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Channel 8 Tourette Syndrome (妥瑞症) documentary and interview
What are tics? What is Tourette Syndrome?
Tics are brief, involuntary, and purposeless movements or sounds.
They can be simple, involving one muscle, or complex, involving a group of muscles. Examples include:
- Simple motor tics include eye blinking, facial grimaces, head/ neck jerks, and shoulder shrugs.
- Complex motor tics can include jumping, touching objects or surfaces.
- Simple vocal tics consist of grunting, coughing, sniffing, and throat clearing noises.
- Complex vocal tics can involve animal-like noises, sentences, counting, swearing, and more.
Some children may experience premonitory urges, feelings or sensations that are relieved by the execution of tics.
Tics can affect up to 10-20% of children and are often temporary, resolving within a few weeks or months. These are called ‘Transient Tics Disorder’.
However, in some cases, tics can persist for more than a year, leading to a diagnosis of Chronic Tic Disorder or Tourette Syndrome (TS). Chronic Tic Disorder refers to a condition where a child experiences motor or vocal tics for more than a year. On the other hand, TS is a Chronic Tic Disorder in which a child experiences both motor and vocal tics. It is important to know that children with TS may also have other conditions such as Anxiety, Obsessive-Compulsive Disorder (OCD), and Attention Deficit Hyperactivity Disorder (ADHD).
It’s crucial that young people, as well as their families, friends, and schools, are educated about tics and TS. The lack of awareness may lead to preventable psychological implications, including anxiety, social isolation, bullying, and even depression.
How is Tourette syndrome diagnosed?
Tourette Syndrome is diagnosed based on careful history-taking and clinical observation. There are no specific tests to diagnose this condition, but there are internationally agreed-upon standards for diagnosing TS. A child or young person must meet the following criteria for a TS diagnosis:
- Age of onset before 18 years old
- Multiple motor and at least one vocal tics that happen regularly, although not necessarily at the same time
- Have tics occurring many times a day or intermittently for more than one year
- Not due to an effect of a substance or other medical conditions, such as Epilepsy, or Hungtington’s disease.
It can be challenging to diagnose TS, as tics may resemble other conditions such as epileptic seizures or chronic cough. Unfortunately, TS symptoms have often been misunderstood as behavioural difficulties or ‘bad habits’.
A confirmed diagnosis of Tourette Syndrome can make a significant difference in the lives of patients and their loved ones. It enables them to gain a better understanding of the disorder, leading to enhanced support and coping mechanisms. Don’t hesitate to seek a diagnosis if you suspect Tourette Syndrome – it could be life-changing.
What is the treatment for Tourette syndrome or Chronic Tics Disorder?
Tics can be distressing, annoying, or even painful. Unfortunately, there is no cure for tics, but most people outgrow them eventually. In the meantime, it is important to learn to live with them, understand them, and explain them to others. This will help individuals cope better and reduce the impact of tics on their daily lives.
Managing tics involves identifying potential triggers such as stress and sleep deprivation. However, if tics are particularly bothersome or intrusive, there are two main approaches that can be considered:
1) Psychological & Behavioural Therapy
Individuals with TS may also have other conditions such as anxiety, obsessive-compulsive disorder (OCD), and Attention Deficit Hyperactivity Disorder (ADHD). Treating these conditions can often lead to an improvement in tics.
Learning relaxation techniques and coping skills to manage stress can be helpful. For instance, breathing exercises and yoga can be beneficial for calming the mind and body.
Behavioural therapy can also be useful by teaching the patient how to recognise when they are about to have a tic, and what techniques they can apply. These interventions are usually taught by a psychologist or psychiatrist.
2) Neuromodulation Therapy
It’s crucial to keep in mind that medication isn’t always the go-to solution when dealing with tics in yourself or your child. However, if the tics begin to interfere with your child’s daily activities, such as eating, bathing, speaking, or learning, certain supplements and medication can be helpful in modulating the chemical transmission in the brain cells and reducing symptoms.
Additionally, it’s crucial to treat associated medical conditions such as OCD and ADHD, as they can be more intrusive than the tics themselves and require unique treatments based on symptoms.
TS can be a lifelong condition, but many individuals experience fewer or less noticeable tics as they age. Tics tend to be most severe between the ages of 7 and 12 years old. After late adolescence, many children may stop having tics or experience them only occasionally. However, for some adults, lifelong treatment may be necessary.
It is important to discuss these options with a paediatric neurologist to determine the best course of action for managing tics, and related conditions to ensure the best possible quality of life.
