but usually slow down and disappear completely during the deeper stages of sleep. Sometimes a person with Tourette syndrome might have other conditions, like attention deficit hyperactivity disorder ADHD , obsessive-compulsive disorder OCD , or trouble learning.
Tourette syndrome is much more common in boys than in girls, and it always starts before age 18 — usually between the ages of 5 and 9. Tourette syndrome is a genetic condition, which means it's passed down from a person's parents.
Tourette syndrome is not contagious and you can't catch it from someone who has it. No one knows the exact cause of Tourette syndrome, but some research points to a problem with how nerves communicate in the brain.
Neurotransmitters — chemicals in the brain that carry nerve signals from cell to cell — may play a role. Anyone who has a tic will need to see a doctor, and maybe a neurologist a doctor who knows a lot about the nervous system. All kids who have Tourette syndrome have tics — but a person can have tics without having Tourette syndrome. Some health conditions and medicine, for instance, can cause tics.
And many kids have tics that disappear on their own in a few months or a year. So, it's important for doctors to know what's causing the tics. Since there is no one test for Tourette syndrome, a doctor will get a good family history and medical history, and look at the person's symptoms. Sometimes a doctor will order several other tests like blood tests, EEG, and brain scans.
There's no cure for Tourette syndrome, but most of the time no treatment is needed. A kid with Tourette syndrome is able to deal with the tics and still do normal stuff, like go to school and play with friends. If tics are making it hard to do normal stuff, a doctor may suggest medicine. Visiting a psychologist or psychiatrist can be helpful, too.
Tourette syndrome isn't a psychological problem, but a therapist can teach coping and relaxation skills that can help. Substance use disorder Substance Use Disorders Substance use disorders are a type of substance-related disorder that involve a pathologic pattern of behaviors in which patients continue to use a substance despite experiencing significant These categories typically form a continuum in which patients begin with provisional tic disorder and sometimes go on to persistent tic disorder or Tourette syndrome.
In all cases, age at onset must be Patients tend to manifest the same set of tics at any given time, although tics tend to vary in type, intensity, and frequency over a period of time. Typically, tics do not occur during sleep. See table Types of Tics Types of Tics Tics are defined as repeated, sudden, rapid, nonrhythmic muscle movements including sounds or vocalizations.
Tourette syndrome is diagnosed when people have had both motor and vocal tics for Simple tics are a very brief movement or vocalization, typically without social meaning. Complex tics last longer and may involve a combination of simple tics. Complex tics may appear to have social meaning ie, be recognizable gestures or words and thus seem intentional.
However, although some patients can voluntarily suppress their tics for a short time seconds to minutes and some notice a premonitory urge to perform the tic, tics are not voluntary and do not represent misbehavior. Stress and fatigue can make tics worse, but tics are often most prominent when the body is relaxed, as while watching TV.
Tics may lessen when patients are engaged in tasks eg, school or work activities. Tics rarely interfere with motor coordination. Sometimes tics are explosive in onset, appearing and becoming constant within a day. Symptoms vary with the organ To differentiate Tourette syndrome from transient tics, physicians may have to monitor patients over time.
See also the American Academy of Neurology's review summary of treatment of tics in people with Tourette syndrome and chronic tic disorders. Often, treatment may be avoided if clinicians help children and their families understand the natural history of tics and if school personnel can help classmates understand the disorder.
A type of behavioral therapy called CBIT may help some older children control or reduce the number or severity of their tics. It includes cognitive-behavioral therapy such as habit reversal learning a new behavior to replace the tic , education about tics, and relaxation techniques.
Sometimes the natural waxing and waning of tics makes it appear that the tics have responded to a particular treatment. Oral clonidine 0. Adverse effects of fatigue may limit daytime dosage; hypotension is uncommon. With any drug, the lowest dose required to make tics tolerable is used; doses are tapered as tics wane. Adverse effects of dysphoria, parkinsonism, akathisia, and tardive dyskinesia are rare but may limit use of antipsychotics; using lower daytime doses and higher bedtime doses may decrease adverse effects.
