Tic.

Tics are involuntary, sudden, abrupt, isolated, short (motor tics) sounds produced by the nose, mouth or cheek (vocal tics, phonatory) or sensation (sensory tics). Motor tics may be sempÍici (eg. Eye closure, twitching of the nose, head shot) or complex (eg. Touching repetitive movements, jumps, kicks, pelvic rotation). Similarly, vocal tics / phonatory may be simple (eg. Throat clearing, grunting, vacuum) or complex (eg. Echolalia, palilalia, coprolalia)

Tics can be, therefore, of various types:

Motor tics (the most common, was sudden and short. In addition to those reported previously recalled the various myoclonus.)

Vocal tics (the emission of unwanted sounds. Includes grunts, words spoken without intention, etc.).

Tic behavior (echolalia, coprolalia, and so on.

Besides those there are other main types:



Tic dystonia (a series of coordinated movements with a presumed but nonexistent end, eg. Jump)

Tic sensitive (when it is triggered by an external stimulation, often found in people with Tourette's syndrome)

Tic transient (detectable in infancy)

The characteristics of tics include sopprimibilità, the raise in terms of stress and restlessness, reduced with distraction and concentration, suggestibility, the variability in the entity and a possible persistence during sleep. The most common cause of tics is GiIIes de la Tourette's syndrome, a genetic disease dominated by tics and a variety of behavioral manifestations. Transient childhood tics and simple tics are likely to represent a persistent form of fragmented de la Tourette syndrome.

The diagnostic criteria are as follows:

1. presence of multiple motor tics and one or more phonatory tics, but not both;

2. almost daily or intermittently for more than a year;

3. variability over time as regards anatomical location, number, frequency, complexity, type and severity of tics;

4. onset before 21 years of age;

5. no other possible causes of involuntary movements and sounds.

Due to the fluctuation of heterogeneous and often bizarre events, the affected patients often have an incorrect medical diagnosis and are abused by teachers, teachers, colleagues and strangers. Epidemiological studies suggest that most deicasi de la Tourette's syndrome have a genetic basis, using commonly with a penetrance of approximately 100%, especially in males. In a few cases I'origine can not be genetically triggered or caused by neuroleptics, carbon monoxide poisoning, head trauma, viral encephalitis, cocaine and opiate withdrawal. Many patients also suffer from an obsessive-compulsive disorder and have problems with attention and learning. Sleep disorders include parasomnias, I'enuresi and awakening as a result of the tics.
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Treatment is varied. Since many patients experience the raise and fall of symptoms and a generally favorable natural course, in cases of average severity may be sufficient assurances and behavioral therapy. The drugs are indicated when the tics are causing physical discomfort or social embarrassment. The effective use of drugs blocking dopamine receptors, such as fluphenazine, pimozide and haloperidol can reduce the frequency and severity of the tics and improve the behavior of impulsive and aggressive. These drugs, however, cause sedation, depression and weight gain. In addition, tardive dyskinesia is a potentially serious complication of chronic neuroleptic therapy. Clonazepam, clonidine, fluoxetine and clomipramine appear to be particularly useful in the treatment of obsessive compulsive disorder and other behavioral disorders often associated with Tourette syndrome.

Tourette syndrome (TS) is a neurological disorder characterized by tics - involuntary, rapid, sudden movements or vocalizations that occur repeatedly in the same way. The diagnostic criteria are:
It DITIC multiple motor and / or more vocal tics present at any time, or not necessarily at the same time;
The occurrence of tics many times a day (usually at times), almost every day or intermittently throughout a period of more than one year;
periodic variations in the number, frequency, type and location of tics, and waxing and waning of their severity. Symptoms can sometimes disappear for weeks or months at a time, onset before age 18.
Although the word "involuntary" is used to describe the nature of tics, this is not entirely accurate. It is incorrect to say that people with TS have absolutely no control over their tics, as if it were some kind of spasm, rather, a more appropriate term would be. "Exciting" People with TS feel an irresistible need to perform their tics, such as the need to scratch a mosquito bite. Some people with TS are able to hold the tics a few hours, but this only leads to a huge explosion of tics once they are finally allowed to be expressed.
Coprolalia must not only be understood as uttering profanity or swear words automatically. Many times the words expressing coprolalia manifests itself socially inappropriate or unacceptable.