How to help a child with Tourette syndrome in school or classroom?
Many children or young adults with TS can manage their education without any additional help. However, some may require extra assistance due to co-existing conditions such as Attention Deficit Hyperactivity Disorder (ADHD) or Obsessive Compulsive Disorder (OCD).
As tics often tend to worsen during stressful situations, parents of children with TS may choose to inform their child’s school or teachers about their condition. Fortunately, many young people with TS can have a successful and fulfilling time in school with the right treatment and support.
How does Tourette syndrome affect your life and workplace?
Individuals with TS are capable of performing a wide range of jobs. It is important to understand that having TS should not hinder young people from pursuing their aspired career paths. We have witnessed individuals with TS who have successfully pursued careers as doctors, footballers, accountants, and various other professions. However, in rare cases, severe tics may make certain physical tasks challenging.
If your child is dealing with tics or related conditions, it’s crucial to seek guidance from a paediatric neurologist. By discussing your options with paediatric neurologist you can determine the best course of action to manage these conditions and improve your child’s quality of life.
1) 妥瑞症是种怎样的疾病？分为哪几种类型？
妥瑞症 (Tourette Sydnrome, TS) 是一种常发病于儿童的神经精神疾病, 大部分患者在 5 – 6 岁
左右发病. TS 并不少见, 儿童盛行率为1%.
TS 主要表现为短暂, 快速, 不自主且重复的抽动, 称为Tics.
抽动症状可以分为 ‘动作抽动’ 和’声语抽动’ 两大类型, 又可再分为简单型和复杂型, 列举如下:
(i) 动作抽动 (Motor Tics):
简单型 (Simple Motor Tics)
突然, 短暂, 快速, 无意义的动作. 例如:眨眼, 眼睛动作, 装鬼脸,手指移动, 等.
复杂型 (Complex Motor Tics)
较缓慢、较长时间、看起来好像较有目的、很像强迫性的动作。例如: 四处碰物体或他人, 模仿
别人的动作, 等.
(ii) 声语抽动 (Vocal or Phonic Tics):
简单型 (Simple Vocal Tics)
快速, 发出没有意义的声音与吵杂音. 如: 清喉咙, 咳嗽声, 吐口水, 像是动物的声音及数不清的其
他声音.
复杂型 (Complex Vocal Tics)
突然, 较有意义的词语, 可能是一个音节或惯用话语. 患者可能会不自主地说脏话.
TS 的病情会时好时坏，在情绪波动 (如紧张, 焦虑, 兴奋, 生气), 或感染时都可能会恶化.
TS 常与其他精神病同时发生，因此会加重诊断和治疗的困难. 常见的共病症包括：注意力不足
过动症、强迫症、情绪不稳定、冲动或破坏行为、睡眠异常。
2) 为什么越早确诊越好？基本上有什么诊断方法?
早期发现和治疗可以让 TS 的孩子和父母相互支持, 然而减轻抽动症状的严重程度, 并预防因
为疾病造成的生活问题.
观察症状和评估以往病史是诊断的主要手段.
血液分析、影像检查或其他医药检测无法辨别 TS 和其他的疾病.
但是, 医生可能会通过 EEG (脑电图), MRI (脑扫描) 或 验血来排除其他可能与 TS 混淆的病
症.
TS 的诊断标准是根据 2013年美国精神医学会出版的诊断与统计手册第五版 (DSM-5).
TS 必须符合以下四个条件：
1. 出现多种动作抽动, 和 ≥ 1种声语抽动; 但不一定需要同时发生
2. 症状持续超过一年
3. 在满十八岁前出现症状.
4. 疾病不是因为使用了某药物 (例如：兴奋剂) 或是一般医学的疾病 [如: 亨丁顿病
(Hungtington’s disease), 或 脑炎 (Encephalitis)].
3) 如何控制妥瑞症的症状，尤其是Tics?
了解 TS 和抽动症来龙去脉, 并能够向其他人解释这个疾病是控制抽动症最重要的策略。
一旦年轻人，他们的家人，朋友和学校了解了TS和抽动症，患者通常可以更好地应对 TS。
控制抽动症的策略也包括了解造成病情恶化的因素，例如情绪波动, 压力, 和睡眠不足。
正常的生活作息、均衡饮食和适当运动是很重要的. 在饮食上, 应尽量避免食用含有咖啡因的巧
克力、咖啡、茶、糖果和加工食品. 已有研究指出，适量的运动是有益的. 专心运动时, 抽动症
一般都会减轻。
抽动症状轻微的 TS 患者一般不需要接受治疗. 而严重的抽动症可能令人不安, 烦恼甚至痛苦,
影响个人生活机能, 妨碍他人生活 .
