Overview
Tourette’s Syndrome
The exact cause is still unknown but it is believed that Tourette’s syndrome is due to a neurotransmitter imbalance in a part of the brain known as the basal ganglia. The disorder is thought to have a genetic basis but the gene(s) have not yet been identified. Although the level of tics is influence by a person’s emotional state, Tourette’s syndrome is not due to a psychological problem or to poor parenting.
Movement disorders in children
Many abnormal involuntary movements as part of various diseased may impact normal smooth execution of voluntary movements. Those are broadly classified as hyperkinetic (excess movement) disorder. The other extreme is lack of adequate movement in spite of normal strength; those are called hypokinetic (less movement) movement disorders. For smooth execution of any motor act, it is imperative not to have either of those problems. Many of those abnormal movements exclusively occur in children. Thus it is essential for a pediatric neurology center to have a dedicated program geared towards management of movement disorders in children. Commonest involuntary movements in children are tics which are discussed separately in the section of tic disorders. The other common problem of dystonia is also discussed separately. Other involuntary movements seen commonly in children are tremor, myoclonus, chorea, Athetosis, ballism, and motor stereotypies. Some involuntary movements seen in children go away with age thus may represent an age related developmental phenomena. Early recognition of those problems may prevent undue costly investigations and allay the anxiety among parents. These may be in the form of sleep myoclonus, jitteriness, episodic infantile torticollis, breath holding spells, shuddering spells, spasmus nutans, hereditary chin tremor, and various stereotypies.
Symptoms
Tourette’s Syndrome
Tics are involuntary actions and they are divided into 2 types. Motor tics involve a physical action such as eye blinking or shoulder shrugging. vocal tics are involuntary actions consisting of a sound or a word. Both types may be preceded by an uncomfortable sensation and ticks typically worsen under the influence of heightened emotion which can be excitement or anxiety. Tics begin in middle childhood, typically between the ages of 4 and 10 years of age. Tourette’s syndrome is a spectrum disorder and tic severity ranges from mild to severe. All persons with TS exhibit a waxing and waning pattern and tic form will change over time. Complicating the situation is the frequent occurrence of other problems along with the tics, generally in the areas of learning and behavior. More than one-half of children with Tourette’s syndrome will also have attention deficit hyperactivity disorder (ADHD) and/or obsessive-compulsive disorder (OCD). Fortunately, the majority of children with TS will eventually completely or almost completely outgrow their tics, typically around 16 to 18 years of age.
Movement disorders in children
- To and fro movement of fingers, more while doing some activity – tremor. Rarely, tremor may spread to head, tongue, voice, and lower limbs.
- Abnormal twisted posturing due to involuntary forceful muscle contraction – dystonia.
- Sudden brief jerking of part or whole of the body – myoclonus.
- Repetitive brief, stereotyped movements in the form of eye blinking, facial grimacing, shoulder shrugging, head rotation, head jerks with or without abnormal sound production – tics, motor, or vocal.
- Involuntary jerky, flickering movement of the limbs or body associated with fidgetiness – Chorea.
- Abnormal slow sinuous movement in the fingers or toes – athetosis.
- Violent sudden flinging uncontrollable limb movement – ballism.
- Repetitive clapping, ringing finger movements, rocking, head nodding, or complex movement patterns when the child is excited – motor stereotypies
Treatment
Tourette’s Syndrome
There are no health risks associated with Tourette’s syndrome and there is no impact on life span. Treatment must always begin with explanations about this sometimes seemingly mysterious disorder. Education of the patient, family, and teachers is crucial to demystifying TS and helping other understand the involuntary nature of the individual’s tics. Understanding this disorder is often enough to allow the individual to cope with its effects without the use of medication. 50% of persons with TS never have taken medication for this. Others do have enough problems that treatment with medications is justified. A variety of medications are available to target the most bothersome symptoms. In addition to medication to help control tics, some persons will benefit from medicine to target the accompanying problems such as ADHD or OCD. The exact program needs to be carefully individualized.
Movement disorders in children
In psychogenic abnormal movements, the mainstay of treatment is psychological evaluation, counseling, and treatment of underlying psychiatric disorders. Many abnormal movements may get worse with anxiety and stress. Appropriate Management of them is very helpful. Physical and occupational therapy in combination with medical management may be beneficial. Botulinum toxin injections, surgical treatments such as Intrathecal Baclofen therapy (ITB), and deep brain stimulation (DBS) may also benefit and improve function.
Specialty Care Providers Who Treat This Condition
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