What causes Tourette syndrome?

The search is ongoing, but it is believed that an altered metabolism of the neurotransmitters dopamine and serotonin are involved with the disease. It is genetically transmitted; parents with a 50% chance of passing the gene to their children. Girls with the gene have a 70% chance of symptoms, while boys with the gene have a 99% chance of displaying symptoms.

Myoclonus

Myoclonus is a movement similar to a click produced by a sudden contraction, rapid and brief (positive myoclonus) or muscle inhibition (negative myoclonus). Segmental myoclonus usually involves the origin of gill structures, innervated by the last cranial nerves and upper cervical nerve roots, consists of rhythmic contractions (I to 3 Hz) caused by a lesion of the midbrain or spinal cord. Palatal myoclonus resulting from acute or chronic injuries involving anatomical triangle between the dentate nucleus, red nucleus and inferior olivary nucleus. The generalized myoclonus is considered to reflect a departure from the shock of the midbrain reticular formation and is divided into physiological, essential, epileptic, or symptomatic. Two forms of myoclonus are associated with sleep myoclonus physiology of sleep, which usually occurs in the early stages of sleep, and nocturnal myoclonus, which is currently defined as "periodic movements of sleep, often associated with" restless leg syndrome "as also to abnormal involuntary movements during wakefulness.

The causes of generalized myoclonus include acute and prolonged hypoxia and ischemia, several metabolic factors, infectious and toxic I'assunzione of neuroleptic drugs (myoclonus late). The myoclonus may be associated with chorea family to dystonia and many neurodegenerative diseases, including Parkinson's disease, progressive myoclonic I'epilessia and a range of rare diseases eredodegenerative. Multifocal myoclonus often occurs in the late stages of Creutzfeldt-Jakob disease, and, less frequently, in Alzheimer's disease.

The specific pathogenesis of myoclonus are unknown. Studies have shown that clonazepam, lorazepam, valproate, carbamazepine and 5-hydroxytryptophan antimioclonica own activities. Clonazepam, at a dose of 1 a9 mg / day, is the drug of first choice but the development of side effects such as drowsiness, ataxia, and sexual problems often limit their use.

Stereo

The term "stereo" means a continuous motion or intermittent, involuntary, coordinated, stereotyped, repetitive, rhythmic aimless, but apparently finalized and ritual. The stereotypes can be simple (eg. Chewing movements, stomping, swinging the body) or complex (es.rituali complicated, and sit up from a chair). Can be suppressed voluntarily. The stereotypes may accompany a variety of behavioral disorders in humans such as anxiety disorder, obsessive-compulsive disorder, Tourette's syndrome to, schizophrenia, akathisia, I'autismo and mental retardation. The stereotypes and self-stimulatory behavior and self-harm are the most recognizable symptoms in patients with mental retardation and autism.

In tardive dyskinesia, a persistent disorder of movement caused by drugs blocking the receptors for dopamine, there is frequently the stereo. Many other problems can arise dalI'uso late movement of the dopamine receptor blocking drugs (neuroleptics). The term describes a combination of akathisia and stereotypy seen as a sensory component inner feeling of restlessness. The disorder affects especially the lower extremities ("Restless Legs") and is often worse at night, causing insomnia, and may be associated with periodic movements in sleep. Older women appear to be particularly at risk for tardive dyskinesia. The pathological mechanism is unknown but is considered by the development of hypersensitivity of dopamine receptors caused by chronic blockade by neuroleptics. Prevention is the best treatment for drug-induced movement disorders. When possible, psychiatric disorders or gastrointestinal drugs should be used other than neuroleptics. When there is no alternative, the dosage and duration of administration should be minimized. The spontaneous tardive dyskinesia occasionally follows the suspension of the causative agent. Depletori dopamine drugs, such as tetrabenazine or reserpine, are most effective as a symptomatic treatment.
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