ADHD can sometimes be successfully treated with low doses of stimulants without exacerbating tics, but an alternative treatment eg, atomoxetine may be preferable. If obsessive or compulsive traits are bothersome, a selective serotonin reuptake inhibitor may be useful. Children who have tics and who are struggling in school should be evaluated for learning disorders and provided with support as needed.
Tics are repeated, sudden, rapid, nonrhythmic muscle movements or vocalizations that develop in children Simple tics are a very brief movement or vocalization eg, head jerk, grunt , typically without social meaning. Complex tics may appear to have social meaning ie, be recognizable gestures or words and thus seem intentional, but they are not. Comprehensive Behavioral Intervention for Tics CBIT and sometimes clonidine or an antipsychotic may lessen severe or troublesome tics, which also tend to lessen with time although a few persist into adulthood.
They may range from very mild to severe, although most cases are mild. Simple tics: sudden, brief, repetitive movements that involve a limited number of muscle groups. They are more common than complex tics. Complex tics: distinct, coordinated patterns of movement involving several muscle groups. Examples of motor tics seen in Tourette syndrome. Examples of vocal phonic tics in Tourette syndrome. Some of the most dramatic and disabling tics may include motor movements that result in self-harm such as punching oneself in the face or vocal tics such as echolalia or swearing.
Some tics are preceded by an urge or sensation in the affected muscle group called a premonitory urge. Some with TS will describe a need to complete a tic in a certain way or a certain number of times to relieve the urge or decrease the sensation.
Tic triggers. Tics are often worse with excitement or anxiety and better during calm, focused activities. Certain physical experiences can trigger or worsen tics; for example, tight collars may trigger neck tics. Hearing another person sniff or clear the throat may trigger similar sounds. Tics do not go away during light sleep but are often significantly diminished; they go away completely in deep sleep.
Although the symptoms of TS are unwanted and unintentional called involuntary , some people can suppress or otherwise manage their tics to minimize their impact on functioning. However, people with TS often report a substantial buildup in tension when suppressing their tics to the point where they feel that the tic must be expressed against their will. Tics in response to an environmental trigger can appear to be voluntary or purposeful but are not.
Disorders Associated with TS. Many individuals with TS experience additional co-occurring neurobehavioral problems how the brain affects emotion, behavior, and learning that often cause more impairment than the tics themselves. Although most individuals with TS experience a significant decline in motor and vocal tics in late adolescence and early adulthood, the associated neurobehavioral conditions may continue into adulthood.
The most common co-occurring conditions include:. Educational Settings. Although students with TS often function well in the regular classroom, ADHD, learning disabilities, obsessive-compulsive symptoms, and frequent tics can greatly interfere with academic performance or social adjustment.
After a comprehensive assessment, students should be placed in an educational setting that meets their individual needs. Students may require tutoring, smaller or special classes, private study areas, exams outside the regular classroom, other individual performance accommodations, and in some cases special schools.
To diagnose TS, a doctor looks for the following:. Common tics are often diagnosed by knowledgeable clinicians. However, atypical symptoms different from classical symptoms or atypical presentations for example, symptoms that begin in adulthood may require specific specialty expertise for diagnosis.
There are no blood, laboratory, or imaging tests needed for diagnosis. In rare cases, neuroimaging studies, such as magnetic resonance imaging MRI or computerized tomography CT , electroencephalogram EEG studies, or certain blood tests may be used to rule out other conditions that might be confused with TS.
It may take some time to receive a formal diagnosis of TS. Families and physicians unfamiliar with the disorder might think mild and even moderate tic symptoms may be negligible or unimportant, a part of a developmental phase, or the result of another condition.
For example, some parents may think that eye blinking is related to vision problems or that sniffing is related to seasonal allergies.
0コメント