Tic disorders are neurodevelopmental disorders that involve sudden, rapid, aimless, irregular, repetitive and stereotypic motor movements that people cannot control. When the child does not perform this set of motor or vocal movements, he feels intense tension and, as a result, repeats the action. The most intense tic disorders were detected between the ages of 7-15. As children get older, they develop the ability to "suppress" these motor movements. Genetic factors, neuroanatomical disorders in basal ganglia and midbrain-related structures, functional problems in neuroendocrine, neurotransmitter and neuromodulator systems, especially central dopaminergic mechanisms, and the interaction of D1 and D2 dopamine systems are held responsible for the emergence of the disorder. Any movement that can be produced by the body can be seen as a tic, and these unexpected motor movements create a wide range of disorders that can cause deterioration in psychosocial development, self-esteem, family life, social relations, academic or work performance. Tic disorder in children can occur in more than one way; Transient tic disorder, Chronic movement/voice tic disorder, Tourette syndrome (TS) and tic disorder not otherwise specified.
Tourette syndrome (TS) is a chronic neuropsychiatric disorder. TS is seen in all societies and cultures. Recent epidemiological studies have stated that it is seen in 1% of children. It is 3-4 times more common in men. It differs from other tic disorders in terms of its chronicity and other accompanying behavioral problems. The onset is usually in childhood, on average around 6-7 years of age. TS typically begins in preschool with temporary simple motor tics that may be ignored, such as eye blinking. As the disorder progresses, these simple motor tics begin to become more complicated and after a while they are accompanied by vocal tics. Many different clinical pictures may accompany TS. These may include obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), conduct disorder, pervasive developmental disorder, sleep disorder, depression, anxiety disorder, and various neurological disorders. The coexistence of TS and ADHD is between 35-54%, learning disorders are seen together with TS at a rate of 47%, and the rate is 51% in children with attention deficit disorder. Compulsive behaviors have also been reported. TS symptoms increase under stress and may cause the child to become more withdrawn in social relationships. Tics occur almost every day for more than 1 year. There is no period when tics are not observed for more than 3 months. Tics usually disappear temporarily during activities that require focused attention and fine motor control, such as reading out loud, playing a musical instrument, or doing sports, or with distracting activities such as relaxation and reading. Tics may continue, although they decrease during sleep. Related disorders, especially Attention Deficit Hyperactivity Disorder (ADHD), can increase sleep difficulties.
Chronic motor/vocal tic disorder
It is a rare tic disorder. Most tics are in the head and neck area and increase during times of stress. It starts before age 18. Periodically, an increase or decrease in the course of tics may be observed. More common is chronic motor tic disorder. Studies suggest that TS and chronic motor or vocal tic disorder (CMVTD) are related, and that TS is a more severe form of CMVTB, or even different manifestations of the same gene.
Transient tic disorder
It is seen as a decrease in the severity of one or more motor tics over weeks or months. It can be observed for less than a year. It is typically seen in the head and neck area. Vocal tics may also occur at certain periods, but their severity is less than motor tics and they do not occur at the same time as motor tics. It is not a long-term disorder and occurs between the ages of 3-8. The probability of occurrence in boys is higher than in girls.
Tic disorders not otherwise specified
Tic disorders that do not meet the criteria of any defined tic disorder are named this way. Tic disorders lasting less than 4 weeks can be given as an example.
Various tic disorders that can be seen in children are:
Touching, grimacing, blinking, coughing, throat clearing, nose picking, jumping, sniffing objects, turning the head, sniffing, licking the lips, kissing, grinding the teeth, nodding, squatting, turning the tongue, raising the eyebrow, making chewing sounds...
Add to this list. Many more motor movements can be added. All motor movements that the child can perform voluntarily and physically may appear as tics.
Treatment
Some of the drugs that have been proven to be effective in the treatment of tics are neuroleptics such as haloperidol and pimozide. It is necessary to adopt a holistic approach in the non-pharmacological part of tic treatment. Carrying out psycho-education activities with the family is recommended in such cases. The family should be given detailed information about tic disorders and the course of the disease, and guidance should be given regarding the family's attitude towards the child. When this type of problem begins in a child, the first question that comes to the parent's mind is what the child might be trying to say with this behavior. After this question, it should be determined when the behavior started and the periods when the symptom appeared. This always requires good observation. Not every tic needs to be treated. A "wait and see" policy should be applied for tics that are not chronic, do not show association with other disorders, and do not cause significant social, academic or other problems. Since the severity of tics may decrease or increase spontaneously, it may sometimes be difficult to understand whether the improvement in tics is due to treatment. In addition, habit reversal therapy is used in the treatment of tics that are considered moderately severe. Each tic is applied separately and the rate of rapid results is high.
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