How to save a child from a nervous tic. Nervous tick in children: symptoms, signs, treatment, traditional medicine

Any short-term involuntary simple movement that occurs due to the contraction of one or more muscles on an erroneous command of the brain is called hyperkinesis. If the inappropriately performed movement becomes fast, repetitive, this phenomenon is called a tick.

Not only the muscular apparatus, but also the vocal apparatus can be affected. Along with movements, smacking, pronouncing some sounds, etc. are possible. A person understands that these manifestations are inappropriate, but he is unable to cope with them. The problem is becoming more and more common, manifesting itself in every fourth child under the age of 10 years.

Among neurological diseases in childhood, it occupies one of the leading places. What is it - a nervous tic in a child? What are the causes of eye twitches, hacking and coughing, shoulder movements, and other symptoms? How to get rid of it, how to treat babies and what is the treatment for older children?

Causes of development depending on age

The mechanism by which tics occur is complex and has not been definitively determined in many respects. All researchers agree that both genetic and psychological factors are involved. Possible organic damage to the brain in the perinatal period is assumed.

In order for a nervous tic to appear, at least three factors must coincide:

• Predisposition, or heredity. Often, with tics, it is found that the father or grandfather had the same problem, and the mother or grandmother suffered from neurosis obsessive states.
• Wrong upbringing. Increased control and uncompromisingness of parents, lack of communication, intra-family conflicts and a formal attitude towards the child provoke problems.
• Severe stress or severe viral disease, operation.

Usually initially the child has increased anxiety, which leads to chronic stress.

Frequent small stresses also lead to this. The baby's brain goes into constant expectation of danger and does not rest even in a dream.

The mechanisms adapting to stress are gradually depleted, and if the baby had a predisposition to insufficient brain inhibition pathological reactions, a traumatic factor can cause the onset of a tick.

In infants, immediately after birth, a tremor may occur, in which physiological twitches of the legs and / or arms, lower jaw, and lips occur. Anything becomes an occasion: colic, crying, bathing, changing clothes, hunger. All these manifestations usually disappear without a trace within the first three months of life.

You should start to worry when the head also starts to twitch. This is already a pathology, which usually increases with time. Tremor can occur on any part of the body; as the baby grows, it becomes more intense and longer.

Inexperienced parents of babies are often frightened, seeing a deviation in almost every movement, and begin to sound the alarm. Behind all this, most often there are no pathologies, the baby outgrows. For peace of mind, it is enough to consult a pediatrician.

Main types, signs, description

Tics are classified according to several indicators:

The way the tic manifests itself is a clear characteristic, understandable even to a non-specialist. As an example, there are several types of nervous tics in children:

Such manifestations, having arisen once, can gradually disappear by themselves. But if the child does not find support in environment, all this turns into a pathological habit and gradually transforms into a tick. Often this happens after severe viral diseases.

Exacerbations of the problem begin in autumn and winter, which is associated with an increasing mental load during schooling. In summer, remission often occurs (attenuation of symptoms).

Complex manifestations

Several muscle groups are involved in a complex tic: abdomen, back, limbs, neck, facial, vocal. In most children, nervous tics begin with blinking of the eyes. Gradually join the lifting of the shoulders, the establishment of the gaze, turning the head, moving the limbs. This makes it difficult for the child to perform written buildings while learning.

May be accompanied by coprolalia (cursing), echolalia (repetition of single words), or rapid slurred speech (palilalia). In the latter case, the last word in the spoken sentence is repeated.

The clinical picture usually becomes more complicated from top to bottom: first, the muscles of the face are involved in the process, then the problem captures the shoulders and arms. Later, the torso and legs join uncontrolled movements.

The most severe form is Tourette's syndrome, described in the 19th century as a disease of multiple tics.

The clinical picture combines obsessive-compulsive disorder with attention deficit, vocal and motor tics.

There is a disease with a frequency of 1 case per 1 thousand boys or 10 thousand girls. The first time the problem manifests itself at the age of 3-7 years is twitching of the shoulders and local facial tics.

One type of tick is replaced by another. After a few years, vocal tics join, sometimes the disease begins with them. It all depends on the age and characteristics of the body. The consciousness of the child during tics is completely preserved, but he cannot control these movements.

The peak of manifestations occurs at the age of 8–11 years. From excessive movements, muscle pains can appear, for example, in the cervical spine due to frequent and strong turns of the head. Throwing the head back sharply can cause the child to hit a hard object behind him, resulting in injury.

During exacerbations, children have a problem with self-care, and they cannot attend school. At 12-15 years old, the disease enters the residual phase - the final one, in which the process stops, residual symptoms are observed in the clinical picture.

This is manifested by local ticks. If Tourette's syndrome was not complicated by an obsessive-compulsive disorder, then in the residual phase a complete cessation of tics may occur.

Watch a video about Tourette's syndrome in children:

How to save a baby from pathology

The duration and nature of the course of the disease is affected by the age at which the disease began to develop:

• up to 3 years is a symptom of an existing complex disease (brain tumor, autism, etc.);
• in the interval from 3 to 6 years - the problem usually drags on until adolescence, then begins to gradually decrease;
• in the interval from 6 to 8 years - a favorable prognosis, the problem will pass without a trace.

The main principle of therapy is an integrated approach, accounting individual features organism and the course of the disease. First, during a conversation with parents, the doctor finds out possible reasons problems, methods of pedagogical correction are discussed. To drug therapy they don't come right away.

And what to do if the child has convulsions at a temperature, you will find out.

What can be done at home

First of all, the identified provoking factors are eliminated. The severity of tics decreases as the requirements for the child are reduced. It is necessary to observe the daily routine, adjust the diet, removing from it products that do not carry any benefit (soda, fast food, etc.), establish adequate physical activity.

If intermittent traumatic family situations are identified, family therapy may be needed. Any joint activity (cleaning the apartment, cooking, baking a pie), a kind word said in time will help the child get rid of internal tension.

The easiest way to calm down the nervous system is evening walks, swimming, warm baths with essential oils lavender and melissa.

Watch a video about how a nervous tic manifests itself in a child, what are the symptoms and treatment of the disorder in children of primary school age:

How can a doctor help

The diagnosis is established by a neurologist after examining the child. It will be good if parents prepare to shoot the problem at home, because during communication with the doctor, the picture may be “blurred”.

The child should also be examined by a psychologist and assessed for his emotional characteristics, degree of attentiveness, ability to remember and ability to control impulsive behavior.

Psychiatric consultation, magnetic resonance imaging or electroencephalogram may be needed. The doctor may advise taking a course psychological correction individually or in group sessions.

Specially trained specialists will correct the emotional or mental sphere, using games, conversations or drawing, will work on the baby's self-esteem.

A teenager in a group will be able to beat possible conflict situations with peers and, having rehearsed in advance, choose the best option for behavior, which will increase the chance of avoiding an exacerbation of a tick.

