TIC

From Big Medical Encyclopedia

TIC (fr. tic) — the type of bystry involuntary stereotypic reductions of a muscle or groups of muscles, at to-rykh arise the violent movements (hyperkinesias), sometimes very expressive, imitating autokinesias. Resistance of T. it is complicated, after any control of T. force it can increase.

On the nature of reductions of muscles distinguish convulsive (bystry, short reductions) and tonic (with the slowed-down relaxation of the reduced muscles) tics. T. can arise in a separate muscle (in simple T.) or to cover group of muscles (difficult T.). Difficult T. groups of synergistic muscles is followed by the expressed motive effect and movement of parts of a body. T. can be localized, i.e. strictly limited by a certain area of a body, or the general, generalized, covering muscular groups in all parts of a body.

On etiological and pathogenetic signs allocate psychogenic and organic T. To emergence of psychogenic T. various psychoinjuring situations precede: an adversity at school, at home, at work, deterioration in conditions of life, long stay in-tse, overfatigue, a fright, etc. The psychoinjuring factors often serve only as a releaser in development psychogenic to T. It appears usually at persons of a neuropathic warehouse in the presence at them motive «muscular readiness» (a syndrome of a hyperactivity) for development of T. T meet., arisen owing to imitation or fixing of usual movements (e.g., a frequent blinking at conjunctivitis) and fixed by the uslovnoreflektorny principle. At neurosis of persuasive states and nek-ry inborn bents to fixing of stereotypic movements and habits so-called tickers form — the people inclined to T. Ryad carries researchers to T. and the ritual movements which are in the same way carried out by the patient to get rid of feeling of alarm, nervousness. The tic ritual is known, e.g., in process to-rogo the patient pulls out at itself hair, is more often on the head. The Tikozny ritual movements at patients are combined with persuasive doubts, strong fears or persuasive actions.

In a wedge, practice T most often meet. an organic origin, being secondary, symptomatic and arising owing to the available or postponed diseases of a brain. Distinguish T. postencephalitic (entsefat itichesky), toxic, posttravmaticheeky, so-called medicamentous (medicinal). The last can arise after the use of various psychopharmacological means (see), as a result of exceeding in the course of treatment of limits of tolerance. T. can come, e.g., at use of L-DOFA. In emergence of T. at children an essential role is played by rheumatism, tonzillotserebralny syndromes, and re-and post-natal injuries of a brain, etc.

In a basis patofiziol. mechanisms T. disturbances of functions of hl lie. obr. educations extrapyramidal system (see) with a disinhibition chetverokholmny start reflexes, etc. Biokhlm. bases of many organic T., perhaps, consist in change of concentration of catecholamines of a brain, napr, in increase in contents in subcrustal kernels of dopamine (see. Catecholamines ).

Organic T. are heterogeneous. T are known., the pathogeny to-rykh is closely connected with damage or irritation of peripheral motor-neuron. E.g., after the postponed neuritis of a facial nerve against the background of the developing contractures in not struck muscular groups the T can appear. In painful T. persons has the reflex nature and accompanies an epileptiform neuralgia. It appears during an attack of pain, can extend to both sides of a face, but after the termination of pain disappears.

Night T meet. preferential legs, caused by a hyperexcitability of the neuromuscular device of extremities owing to vascular (ischemic) and exchange disorders in muscles.

At children of T. have an organic origin more often, appear usually at the age of 7 — 8 years, extend to a face, a neck, hands, with firmness keep, can amplify in the pubertal period. Psychogenic T meet., there are also children tickers. A specific place is held by a generalized tic of Turett (see Turett a syndrome), to-ry develops preferential at boys (average age of sick 8 years) and according to the last researches is considered as the organic syndrome caused by a number of disturbing factors (measles, chicken pox, a craniocereberal injury, etc.).

Morfol. changes at T. note in formations of striopallidal system, the lower olive, a reticular formation of a trunk of a brain. On character they correspond to an etiology of a basic disease (inflammatory, toxic, etc.).

Klien, a picture of tics is various. The T is most often observed. persons, involving his various muscles: there are twitchings and a nakhmurivaniye of eyebrows, a blinking, twitching of wings of a nose, the stereotypic chewing movements, etc. Meets in simple T more often. persons, characterized by any one stereotypic movement, napr, a zazhmurivaniye of eyes (blefarotik). At difficult T. faces involuntary reductions of muscles replace each other, stop and arise again (twitching of a cheek, a shmyganye a nose, then procrastination of a corner of a mouth, a pulling of lips a tubule, etc.). Sometimes T. creates a grimace when unexpectedly without the corresponding occasion there is an expression of a fright, surprise, joy.

