Tics & Tourette Syndrome

Tics ine mamwe maviri akasarudzika maficha. Kutanga, ivo vanowanzotangirwa nechiitiko chisingafadzi chekunzwa, chinonyanya kunyorwa se "premonitory urge". Zvichienderana nezviitiko zvekufungidzira, varwere vanowanzoomerwa nekupa nhoroondo chaidzo dzekukurudzira kwekare, kazhinji vachishandisa mazwi se "itch", "kupisa", "muscle tension" kana "kudiwa kwekuita tic" kuzvitsanangura. Kazhinji, kuitwa kwemaitiro etic kunopa zororo renguva pfupi kubva kune inodzivirira premonitory kukurudzira. Chechipiri, tic inogona kudzvinyirirwa nekuzvidira kwenguva pfupi. Chokwadi, kuvepo kwepremonitory kukurudzira uye kugona kudzvanya tic maitiro pane zvinodiwa zviratidzo zvinobatsira muzviitiko zvakakomba, apo mutsauko kubva kune mamwe hyperkinetic kufamba kusagadzikana, semuenzaniso, chorea ingave yakaoma.

Tics inogona kusangana mune dzakasiyana siyana neurodevelopmental, neurometabolic uye neurodegenerative kusagadzikana. Nekudaro, munzvimbo yekiriniki inowanzoitika muGilles de la Tourette syndrome (kana kungoti Tourette syndrome: TS). Maererano neDSM-5, TS inotsanangurwa nekuvapo kwemaitiro maviri emotokari tic uye imwe yezwi tic maitiro kwenguva shoma yegore, ichiratidza kusati kwasvika makore 18. Zvimwe zvirwere zvepakutanga tic zvinosanganisira chronic motor uye vocal tic disorder - inotsanangurwa nekuvapo kweicho motokari kana tic tic sezviratidziro zvakaparadzana -, uye chirwere chenguva chenguva, apo tic disorder yakambovapo kwenguva shoma pane gore. Zvinokosha kuziva, kuti muhuwandu hwezviitiko neTS, varwere vanouyawo nehuwandu hwakasiyana hwehutachiona hwepfungwa. Izvi zvinosanganisira kutarisisa-deficit hyperactivity disorder (ADHD), obsessive compulsive behaviour/ disorder (OCB/OCD), depression, anxiety disorder, hunhu hwekuzvikuvadza nevamwe. Zvakakosha, huwandu hwemakiriniki akakodzera comorbidities mumunhu akapihwa anogona kuchinja nekufamba kwenguva. Semuenzaniso, kuora mwoyo uye kusagadzikana kwekuzvidya mwoyo kunowedzera mukurumbira kune vanhu vakuru vane TS, kusiyana nevana vaduku, apo ADHD inogona kunge iri nyaya huru yekliniki.

Sezvakaita chero dambudziko, asi zvakanyanya netic, kurapwa kunototanga panguva yekuongororwa. Izvi zvinoreva kuti muhuwandu hwezviitiko zvinotsanangura neurobiological background yehutano uye huwandu hwezviitiko zvinosanganiswa uye comorbidities zvinogona kukwana. Zvakare, muzviitiko zvakawanda kukosheswa kwezvinangwa zvekurapa kunogona kunongedza kumapindiro ane chinangwa chekudzikisa kukanganiswa kwecomorbidities senge ADHD, OCD kana kushungurudzika. Nekudaro, kana tics ichikuvadza kana kuvhiringidza nzanga, nzvimbo dzekurapa, kusanganisira maitiro uye pharmacological zvinodiwa. Mukati mehuwandu hwemishonga inowanikwa yemishonga, makirasi maviri akasiyana emishonga, a2-adrenergic agonists uye antipsychotics inonyanya kukurudzirwa.

Clonidine uye guanfacine ndea2-adrenergic agonists, ane humbowo hwakaratidzwa kunyanya muzviitiko zvine comorbid ADHD. Zvishoma nezvishoma titration uye kunyatsoongorora kunodiwa kune zvinogoneka mhedzisiro, kusanganisira hypotension, bradycardia, dzungu uye musoro. Zvakare, kuchenjerera kunoda kushandiswa munyaya yekurega kurapwa, sezvo rebound hypertension inogona kuitika.

Atypical (eg aripiprazole, risperidone, olanzapine, ziprasidone) uye antipsychotics ekutanga (eg haloperidol, pimozide, fluphenazine) ese akaongororwa kuti arapwe tic. Zvichienderana nechimiro checomorbidities, atypical antipsychotics inowanzofarirwa pane yekutanga-mutsara antipsychotics. Muzviitiko zvese, kunonoka kutara uye kunyatso tarisisa yeuropsychiatric mhedzisiro pamwe nekukanganisika kwekufamba, metabolic, uye kukanganiswa kwehomoni kunodiwa. Zvakare, nekuda kwekushanduka-shanduka kwema tic, kurapwa kunofanirwa kutanga munguva yakareba kwenguva, kuitira kuongorora kushanda kwechokwadi. Benzamides, senge tiapride uye sulpiride, zvinhu zvinowanzofarirwa muEurope.

Mimwe mishonga yemishonga, inosanganisira tetrabenazine uye deutetrabenazine, pamwe chete ne cannabinoids yekurapa kwevanhu vakuru vane tic. Botulinum toxin inogonawo kubatsira kazhinji, kunyanya muzviitiko zvine somatotopically zvinorambidzwa uye kunyanya kunetsa tic, kazhinji inosanganisira chiso kana mutsipa nemapfudzi. Kunyangwe, kusimudzirwa kwehuropi kwakadzama kunobata vimbiso yekurapa, kunyanya mumatambudziko anoramba kurapwa, izvi zvinofanirwa kuitwa munzvimbo dzine ruzivo rwakakura rwekiriniki zvese mu tic kusagadzikana / TS uye yakadzika uropi kukurudzira.

Mumashoko ake ekutanga pamusoro pechinyorwa chaMeige naFeindel che “Tics and their treatment”, Édouard Brissaud anokwevera ngwariro kutsika isiri yesainzi yekumisikidza “hierarchies pakati pezvinetso zvekurapa zvichibva pakuoma kwezviratidzo” uye anosimbisa kuti “hapagone kuve nekupatsanurwa kwezvirwere kuita zvikuru nezvidiki”. Chokwadi, tic uye kurapwa kwavo kunowanzo kudonha nekuda kwehunhu husina kunaka hwekufamba kusagadzikana uye kunetsa kwakasiyana kweanobatanidzwa neuropsychiatric comorbidities. Nekudaro, tic nemasonganiro avo anowanzo kugoneka nenzira inogutsa, kunyanya munzvimbo umo hunyanzvi hwekufamba-famba hunosanganiswa neruzivo uye hunyanzvi kubva kunharaunda dzakavakidzana dze neuropsychiatry, psychology uye vana.

Yakanyorwa naHubert Fernandez, MD
Dhipatimendi reNeurology
Cleveland Clinic
Cleveland, Ohio USA

Ongororo ye2019 yakapihwa ne:
Christos Ganos, MD, Movement Disorders uye Kudzora Muviri,
Movement Disorders uye Neuromodulation Unit, Dhipatimendi reNeurology Charité, University Medicine
Berlin, Germany