Treatment with medications is resorted to only when previous methods of therapy have exhausted themselves without giving results.

Drugs are prescribed by a neurologist, self-medication is strictly prohibited.

After the complete disappearance of the tick, the medication continues for another six months, then the doses are gradually reduced, up to complete cancellation.

What medications are prescribed

Antipsychotics may be prescribed, which have analgesic, anticonvulsant,, antihistamine, sedative, antipsychotic actions. These are Fluphenazine, Haloperidol, Pimozide, Tiapride, Risperidone.

Auxiliaries are connected to the main course: to maintain general well-being (vitamins), vascular preparations and nootropics that improve metabolic processes in the brain.

If obsessive-compulsive disorder is also present, then antidepressants are added to the treatment.- Fluoxetine (Prozac), Clomipramine (Clofranil, Clominal, Anafranil).

When choosing a drug for a child, the convenience of titration (dosing) of the drug is taken into account. The most convenient are drops (Risperidone, Haloperidol) - using liquid form it is convenient to measure the required maintenance volume, avoiding unjustified overdoses. This is very important when prescribing long courses.

Folk remedies

As an easily accessible remedy, it is easiest to use motherwort tincture, giving it to a child at bedtime. You can buy a few herbs and make your own fees:

• Grass cudweed, thyme, valerian and chicory roots, chop heather leaves. Mix by adding to 1 part of chicory 2 parts of the remaining components. Brew a tablespoon of the mixture, like tea, in a glass of boiling water for about half an hour. Give the child three times a day from 50 to 150 ml, depending on age. This infusion quickly relieves stress and soothes.
• To 3 parts chamomile add 1 share of valerian root and 2 parts of mint and lemon balm. Brew in the same dosage as in the previous recipe. Take in the morning before meals and at bedtime from 50 to 150 ml, depending on age.

Massage and exercise

With nervous tics, massage has proven itself the best way, because is effective tool. But the features of the procedure depend on the type of disorder. The essence of all manipulations is to relax the necessary part of the body.. Light stroking, rubbing, kneading are performed.

Sharp are not allowed. strong impacts, toning muscles, the goal of all movements is relaxation. To improve the blood supply to the brain, the collar zone is massaged.

Improving blood circulation in the brain improves the condition of the entire nervous system .

Perfectly relieves muscle tension and underwater massaging shower. Usually a course of 10 sessions is prescribed, you need to complete it completely, even if you feel better sooner. Exercises are of great help, in particular, breathing exercises Strelnikova.

Therapeutic stretching with weights will also be effective.. With the help of a complex selected by a specialist, it is possible to change muscle tone and form correct work brain. Thanks to biofeedback between muscles and brain neurons, it is possible to change existing behavioral programs.

The alternation of stretching and relaxation has a beneficial effect on the entire body.

Loads should be directed not to the elasticity of one muscle, but to the entire body, the spinal column, shoulder and hip joints.

Features of the treatment of infants

Babies at pathological tremor massage is prescribed necessarily to avoid such severe consequences like hyperglycemia, pathological changes in intracranial pressure, hypocalcemia, cerebral hemorrhage. Children's therapeutic massage for a nervous tic in a child up to a year old can be used from 1.5 months of age. Massage relieves muscle spasms, stabilizes the nervous system.

To conduct a massage course, contact a specialist or at least go through a few initial sessions with him. By learning simple techniques, you can massage at home on your own.

Movements are used simple (stroking, rubbing, kneading, vibration). Learn how to do them right. Look at what areas on the body of the baby should be avoided (lymph nodes, heart, liver and spine).

For infants up to 3 months, the procedure should not exceed 5 minutes, for older children, the time can be increased, but the duration of the session should not exceed 20 minutes.

The main criterion during the massage is the behavior of the child. If he behaves restlessly or is capricious, the procedure is stopped.

Prevention of not only tics, but also any psycho-emotional problems - a friendly, calm atmosphere in the family, a balanced diet. diet all foods and drinks that excite the nervous system (coffee, tea, chocolate, cocoa) are limited.

Spending time at the computer and in front of the TV should be limited to half an hour a day, and devote all free time to sports, needlework, and walks.

The psychological aspect is very important, all parents should remember this, therefore, at every opportunity:

• listen to the opinion of the baby;
• avoid overwhelming tasks
• praise the child if deserved;
• refer a vulnerable child to a psychologist.

You need to be patient with the child and engage in his upbringing, and not let development take its course. The state of the physical and mental health the child largely depends on the relationships that develop with peers in kindergarten and school, from the fulfillment of their duties by parents, from their attitude towards themselves and towards each other.

In a comfortable microclimate, everyone's self-esteem increases, which eliminates the appearance of neuroses and similar states that can lead to the formation of a nervous tic.

If it so happens that the tic nevertheless began, one should not wait in the hope that it will pass by itself. Contact your doctor immediately.

What to do if you notice manifestations of a nervous tic in a child, how to cure the pathology, you will learn from this video:

In contact with

Often children of 5-7 and 10-11 years old are subject to nervous tics. This phenomenon occurs due to psychological experiences. However, a nervous tic may appear as a result of damage to the central nervous system, which happens with epidemic encephalitis.

In addition, facial tics may be caused by inflammatory processes in this region. Tick-like movements can also cause magnesium deficiency in the body. To make up for the lack of this trace element, you need to eat legumes - peas and beans, oatmeal and buckwheat porridge.

It is necessary to eliminate the cause, and therefore the method of treating a tick depends on its nature. In particular, if it is caused by organic problems, first of all, these problems should be eliminated. However, in any case, the treatment will be quite long, requiring observation by a neurologist and great patience.

stress tic in a child

It is more difficult to cure a stressful nervous tic in a child. Most often, smart and emotional children, quite developed, suddenly begin to show signs of a tick - trembling of the eyelids, lips, hands, etc.

However, this is not a disease, but a feature of the structure of the nervous system inherent in impressionable babies. Their nervous system is tense to a greater extent than that of phlegmatic people. Such manifestations last long enough, but by adolescence they usually gradually disappear. And the more calm and friendly the atmosphere in the family, the less stress the child has, the will pass faster nervous tic.

The child began to have a nervous tic: what to do?

No need to think that you should just calm down and wait for the disappearance of the manifestation of a nervous tic, with folded arms. On the contrary, it is necessary to identify all problems in relationships in the family, in kindergarten or school, with friends. Then it is necessary to stop the excessive load on the sensitive child in a timely manner.

It is impossible to allow various long-term influences that injure his psyche. Excessive exactingness and severity, lack of attention from parents, their warmth and manifestations of love for the child, as well as a lack of interest in his anxieties and concerns can easily violate peace of mind.

