Pediatric tic disorder is a chronic neuropsychiatric disorder, also known as multiple tics. It refers to tic disorders characterized by involuntary sudden multiple tics and tics, accompanied by fulminant vocalizations and profanity. Most of the children develop between the ages of 4~12, and there are often a variety of comorbidities, such as attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), behavioral problems, etc.
The disease is characterized by involuntary, sudden, rapidly repetitive muscle tics, often accompanied by fulminant, involuntary vocalizations and profanity. Tic symptoms begin on the face and neck and gradually spread downwards. The parts and forms of twitching are varied, such as blinking, strabismus, pouting, shaking the head, shrugging the shoulders, shrinking the neck, extending the arms, throwing the arms, straightening the chest, bending over, rotating the body, etc.
Vocal tics are manifested as laryngeal sounds and roars, which can gradually change into stereotypical swearing and statements of obscene words. Some children gradually develop language movement disorders after involuntary tics, and some children can also produce imitation of language, imitation of movements, imitation of expressions and other behaviors.
Involuntary laryngeal sounds appear late, a small number appear in the early stage, and most of them appear 6~7 years after the onset. The condition is often fluctuating, mild and severe, and sometimes resolves spontaneously for a period of time. The location, frequency and intensity of the tics can be varied. May be aggravated by nervousness, anxiety, fatigue, and lack of sleep; It decreases when the mind is relaxed and disappears after sleep.
Pediatric tics is a neuropsychiatric disorder, and commonly used drugs include haloperidol tablets, pimozide tablets, clonidine hydrochloride tablets, etc. However, there may be side effects of the drug, so special attention should be taken.
Haloperidol tablets are one of the drugs for the treatment of Tourette's syndrome in children, but there are many side effects, common are constipation, dizziness, physical weakness, drowsiness, depressive reactions, etc.
Pimozide tablets and haloperidol tablets are relatively similar, and there will be more side effects after medication, mainly akathisia, depression, weight gain, acute dystonia, Parkinson's symptoms, etc.
Clonidine hydrochloride tablets have an effect on some children, which can reduce tics, improve mood disorders, hyperactivity, inattention and other performance. Side effects include orthostatic hypotension, dizziness, drowsiness, ECG changes, etc., so it is necessary to check the ECG and blood pressure regularly during medication.
Sensory integration training is based on the neuropsychological characteristics of children, guiding them to respond appropriately to sensory stimuli such as sight, hearing, touch, smell, etc., which can promote children's neurological and psychological development, and the application in children with tics has gradually attracted clinical attention.
Dr. Li Li of Zhejiang made a detailed summary of this in the article "Application of Sensory Integration Training in Children with Multiple Tics".
The researchers divided 70 children (average age 10.8 years, disease course 1.4-2.5 years) into observation group and control group, with 35 cases in each group.
Aripiprazole was taken orally in both groups, with the first dose of 2.5mg/time, 1 time/day, and then gradually increased, 2.5mg per week, with a maximum of 10mg/day.
The control group received routine care, and the observation group received sensory integration training on the basis of the control group. The training includes:
Physical training
It adopts the way of balance wood, skateboard, cylinder, four-corner hanging cable, trampoline, jumping bag, slide and other games to improve physical coordination, 30min/time, 2 times/day.
Fine motor training
Training is carried out using games such as assembling items, beading, threading needles, etc., 30min/time, 2 times/day.
Visual, auditory, memory and attention training
Using text, graphics, digital forms, special training in sight, hearing, memory and other aspects to improve children's attention, observation, thinking, etc., not only improve concentration, but also relieve the symptoms of hyperactivity tics. 60min/time, 3 times/day. Both groups were treated for 1 to 2 weeks.
After the intervention, the Yale Composite Tic Severity Scale (YGTSS) was used to evaluate the improvement of symptoms in the two groups, including motor tics, phonogenic tics and comprehensive injury, with a total score of 25 points each for motor tic and vocal tics, and a total score of 50 points for comprehensive injury.
The results are shown in the figure above, the Yale Comprehensive Tic Severity Scale (YGTSS) score of the two groups is significantly lower than that before the intervention, and the score of the observation group (usual care + sensory integration training) is significantly lower than that of the control group (usual care only).
Conclusion of the study
Sensory integration training is the best way to correct the dysfunction of sensory integration in children, mainly through the infiltration education of game activities, operations and daily life, establish neural connections, produce adaptive responses, and promote the development of brain neurophysiology.
In the process of the child's initial mastery of a certain action to the skillful practice of free movement, through the control of the sports body, enhance the tolerance and adaptability of the nervous system to the external environment, improve the child's self-confidence and self-control, activate and further strengthen the brain's control over other parts of the body, make the body feel healthy and develop, improve brain function, not only can promote the development of children's motor, motor skills and sensory integration ability, thereby alleviating the symptoms of hyperactivity tics, promoting the recovery of the child's social adaptability, and preventing recurrence.
The results of the above clinical trials showed that after the intervention, the Yale Comprehensive Tic Severity Scale (YGTSS) score in the observation group was significantly lower than that in the control group, indicating that sensory integration training can significantly improve the clinical symptoms of children with tics.
Resources
WEI Jingjing. Early participatory health education intervention in children with multiple tics[J]. Primary Medicine Forum,2012,16(27):3618-3619. DOI:10.3969/j.issn.1672-1721.2012.27.059.
LI Li. Application of sensory integration training in children with multiple tics[J]. China Rural Medicine, 2017, 24(8):2.