It is various T. cervical muscles. It is known nodding to T., at Krom the rhythmical nodding movements by the head caused by periodic twitching grudino - clavicular and mastoidal muscles are made. In such T. it is possible to observe sometimes at children in the period of a teething. It is expressive rotatorny T. necks, consisting in the bystry violent turns of the head reminding implementation of the front command. Difficult T. can involve muscles of a neck, nadplechiya, shovels. At the same time shudder, shoulders twitch, the head, etc. tolchkoobrazno moves. T. persons and necks it is quite often combined with reductions of pharyngeal and respiratory muscles, owing to-rykh the patient at T. publishes peep, rumbling, sighs, sobs, smacks the lips. K T. carry the clonic form of stutter which is characterized by repetition of sounds owing to involuntary reduction of the muscles participating in the speech act. It is known to T. diaphragms with a rhythmical hiccups. At T. muscles of hands there are difficult synergies in the form of the gesticulation reminding odergivany clothes, a greeting, handshake, fastening of buttons, etc. At T. muscles of legs there are violent movements — squats, marking time, a pritantsovyvaniye, a podskakivaniye (saltatorny T.). Meets gemitik the short starts of one half of a body accompanied with aspiration.

Current of T. often chronic, sometimes progreduated, is possible both the spontaneous termination

of T. Differentsirovat psychogenic and organic T. difficult. For confirmation of the psychogenic nature of T. it is necessary to use special psychological tests (see. psychological tests ), information about the identity of the patient, existence of inversion, features of the premorbidal period, degree of reactivity of a nervous system of the patient, psychoconflict situations, etc. For the proof of the organic nature of T. comprehensive examination using an electroencephalography is necessary, for a pneumoencephalography, an electromyography and other methods of a research. At organic T., connected with diseases of a brain, find various organic disturbances of a nervous system: changes of a muscle tone, pyramidal signs, other types of organic hyperkinesias (tremor, choreoathetosis). On EEG changes in a type of disorganization of the main rhythms, emergence of slow waves (delta, a theta waves) the big amplitude, signs of paroxysmal activity are possible. At a pneumoencephalography changes in ventricular system of a brain and other signs indicating the postponed inflammatory process can be found. By means of an electromyography characteristic change of electric activity of muscles with existence of volleys of activity comes to light. For an exception of a hysterical chorea at children it is necessary to carry out complex a wedge, inspection and tests on rheumatism (see). At establishment of the diagnosis investigate indicators of excretion of catecholamines, etc.

Tonic T. like a blefarotik in some cases can be the first symptom of a front paraspasm (a medial spasm of the person, a spasm of Meyzha) therefore for the differential diagnosis it is necessary to establish extent of participation in a spasm of muscles of lower parts of the person, symmetry of violent movements (more inherent to a paraspasm). Assessment of nature of involuntary muscular contractions matters: at a paraspasm they have sharply expressed tonic character that to a lesser extent is peculiar to T.

For differentiation front T. with a tikopodobny form of a hemispasm of the person it is necessary to consider the following signs inherent to a hemispasm: systemacity of spasms in a zone of an innervation of a facial nerve with involvement of a hypodermic muscle of a neck (platysma myoides), firmness of symptomatology, etc.

Rotatorny T. of cervical muscles it is necessary to differentiate with a spastic wryneck (see), at a cut muscle tension of a neck, the fixed position of the head is observed.

Treatment psychogenic T. includes psychotherapy (hypnosis, narcohypnosis), auto-training, special gymnastics with control of movements at a mirror, reproduction sick observed at it T., what can slow down its manifestation. Recommend fortifying treatment (thalassotherapy, swimming, LFK, to lay down. gymnastics, such pharmaceuticals, as eleuterokokk, amino acids, etc.), sedatives and small tranquilizers. At organic T. carry out causal treatment (antiinflammatory, dehydrating, etc.), fortifying (Aminalonum, nootropil, methionine, etc.) and symptomatic (neuroleptics, tranquilizers, beta and adrenoblockers) treatment. In some cases apply operational neurosurgical treatment — perform stereotaxic operations on subcrustal formations of a brain (see. Stereotaxic neurosurgery). At adequate treatment of T. can decrease or stop.

See also Spasm , Spasms .



Bibliography: Bogolepov N. K. Disturbance of motive functions at vascular damages of a brain, M., 1953; Garbuzov V. I. To a question of differential diagnosis of ti-koidny and persuasive movements, and also choreic hyperkinesias, in book: Residual psychological frustration at children, under the editorship of S. S. Mnukhin, page 266, L., 1968; D and in and d e N to about in S. N. Clinical lectures on nervous diseases, century 2, JI., 1956; Karvasarsky B. D. Neurosises, M., 1980; M. I. Neyding and JI Form. Hyperkinesias and hypertensions of facial muscles, Sovr. psikhonevrol., No. 2-3, page 120, 1929; Petelin JI. C. Extrapyramidal hyperkinesias, M., 1970; C at to e r M. B. Clinical neuropathology of children's age, M., 1972; Shanko G. G. A generalized tic (a disease Shil de la Turetta) at children and teenagers, Minsk, 1979, bibliogr.; Fernando S. J. Six cases of Gilles de la Tourette’s syndrome, Brit. J. Psychiat., v. 128, p. 436, 1976; Handbook of clinical neurology, ed. by P. J. Vinken a. G. W. Bruyn, y. 1, Amsterdam a. o., 1975; Shapiro A. K., Shapiro E. Wayne K. Birth, developmental, and family histories and demographic information in Tourette’s syndrome, J. nerv. ment. Dis., v. 155, p. 335, 1972; W e i n g a r-ten K. Einige Bemerkungen zum Tic-Problem, Wien. klin. Wschr., S. 83, 1968.


L. S. Petelin.

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