For a receptive child, a friendly and relaxed atmosphere at home is extremely important. The same can be said about school problems, as well as the stress that studies require, the fear of testing school knowledge and grades from classmates. Having found out such moments in all contact places of the child, you may be able to determine real reason stress. Then it will become much easier to deal with him.

At the same time, the child should be helped to relieve internal and external tension. This will help soothing and restorative agents, baths, massage.

It should be borne in mind that drugs that affect the nervous system also have side effects. Therefore, the help of a neuropathologist is needed, who will prescribe medications that are most suitable for your child. The help of a psychotherapist who has various special techniques and techniques will also be very useful.

Violent movements, called tics, are a type of hyperkinesis. The appearance of a nervous tic in a child can alarm many parents. Involuntary mimic contractions or twitches of arms, legs and shoulders cause real panic in suspicious mothers. Others do not pay due attention to the problem for a long time, considering this phenomenon to be temporary.

In fact, in order to understand whether a nervous tic in children goes away on its own or requires treatment, you need to know the causes of its occurrence, as well as determine the type. Only on the basis of this can one understand the need for medical intervention.

Nervous tics in children, depending on the causes of occurrence, are divided into 2 types: primary and secondary. By type of manifestation, they are motor and vocal. The first type is familiar to many people firsthand.

These include normally coordinated, short-term, repeatedly repeated actions:

• extension or flexion of the fingers;
• frowning or raising the eyebrows;
• grimacing, wrinkling of the nose;
• movement of arms, legs, head or shoulders;
• twitching or biting the lips;
• twitching or blinking of the eyes;
• expansion of the nostrils or twitching of the cheeks.

The most common are various facial tics, especially eye movements. Motor hyperkinesis of large parts of the body occurs much less frequently, although they are immediately noticeable, as are vivid voice actions. Involuntary mild vocal manifestations go unnoticed for a long time. Parents consider them pampering and scold children, not understanding the reason for inappropriately made sounds.

• snorting, hissing;
• sniffing, sniffling;
• rhythmic coughing;
• various repetitive sounds.

In addition to division on the basis of manifestation and the primacy of the causes of occurrence, nervous tics have two more classifications:

1. According to the severity - local, multiple, generalized.
2. By duration - transient, up to 1 year, and chronic.

The degree of manifestation and duration often depend on the manifestation factors. The causes of occurrence are different, and some of them threaten the life of the child.

Causes

Adults do not always pay due attention to the appearance of a tick in a child, attributing its occurrence to fatigue or excessive emotionality. This may be true only for mild primary hyperkinesis.

Primary tics are often caused by seemingly minor situations and do not always need medical attention. The causes of secondary hyperkinesis are very serious and require an urgent response.

Primary ticks

Tics of this type are not associated with other diseases and occur due to specific psychological or physiological factors. They directly indicate a disorder of the nervous system and in some cases can be eliminated without specific treatment.

Psychological

Often, parents can notice the appearance of a tick in a child at 3 years old. With a high degree of probability, its appearance at this age indicates the primacy of the disease. Children are experiencing a psychological crisis of independence called "I myself!", Which puts a strain on the psyche. It is age-related crises in children that are often provocateurs of tics.

Parents take note! The most frequent appearance of a tick in a child of 7-8 years old falls on September 1. New responsibilities and acquaintances can overload the fragile psyche of first-graders, causing subsequent tic hyperkinesis. Schoolchildren moving into the 5th grade are exposed to similar stress, which contributes to the appearance of primary tics in children 10-11 years old.

In addition to the crises of growing up, there are other psychological reasons:

1. Emotional shock - fear, quarrel, death of loved ones or a pet.
2. Features of education - excessive severity of parents, excessive demands.
3. Psychological situation - attention deficit, conflicts at home, in kindergarten or school.

Physiological

At the heart of the appearance of such causes there is a direct connection with the biochemical processes in the body. Some of them can also be easily eliminated by treating them without medical help. Others cannot be eliminated without the simultaneous creation of a favorable psychological environment in the family and environment. This species includes a hereditary predisposition associated with the transfer of genes responsible for increased activity extrapyramidal system.

Attention! The presence of hyperkinesis in one or both parents increases the likelihood of their occurrence in a child by 50%. It is important for these children to provide proper nutrition and peace in the family. It is also desirable to observe the daily routine and minimize stressful situations.

Other physiological factors may also have an illusory hereditary influence. These are family habits that negatively affect the psyche of the child. They are associated with lifestyle, nutrition, drinking regimen and poor hygiene.

Hyperkinesis can occur for the following reasons:

1. Deficiency in diet of calcium and magnesium.
2. An excess of psychostimulating drinks - tea, coffee, energy drinks.
3. Incorrect daily routine and lack of sleep.
4. Insufficient level of lighting in the evening.
5. Physical overwork or prolonged stress from computer games.

Secondary tics

Not all parents know what to do if a child has a nervous tic, they attribute all types of hyperkinesis to nerves and are unaware of possible consequences. In the case of secondary tics, neglect can be dangerous. They develop under the influence various diseases nervous system or aggressive influence on it.

They can pass on their own only in 2 cases - if they arose under the influence of medications or as a result of minor intoxication carbon monoxide. In other cases, it is required to eliminate the original disease, although sometimes this is not possible.

The reasons for the appearance may be:

1. , cytomegalovirus.
2. Trigeminal neuralgia.
3. Congenital or received traumatic brain injury.
4. Encephalitis and streptococcal infections.
5. Acquired and genetic diseases nervous system.

In primary and secondary nervous tics, the symptoms are quite similar. So it's hard to suspect serious illness without other concomitant manifestations or specific diagnosis.

Symptoms

Any attentive parent will notice the signs of a nervous tic. Muscle twitching in the area of ​​increased innervation or a constantly emitted sound, especially appearing when the child is agitated, are the only symptoms.

Interesting! If a child simply blinks his eyes often, then this does not always mean that he has motor hyperkinesis. The tic always repeats at regular intervals, it has a specific rhythm. Simple blinking is irregular, but can be excessively frequent due to eye fatigue or too dry indoor air.

The combination of visual and vocal manifestations, as well as multiple motor hyperkinesis, require more attention from parents. With such symptoms, it is better to visit a neurologist and undergo additional diagnostics. The presence of local or multiple tics in combination with high temperature or lethargy of the child require urgent medical attention.

Diagnostics

A single occurrence of short-term hyperkinesis should not be ignored, but should not cause panic among parents. For an additional examination, you need to consult a doctor if the child has multiple hyperkinesias or local tics that regularly appear throughout the month.

The doctor will evaluate sensory and motor functions, check for hyperreflexia. Parents should be prepared to answer questions about recent traumatic experiences, the child's diet, medications, and daily routine. Based on the results of the examination, it is possible to prescribe such tests and examinations:

1. General blood analysis;
2. Analyzes for helminths;
3. Tomography;
4. Ionography;
5. encephalography;
6. Consultation with a psychologist.