严重的 TS 患者可以考虑接受 两种主要治疗:
对于精神的策略 – 心理和行为治疗
TS 常与其他精神病症同时发生. 常见的精神病症包括：注意力不足过动症, 强迫症, 情绪不稳定
, 破坏行为、睡眠异常. 这些状况可能比抽动症更具破坏性，并需要根据症状进行不同的治疗.
通常我会建议 TS 患者学习放松技巧, 例如: 呼吸练习和瑜伽, 这能帮助紓解壓力也能減輕病情.
近来有研究发现，行为治疗法对于 TS 也可以达到不错的效果. Habit Reversal Therapy (习惯
反向训练) 是目前经常用于 TS 的行为治疗法，其中包含3个部分：Awareness Training (认知
训练), Competing Response Training (对抗反应训练), Building Motivation (社会支持).
对于脑神经的策略 – 药物治疗
目前的药物治疗都不能让TS得到痊愈, 但可以减轻抽动症. 常用的药物包括 clonidine ,
risperidone, 和 aripiprazole. 这些药物可以帮助改变脑细胞化学传递, 从而减轻病症.
药物也可治疗相关疾病，例如强迫症和多动症。
4) 如果不善于控制症状，会带来什么影响，甚至有什么后果
因为TS 患者需要长期应对失常行为的种种困难, 以及社会对这种疾病的眼光, TS 患者可能出现
精神健康问题，如焦虑症, 睡眠异常, 社交隔離, 自尊的喪失, 等. 所以精神和心理治疗也是普遍
需要的。
5) 目前，有什么有效的治疗方法？需要长期治疗吗？
TS可能是终生的状况。但是我们知道，随着年龄的增长，许多人的抽动症越来越少。
抽动通常在7到12岁之间最严重. 大多数TS患者在青少年晚期到二十岁初症状都会显著改善，
约30% 的患者可以回复无疾病状态，然而其他相关症状如：强迫症、 注意力问题等，则会在
成年后持续存在，需要持续治疗.
6) 患有妥瑞症的人，可以从事什么类型的工作？因为症状的关系，动作或行动方面 会有什么限制?
TS 不会威胁生命，也不会影响智力发展和学习，只有症状严重时需就医治疗.
TS 患者可以学习与症状共处，仍然能够有精彩的人生. TS患者 也可当医生，足球运动员或会
计师。
7) 家人，朋友，和同事应该如何给予协助？
TS 多半在学龄阶段发病. 因此, 学校的卫生教育应包括师生认识 TS 及其他相关症状如: 强迫症,
注意力问题等.
学校师生可以应该给予支持及帮助, 让TS 孩童维持正常的生活机能, 社交关系和学业表现.
家长和老师应该培养孩童对自己行为的自信和幽默感, 也要适当地观察和监控孩童的病程发展
状况, 采取合适的处理方式. 减少孩童的压力和情绪波动, 也有助于缓和病情.
家长和老师应该以鼓励代替责备，并且尽量不要提醒TS患者症状. 当孩子开始抽动时，家长应
该提醒他多做对抗反应练习，而不是说 '别再动了'. 而当孩子成功觉察并使用对抗反应取代抽动时, 家长应给予鼓励, 增加他们的正向感受, 提高继续练习的动机.
联合早报
Zao Bao
7 June 2022
Tourette Syndrome – when involuntary twitching is not a bad habit
By Swee Hwee Weng
In conjunction with Tourette’s Awareness Day, this report on Tourette Syndrome (TS) raises awareness on the disease. Dr Dr Yeo Tong Hong, Head and
Senior Consultant, Neurology Service, Department of Paediatrics, KK Women’s and Children’s Hospital (KKH) shared about the challenges in diagnosing TS, and some of the internationally agreed diagnostic criteria. Dr Yeo also shared some ways to manage and cope with TS, even though there is no treatment to completely cure TS. Current therapies focus on treating the mind, as well as the brain. He also shared some ways for caregivers to help TS patients cope better such as providing adequate reassurance and understanding, and keeping a diary of the types of tics, with the frequency and possible triggers. The report also features a patient profile, along with specialist views from National Neuroscience Institute and Khoo Teck Puat – National University Children’s Medical Institute.