Even before going to the doctor, parents can learn how to treat a nervous tic in a child. Timely started non-drug treatment in some cases, it allows you to do without medical help.

Treatment

It is often enough to eliminate the factors that cause them to treat primary tics. In addition to this, you can use physiological and folk methods that contribute to the rapid restoration of the nervous system. Secondary hyperkinesias require specialized treatment or cannot be eliminated at all.

Folk ways

Topical folk remedies There will be various soothing infusions and decoctions. They can be used instead of drinking or given separately.

Can be used:

• chamomile tea;
• drink from hawthorn fruits;
• infusion of anise seeds;
• decoction of meadowsweet with honey;
• collection with valerian, motherwort or mint.

If the child is comfortable with herbal teas, it is better to replace all stimulating drinks with them, offering to quench your thirst with decoctions or natural lemonade with honey and mint. The exclusion of ordinary tea and coffee in combination with sedative infusions can quickly reduce the load on the nervous system.

Worth knowing! Timely treatment with folk remedies for psychological tics can be very effective. Hyperkinesis due to malnutrition or secondary tics cannot be overcome with sedative fees and other popular ways.

You can also apply 1-2 times a day warm compress from fresh leaves geraniums. They need to be crushed and applied to the place of increased innervation for one hour, covered with a scarf or scarf. This method should not be used for more than 7 days.

Alternative treatment

Unusual methods of treatment or special Chinese techniques may seem ineffective only at first glance. Relaxing procedures aimed at calming the nervous system are acceptable to relieve stress.

These include:

• massage;
• acupuncture;
• electrosleep;
• aromatherapy;
• water treatments.

A visit to the bathhouse, swimming in the pool and a relaxing massage can relieve tension in and of themselves. Electrosleep and aromatherapy have not only a calming effect, but also subsequently contribute to an increase in resistance to nervous strain.

Nervous tic eyes can be eliminated by acupressure. You need to find a small hole on the superciliary arch, located closer to the center and press it with your finger, holding it for 10 seconds. After that, repeat the procedure at the outer and outer edge of the eye, pressing on the orbit, and not on the soft tissues.

Medical

Treatment with the use of drugs is associated with the causes of occurrence. Secondary tics are treated only after overcoming the disease that caused them or together with it, and primary ones according to the examination.

The list of medicines is wide (only a doctor can prescribe):

• sedatives - Novopassit, Tenoten;
• antipsychotropic - Sonapax, Haloperidol;
• nootropic - Piracetam, Phenibut, Cinnarizine;
• tranquilizers - Diazepam, Sibazol, Seduxen;
• mineral preparations - Calcium glucanate, Calcium D3.

It sometimes takes a long time to cure a nervous tic in a child. It is much easier to provide prophylaxis in advance, this is especially true for primary tics.

Prevention

The most effective measures to prevent nervous tics in children are healthy relationships in the family, proper nutrition, adherence to the daily routine and adequate exercise.

Worth spending more time on fresh air, be sure to play sports and teach the child to splash out correctly negative emotions and reduce the amount of time spent playing video games. Timely treatment helminthic invasions also helps to prevent the appearance of nervous tics.

It is important to remember that it can be a nervous tic and requires a timely response. Eye hyperkinesias in children are very common and in most cases are easily eliminated immediately after the onset.

Parents should be aware of age-related crises and educate their children in the right attitude to changing circumstances. Multiple or prolonged tics, especially in combination with other symptoms, require additional examination and should not be ignored.

Tics, or hyperkinesias, are repetitive, unexpected, short, stereotyped movements or statements that are outwardly similar to voluntary actions. characteristic feature tics is their involuntariness, but in most cases the patient can reproduce or partially control his own hyperkinesis. At a normal level of intellectual development of children, the disease is often accompanied by cognitive impairments, motor stereotypes, and anxiety disorders.

The prevalence of tics reaches approximately 20% in the population.

Until now, there is no consensus on the occurrence of tics. The decisive role in the etiology of the disease is assigned to the subcortical nuclei - the caudate nucleus, the pale ball, the subthalamic nucleus, the substantia nigra. The subcortical structures closely interact with the reticular formation, the thalamus, the limbic system, the cerebellar hemispheres, and the frontal cortex of the dominant hemisphere. The activity of subcortical structures and frontal lobes is regulated by the neurotransmitter dopamine. Insufficiency of the dopaminergic system leads to impaired attention, lack of self-regulation and behavioral inhibition, decreased control of motor activity and the appearance of excessive, uncontrolled movements.

The effectiveness of the dopaminergic system can be affected by disorders prenatal development due to hypoxia, infection, birth trauma or hereditary insufficiency of dopamine metabolism. There are indications of an autosomal dominant type of inheritance; however, it is known that boys suffer from tics about 3 times more often than girls. Maybe, we are talking about cases of incomplete and sex-dependent gene penetration.

In most cases, the first appearance of tics in children is preceded by the action of external adverse factors. Up to 64% of tics in children are triggered by stressful situations- school maladaptation, additional training sessions, uncontrolled TV viewing or prolonged work on the computer, conflicts in the family and separation from one of the parents, hospitalization.

Simple motor tics can be observed in the long-term period of traumatic brain injury. Voice tics - coughing, sniffing, expectorating throat sounds - are often found in children who are often ill respiratory infections(bronchitis, tonsillitis, rhinitis).

In most patients, there is a daily and seasonal dependence of tics - they intensify in the evening and worsen in the autumn-winter period.

A separate type of hyperkinesis should include tics that occur as a result of involuntary imitation in some highly suggestible and impressionable children. This happens in the process of direct communication and subject to the well-known authority of a child with tics among peers. Such tics go away on their own some time after the cessation of communication, but in some cases such imitation is the debut of the disease.

Clinical classification of tics in children

By etiology

Primary, or hereditary, including Tourette's syndrome. The main type of inheritance is autosomal dominant with varying degrees of penetrance; sporadic cases of the onset of the disease are possible.

Secondary, or organic. Risk factors: anemia in pregnant women, mother's age over 30 years, fetal malnutrition, prematurity, birth trauma, previous brain injury.

Cryptogenic. Occur against the background of full health in a third of patients with tics.

According to clinical manifestations

Local (facies) tick. Hyperkinesias capture one muscle group, mainly mimic muscles; rapid blinking, squinting, twitching of the corners of the mouth and wings of the nose predominate (Table 1). Blinking is the most persistent of all localized tic disorders. Squinting is characterized by a more pronounced violation of tone (dystonic component). The movements of the wings of the nose, as a rule, join the rapid blinking and are intermittent symptoms of facial tics. Single facial tics practically do not interfere with patients and in most cases are not noticed by the patients themselves.

Common tic. Several muscle groups are involved in hyperkinesis: mimic, muscles of the head and neck, shoulder girdle, upper limbs, muscles of the abdomen and back. In most patients, a common tic begins with blinking, which is followed by the establishment of a gaze, turns and tilts of the head, and shoulder lifts. During periods of exacerbation of tics, schoolchildren may have problems completing written assignments.

Vocal tics. There are simple and complex vocal tics.

The clinical picture of simple vocal tics is presented mainly low sounds: coughing, "clearing the throat", grunting, noisy breathing, sniffing. Less common are such high-pitched sounds as “i”, “a”, “u-u”, “uf”, “af”, “ay”, squeal and whistle. With exacerbation of tic hyperkinesis, vocal phenomena may change, for example, coughing turns into grunting or noisy breathing.

Complex vocal tics are observed in 6% of patients with Tourette's syndrome and are characterized by the pronunciation of individual words, swearing (coprolalia), repetition of words (echolalia), rapid uneven, slurred speech (palilalia). Echolalia is a non-permanent symptom and may occur over several weeks or months. Coprolalia is usually a status condition in the form of a serial utterance of curses. Often, coprolalia significantly limits the child's social activity, depriving him of the opportunity to attend school or public places. Palilalia is manifested by obsessive repetition last word in a sentence.

Generalized tic (Tourette's syndrome). It is manifested by a combination of common motor and vocal simple and complex tics.

Table 1 presents the main types of motor tics, depending on their prevalence and clinical manifestations.

As can be seen from the presented table, with the complication of the clinical picture of hyperkinesis, from local to generalized, tics spread from top to bottom. So, with a local tic, violent movements are noted in the muscles of the face, with a widespread one they move to the neck and arms, with a generalized one, the torso and legs are involved in the process. Blinking occurs with the same frequency in all types of tics.

By severity clinical picture

The severity of the clinical picture is assessed by the number of hyperkinesis in a child during 20 minutes of observation. In this case, ticks can be absent, single, serial or status ticks. Severity assessment is used to unify the clinical picture and determine the effectiveness of treatment.

At single ticks their number for 20 minutes of examination ranges from 2 to 9, they are more common in patients with local forms and in remission in patients with widespread tic and Tourette's syndrome.

At serial ticks in 20 minutes of examination, from 10 to 29 hyperkinesias are observed, after which there are many hours of breaks. A similar picture is typical during an exacerbation of the disease, occurs in any localization of hyperkinesis.

At tic status serial tics follow with a frequency of 30 to 120 or more per 20 minutes of examination without interruption during the day.

Like motor tics, vocal tics can also be single, serial and status tics; they intensify in the evening, after emotional stress and overwork.

According to the course of the disease

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), there are transient tics, chronic tics, and Tourette's syndrome.

transient , or transitory , the course of tics implies the presence of motor or vocal tics in a child with the complete disappearance of symptoms of the disease within 1 year. Typical for local and widespread tics.

Chronic A tic disorder is characterized by motor tics lasting more than 1 year without a vocal component. Chronic vocal tics in an isolated form are rare. There are remitting, stationary and progredient subtypes of the course of chronic tics.

With a relapsing course, periods of exacerbations are replaced by a complete regression of symptoms or the presence of local single ticks that occur against the background of intense emotional or intellectual stress. The relapsing subtype is the main variant of the course of tics. With local and widespread tics, exacerbation lasts from several weeks to 3 months, remissions last from 2-6 months to a year, in rare cases up to 5-6 years. Against the background of drug treatment, a complete or incomplete remission of hyperkinesis is possible.

The stationary type of the course of the disease is determined by the presence of persistent hyperkinesis in various groups muscles that persist for 2-3 years.

The progressive course is characterized by the absence of remissions, the transition of local tics to widespread or generalized ones, the complication of stereotypes and rituals, the development of tic statuses, and resistance to therapy. The progredient course predominates in boys with hereditary tics. Unfavorable signs are the presence of aggressiveness, coprolalia, obsessions in a child.

There is a relationship between the location of tics and the course of the disease. So, for a local tic, a transient-remitting type of flow is characteristic, for a common tic - a remitting-stationary type, for Tourette's syndrome - a remitting-progressive type.

Age dynamics of tics

Most often, tics appear in children aged 2 to 17 years, the average age is 6-7 years, the frequency of occurrence in the child population is 6-10%. Most children (96%) develop tics before the age of 11 years. The most common manifestation of tics is eye blinking. At the age of 8-10 years, vocal tics appear, which make up about a third of cases of all tics in children and occur both independently and against the background of motor tics. More often, the initial manifestations of vocal tics are sniffing and coughing. The disease is characterized by an increasing course with a peak of manifestations at 10-12 years, then a decrease in symptoms is noted. By the age of 18, approximately 50% of patients are spontaneously free of tics. At the same time, there is no relationship between the severity of tics in childhood and adulthood, but in most cases, in adults, the manifestations of hyperkinesis are less pronounced. Sometimes tics first occur in adults, but they are milder and usually last no more than 1 year.

The prognosis for local tics is favorable in 90% of cases. In the case of widespread tics, 50% of children have a complete regression of symptoms.

Tourette syndrome

The most severe form of hyperkinesis in children is, without a doubt, Tourette's syndrome. Its frequency is 1 case per 1000 of the child population in boys and 1 in 10,000 in girls. The syndrome was first described by Gilles de la Tourette in 1882 as "a disease of multiple tics". The clinical picture includes motor and vocal tics, attention deficit disorder, and obsessive-compulsive disorder. The syndrome is inherited with high penetrate in an autosomal dominant manner, and in boys tics are more often combined with attention deficit hyperactivity disorder, and in girls with obsessive-compulsive disorder.

The currently accepted criteria for Tourette's syndrome are those given in the DSM classification III revision. Let's list them.

• A combination of motor and vocal tics that occur simultaneously or at different time intervals.
• Repeated tics throughout the day (usually in series).
• The location, number, frequency, complexity, and severity of tics change over time.
• The onset of the disease is up to 18 years, the duration is more than 1 year.
• Symptoms of the disease are not associated with the use of psychotropic drugs or CNS disease (Huntington's chorea, viral encephalitis, systemic diseases).

The clinical picture of Tourette's syndrome depends on the age of the patient. Knowledge of the basic patterns of the development of the disease helps to choose the right treatment tactics.

Debut The disease develops at 3-7 years of age. The first symptoms are local facial tics and twitching of the shoulders. Then hyperkinesias spread to the upper and lower limbs, shudders and turns of the head appear, flexion and extension of the hand and fingers, tilting the head back, contraction of the abdominal muscles, bouncing and squatting, one type of tics is replaced by another. Vocal tics are often associated with motor symptoms within a few years after the onset of the disease and increase in the acute stage. In a number of patients, vocalisms are the first manifestations of Tourette's syndrome, which are subsequently joined by motor hyperkinesis.

Generalization of tic hyperkinesis occurs over a period of several months to 4 years. At the age of 8-11 years, children have peak of clinical manifestations of symptoms in the form of a series of hyperkinesias or repeated hyperkinetic statuses in combination with ritual actions and autoaggression. The tic status in Tourette's syndrome characterizes a severe hyperkinetic state. A series of hyperkinesis is characterized by a change in motor tics to vocal ones, followed by the appearance of ritual movements. Patients note discomfort from excessive movements, for example, pain in the cervical spine that occurs against the background of head turns. The most severe hyperkinesis is a tilting of the head - while the patient can repeatedly hit the back of the head against the wall, often in combination with simultaneous clonic twitching of the arms and legs and the appearance of muscle pain in the extremities. The duration of status ticks ranges from several days to several weeks. In some cases, exclusively motor or predominantly vocal tics (coprolalia) are noted. During status tics, consciousness in children is completely preserved, however, hyperkinesis is not controlled by patients. During exacerbations of the disease, children cannot attend school, they find it difficult to self-service. Characteristically relapsing course with exacerbations lasting from 2 to 12-14 months and incomplete remissions from several weeks to 2-3 months. The duration of exacerbations and remissions is directly dependent on the severity of tics.

In the majority of patients at the age of 12-15, generalized hyperkinesias pass into residual phase , manifested by local or widespread tics. In a third of patients with Tourette's syndrome without obsessive-compulsive disorders in the residual stage, a complete cessation of tics is observed, which can be considered as an age-dependent infantile form of the disease.

Comorbidity of tics in children

Tics often occur in children with pre-existing central nervous system (CNS) disorders such as attention deficit hyperactivity disorder (ADHD), cerebral asthenic syndrome, as well as anxiety disorders, including generalized anxiety disorder, specific phobias, and obsessive-compulsive disorder.

Approximately 11% of children with ADHD have tics. Mostly these are simple motor and vocal tics with a chronic relapsing course and a favorable prognosis. In some cases, the differential diagnosis between ADHD and Tourette's syndrome is difficult, when hyperactivity and impulsivity appear in a child before the development of hyperkinesis.

In children with generalized anxiety disorder or specific phobias, tics can be provoked or exacerbated by worries and experiences, an unusual environment, a long wait for an event and an accompanying increase in psycho-emotional stress.

In children with obsessive-compulsive disorder, vocal and motor tics are combined with a compulsive repetition of a movement or activity. Apparently, in children with anxiety disorders, tics are an additional, albeit pathological form of psychomotor discharge, a way of calming and “processing” accumulated internal discomfort.

Cerebrosthenic syndrome in childhood is the result of traumatic brain injuries or neuroinfections. The appearance or intensification of tics in children with cerebrasthenic syndrome is often provoked external factors: heat, stuffiness, change in barometric pressure. Characterized by an increase in tics with fatigue, after prolonged or repeated somatic and infectious diseases, an increase in training loads.

We present our own data. Of the 52 children who complained of tics, there were 44 boys, 7 girls; the ratio "boys: girls" was "6: 1" (Table 2).

So, largest number reports of tics were noted in boys aged 5–10 years, with a peak at 7–8 years. The clinical picture of ticks is presented in Table. 3.

Thus, simple motor tics with localization mainly in the muscles of the face and neck and simple vocal tics imitating physiological actions (cough, expectoration) were most often noted. Bouncing and complex vocal utterances were much less common, only in children with Tourette's syndrome.

Temporary (transient) tics lasting less than 1 year were observed more often than chronic (remitting or stationary). Tourette's syndrome (chronic stationary generalized tic) was observed in 7 children (5 boys and 2 girls) (Table 4).

Treatment

The main principle of therapy for tics in children is a comprehensive and differentiated approach to treatment. Before prescribing medication or other therapy, it is necessary to find out the possible causes of the disease and discuss with parents ways of pedagogical correction. It is necessary to explain the involuntary nature of hyperkinesis, the impossibility of controlling them by willpower and, as a result, the inadmissibility of remarks to the child about tics. Often, the severity of tics decreases with a decrease in the requirements for the child on the part of the parents, the absence of fixing attention on his shortcomings, the perception of his personality as a whole, without isolating "good" and "bad" qualities. The therapeutic effect is the streamlining of the regimen, sports, especially in the fresh air. If induced tics are suspected, the help of a psychotherapist is necessary, since such hyperkinesis is removed by suggestion.

When deciding on the appointment of drug treatment, it is necessary to take into account such factors as the etiology, age of the patient, the severity and severity of tics, their nature, concomitant diseases. Drug treatment should be carried out with severe, pronounced, persistent tics, combined with behavioral disorders, school failure, affecting the child's well-being, complicating his adaptation in the team, limiting his opportunities for self-realization. Drug therapy should not be given if the tics are only a concern for the parents but do not interfere with the child's normal activities.

The main group of drugs prescribed for tics are neuroleptics: haloperidol, pimozide, fluphenazine, tiapride, risperidone. Their effectiveness in the treatment of hyperkinesis reaches 80%. The drugs have analgesic, anticonvulsant, antihistamine, antiemetic, neuroleptic, antipsychotic, sedative effects. The mechanisms of their action include blockade of postsynaptic dopaminergic receptors of the limbic system, hypothalamus, trigger zone of the gag reflex, extrapyramidal system, inhibition of dopamine reuptake by the presynaptic membrane and subsequent deposition, as well as blockade of adrenoreceptors of the reticular formation of the brain. Side effects: headache, drowsiness, impaired concentration, dry mouth, increased appetite, agitation, anxiety, anxiety, fear. At long-term use extrapyramidal disorders may develop, including increased muscle tone, tremor, akinesia.

Haloperidol: the initial dose is 0.5 mg at night, then it is increased by 0.5 mg per week until a therapeutic effect is achieved (1-3 mg / day in 2 divided doses).

Pimozide (Orap) is comparable in effectiveness to haloperidol, but has fewer side effects. The initial dose is 2 mg / day in 2 doses, if necessary, the dose is increased by 2 mg per week, but not more than 10 mg / day.

Fluphenazine is prescribed at a dose of 1 mg / day, then the dose is increased by 1 mg per week to 2-6 mg / day.

Risperidone belongs to the group of atypical antipsychotics. The effectiveness of risperidone in tics and related behavioral disorders, especially oppositional defiant ones, is known. The initial dose is 0.5-1 mg / day with a gradual increase until a positive trend is achieved.

When choosing a drug for the treatment of a child with tics, the most convenient form of release for dosing should be considered. Optimum for titration and subsequent treatment in childhood are drip forms (haloperidol, risperidone), which allow you to most accurately select the maintenance dose and avoid unjustified drug overdose, which is especially important during long courses of treatment. Preference is also given to drugs with a relatively low risk of side effects (risperidone, tiapride).

Metoclopramide (Reglan, Cerucal) is a specific blocker of dopamine and serotonin receptors in the trigger zone of the brainstem. With Tourette's syndrome in children, it is used at a dose of 5-10 mg per day (1/2-1 tablet), in 2-3 doses. Side effects- extrapyramidal disorders, manifested when the dose is exceeded 0.5 mg / kg / day.

For the treatment of hyperkinesis in last years valproic acid preparations are used. The main mechanism of action of valproates is to enhance the synthesis and release of γ -aminobutyric acid, which is an inhibitory mediator of the CNS. Valproates are the drugs of first choice in the treatment of epilepsy, however, their thymoleptic effect is of interest, which manifests itself in a decrease in hyperactivity, aggressiveness, irritability, as well as a positive effect on the severity of hyperkinesis. The therapeutic dose recommended for the treatment of hyperkinesis is significantly lower than for the treatment of epilepsy and is 20 mg/kg/day. Side effects include drowsiness, weight gain, and hair loss.

When hyperkinesis is combined with obsessive-compulsive disorder, antidepressants - clomipramine, fluoxetine - have a positive effect.

Clomipramine (Anafranil, Clominal, Clofranil) is a tricyclic antidepressant, the mechanism of action is inhibition of the reuptake of norepinephrine and serotonin. The recommended dose in children with tics is 3 mg/kg/day. Side effects include transient visual disturbances, dry mouth, nausea, urinary retention, headache, dizziness, insomnia, irritability, extrapyramidal disorders.

Fluoxetine (Prozac) is an antidepressant drug, a selective serotonin reuptake inhibitor with low activity in relation to the norepinephrine and dopaminergic systems of the brain. In children with Tourette's syndrome, it eliminates anxiety, anxiety, and fear well. The initial dose in childhood is 5 mg / day 1 time per day, the effective dose is 10-20 mg / day 1 time in the morning. Tolerability of the drug is generally good, side effects occur relatively rarely. Among them, the most significant are anxiety, sleep disorders, asthenic syndrome, sweating, weight loss. The drug is also effective in combination with pimozide.

Literature

1. Zavadenko N. N. Hyperactivity and attention deficit in childhood. Moscow: ACADEMA, 2005.
2. Mash E, Wolf D. Child mental disorder. St. Petersburg: Prime EUROZNAK; M.: OLMA PRESS, 2003.
3. Omelyanenko A., Evtushenko O. S., Kutyakova and others // International neurological journal. Donetsk. 2006. No. 3(7). pp. 81-82.
4. Petrukhin A.S. Neurology childhood. M.: Medicine, 2004.
5. Fenichel J.M. Pediatric neurology. Basics clinical diagnostics. M.: Medicine, 2004.
6. L. Bradley, Schlaggar, Jonathan W. Mink. Movement // Disorders in Children Pediatrics in Review. 2003; 24(2).

N. Yu. Suvorinova, Candidate of Medical Sciences
RSMU, Moscow

Tiki- lightning-fast involuntary muscle contractions, most often of the face and limbs (blinking, raising the eyebrows, twitching the cheek, corner of the mouth, shrugging the shoulders, wincing, etc.). By frequency tics occupy one of the leading places among neurological diseases of childhood. Tics occur in 11% of girls and 13% of boys. Under the age of 10 tics occur in 20% of children (i.e. every fifth child). Tics appear in children aged 2 to 18 years, but there are 2 peaks - these are 3 years and 7-11 years. hallmark tics from convulsive muscle contractions in other diseases: child can reproduce and partially control tics; tics do not occur during voluntary movements (for example, when taking a cup and while drinking from it). The severity of tics can vary depending on the time of year, day, mood, nature of the activity. Their localization also changes (for example, in child involuntary blinking was noted, which after a while was replaced by an involuntary shrug of the shoulders), and this does not indicate a new disease, but a relapse (repetition) of an existing disorder. Tick ​​amplification usually occurs when child watches TV, stays in one position for a long time (for example, sitting in class or in transport). Tics weaken and even completely disappear during the game, when performing an interesting task that requires full concentration (for example, when reading an exciting story). Once child loses interest in their activities tics reappear with increasing force. The child may suppress tics for a short time, but this requires great self-control and subsequent discharge.

Psychologically, children with tics are characterized by:

• attention disorders;
• impaired perception;
• in children with severe tics, violations of spatial perception are expressed.
• In children with tics, it is difficult to develop motor skills and coordinated movements, the smoothness of movements is impaired, and the performance of motor acts is slowed down.

Tick ​​classification:

• motor tics (blinking, twitching of the cheek, shrugging the shoulders, straining the wings of the nose, etc.)
• vocal tics (coughing, sniffing, grunting, sniffing)
• rituals(walking in circles)
• generalized forms of tics(when one child there is not one tick, but several).

In addition, distinguish simple tics , capturing only the muscles of the eyelids or arms or legs, and complex tics - movements occur simultaneously in different muscle groups.

The course of ticks

• The illness can last from a few hours to many years.
• The severity of tics varies from almost imperceptible to severe (resulting in the inability to go outside).
• Tick ​​frequency varies throughout the day.
• The effectiveness of treatment: from complete cure to ineffectiveness.
• Related behavioral disorders may be subtle or pronounced.

Causes of tics

There is a widespread point of view among parents and educators that "nervous" children suffer from tics. However, it is known that all children are “nervous”, especially during periods of the so-called crisis (periods active struggle for independence), for example, 3 years and 6-7 years, and tics appear only in some children. Tics are often associated with hyperactive behavior and attention disorders (ADHD - attention deficit hyperactivity disorder), low mood (depression), anxiety, ritualistic and obsessive behavior (pulling out hair or winding it around a finger, biting nails, etc.). Besides, child with tics usually does not tolerate transport and stuffy rooms, gets tired quickly, gets tired of sights and activities, sleeps restlessly or falls asleep badly. The role of heredity Tics appear in children with a hereditary predisposition: Parents or relatives of children with tics may themselves suffer from obsessive movements or thoughts. It has been scientifically proven that tics:

• easier provoked in males;
• boys have more severe tics than girls;
• in children tics appear in more early age than their parents;
• if child tics, it is often found that his male relatives also suffer from tics, and female relatives from obsessive-compulsive disorder.

Parental Behavior Despite the important role of heredity, developmental characteristics and emotional and personality traits child, his character and ability to withstand the influence outside world formed within the family. An unfavorable ratio of verbal (speech) and non-verbal (non-speech) communications in the family contributes to the development of behavioral and character anomalies. For example, constant shouting and countless remarks lead to the restraint of free physiological activity. child(and it is different for each baby and depends on temperament), which can be replaced by a pathological form in the form of tics and obsessions. At the same time, children from mothers raising child in an environment of permissiveness, remain infantile, which predisposes to the occurrence of tics. Tick ​​provocation: psychological stress If a child with a hereditary predisposition and an unfavorable type of upbringing, he suddenly encounters an unbearable problem for him (a psycho-traumatic factor), develop tics. As a rule, the surrounding child adults do not know what triggered the appearance of tics. That is, for everyone except himself child, the external situation seems normal. As a rule, he does not talk about his experiences. But at such moments child becomes more demanding of loved ones, seeks close contact with them, requires constant attention. Are activated non-verbal types communication: gestures and facial expressions. The laryngeal coughing becomes more frequent, which is similar to such sounds as grunting, smacking, sniffing, etc., arising during thoughtfulness, embarrassment. The throaty cough is always aggravated by anxiety or danger. Movements in the hands appear or intensify - sorting through the folds of clothes, winding hair around a finger. These movements are involuntary and unconscious (a person may sincerely not remember what he just did), intensify with excitement and tension, clearly reflecting emotional condition. Teeth grinding during sleep may also appear, often combined with bedwetting and nightmares. All these movements, having arisen once, can gradually disappear by themselves. But if child does not find support from others, they are fixed in the form of a pathological habit and then transformed into tics. Parents often say that, for example, after a severe sore throat, their child became nervous, capricious, did not want to play alone, and only then appeared tics. Often, the onset of tics is preceded by acute viral infections or other serious illnesses. In particular, inflammatory diseases of the eye are often complicated by subsequent blinking tics; long-term ENT diseases contribute to the appearance of obsessive coughing, sniffing, grumbling. Thus, for the appearance of ticks, a coincidence of 3 factors is necessary:

1. hereditary predisposition
2. Wrong upbringing(the presence of intra-family conflict; increased demands and control (hyper-custody); increased adherence to principles, uncompromising parents; formal attitude towards to kid(hypo-custody), lack of communication)
3. Acute stress causing tics

Mechanism of tick development

If child internal anxiety is constantly present, or, as the people say, “restless in the soul”, stress becomes chronic. Anxiety itself is a necessary defense mechanism which allows you to prepare for it in advance before the onset of a dangerous event, accelerate reflex activity, increase the speed of reaction and the sharpness of the senses, use all the body's reserves to survive in extreme conditions. At child, often experiencing stress, the brain is constantly in a state of anxiety and anticipation of danger. The ability to arbitrarily suppress (slow down) unnecessary activity of brain cells is lost. Brain child does not rest; even in his sleep he is haunted by terrible images, nightmares. As a result, the body's adaptation systems to stress are gradually depleted. Irritability, aggressiveness appear, academic performance decreases. And in children with an initial predisposition to a deficiency in the inhibition of pathological reactions in the brain, harmful psychotraumatic factors cause the development of tics.

Tics and behavioral disorders

In children with tics, neurotic disorders are always noted in the form of low mood, internal anxiety, and a tendency to internal “self-digging”. Characterized by irritability, fatigue, difficulty concentrating, sleep disturbances, which requires the consultation of a qualified psychiatrist. It should be noted that in some cases tics are the first symptom of a more severe neurological and mental illness which may develop over time. So child with tics should be carefully examined by a neurologist and psychologist.

Tick ​​Diagnostics

The diagnosis is established on the basis of an examination by a neurologist. At the same time, video filming at home is useful, because. child tries to suppress or hide his tics while talking to a doctor. Psychological examination is required child to identify his emotional and personal characteristics, concomitant disorders of attention, memory, control of impulsive behavior in order to diagnose tics variant of the course of ticks; identification of provoking factors; as well as further psychological and medical correction. In some cases, the neurologist prescribes a number of additional surveys(electroencephalography, magnetic resonance imaging), based on a conversation with parents and the clinical picture of the disease and a consultation with a psychiatrist. Medical diagnoses Transient (transient) tic disorder characterized by simple or complex motor tics, short, repetitive, hard-to-control movements, and mannerisms. Tics occur in child daily for 4 weeks but less than 1 year. Chronic tic disorder characterized by rapid, repetitive, uncontrollable movements or vocalizations (but not both) that occur almost daily for more than 1 year.

Treatment of tics

1. To correct ticks, it is recommended first of all rule out precipitating factors . Of course, it is necessary to observe the sleep and nutrition regimen, the adequacy physical activity. 2. Family Psychotherapy effective in those cases when the analysis of intra-family relations reveals a chronic psycho-traumatic situation. Psychotherapy is useful even when harmonious relationship in the family, because it allows to kid and parents to change negative attitudes towards tics. In addition, parents should remember that a timely spoken kind word, touch, joint activities (for example, baking cookies or a walk in the park) help to kid cope with the accumulated unresolved problems, eliminate anxiety and tension. 3. Psychological correction .

• Can be carried out individually- for the development of areas of mental activity lagging in development (attention, memory, self-control) and reducing internal anxiety while working on self-esteem (using games, conversations, drawings and other psychological techniques).
• Can be carried out in the form of group lessons with other children (who have tics or other behavioral features) - for the development of the sphere of communication and playing with possible conflict situations. At the same time, child opportunity to choose the most best option behavior in conflict (“rehearse” it in advance), which reduces the likelihood of exacerbation of tics. 4. Medical treatment ticks should be started when the possibilities of the previous methods have already been exhausted. Medications are prescribed by a neurologist depending on the clinical picture and additional examination data.
  • Basic therapy for tics includes 2 groups of drugs: anti-anxiety (antidepressant) - Phenibut, Zoloft, Paxil etc.; reducing the severity of motor phenomena - TIAPRIDAL, TERALEN etc.
  • Basic therapy, as an additional, can be connected to drugs that improve metabolic processes in the brain ( nootropic drugs), vascular preparations, vitamins.
  The duration of drug therapy after the complete disappearance of ticks is 6 months, then you can slowly reduce the dose of the drug until it is completely canceled. Forecast for children who have tics appeared at the age of 6-8 years favorable (i.e. tics pass without a trace). early start tics (3-6 years) is typical for their long course, up to adolescence, when tics gradually decrease if tics appear before the age of 3, they are usually a symptom of some serious illness (for example, schizophrenia, autism, brain tumors, etc.). In these cases, a thorough examination is required child.

  See the article "Hyperactive child”, No. 9, 2004

  Electroencephalography (EEG) is a study that allows, using electrodes placed on the head, to register the electrical potentials of the brain and identify the corresponding changes.

  Magnetic resonance imaging (MRI) is one of the most informative methods diagnosis tics(not associated with X-ray radiation), which allows you to get a layered image of organs in different planes, to build a three-dimensional reconstruction of the area under study. It is based on the ability of some atomic nuclei, when placed in a magnetic field, to absorb energy in the radio frequency range and radiate it after the cessation of exposure to the radio frequency pulse.