Tics & Tourette Syndrome

I-Tics ineempawu ezimbini ezongezelelweyo ezahlukileyo. Okokuqala, zihlala zandulelwa ngamava angemnandanga eemvakalelo, adla ngokubhalwa ngokuba “yi-premonitory urge”. Ngokubhekiselele kumava e-interoceptive, izigulane zinobunzima bokubonelela ngeengxelo ezichanekileyo ze-premonitory urges, zihlala zisebenzisa amagama athi "itch", "ukutshisa", "ukuxinana kwemisipha" okanye "isidingo sokwenza i-tic" ukuyichaza. Ngokuqhelekileyo, ukuphunyezwa kokuziphatha kwe-tic kunika isiqabu sexeshana kwi-premonitory ephazamisayo. Okwesibini, i-tics inokunyanzeliswa ngokuzithandela ixesha elifutshane. Ewe, zombini ubukho bezibongozo ze-premonitory kunye namandla okucinezela ngamandla ukuziphatha kwe-tic kwimfuno zikhokelo eziluncedo kwiimeko ezinzima, apho umahluko ovela kwezinye ukuphazamiseka kwentshukumo ye-hyperkinetic, njengomzekelo, i-chorea inokuba nzima.

Ii-tics zinokuqubisana noluhlu olubanzi lwe-neurodevelopmental, neurometabolic kunye ne-neurodeergenerative disorders. Nangona kunjalo, kwiimeko zeklinikhi zibonwa ngokuqhelekileyo kwi-Gilles de la Tourette syndrome (okanye nje i-Tourette syndrome: TS). Ngokutsho kwe-DSM-5, i-TS ichazwa kubukho ubuncinane beendlela ezimbini zokuziphatha ze-motor tic kunye ne-vocal tic yokuziphatha kwisithuba esincinci sonyaka, ebonakalisa phambi kweminyaka eyi-18. Ezinye izifo eziziiprayimari ze-tic ziquka ukuphazamiseka kwe-motor kunye ne-vocal tic disorder - echazwe kubukho be-motor okanye i-tic tic njengezibonakaliso ezizimeleyo -, kunye nokuphazamiseka kwe-tic okwethutyana, xa i-tic ingaphantsi konyaka. Kuyaphawuleka ukuba kuninzi lwamatyala ane-TS, izigulana ziya kubakho noluhlu olubanzi lwe-neuropsychiatric comorbidities. Ezi ziquka ingqalelo-intsilelo hyperactivity disorder (ADHD), obsessive compulsive behaviour/ disorder (OCB/OCD), depression, ixhala disorder, ukuziphatha ukuzenzakalisa kunye nabanye. Okubalulekileyo, uluhlu lwezinto ezihambelana neklinikhi kumntu onikiweyo zinokutshintsha ngokuhamba kwexesha. Umzekelo, ukudakumba kunye nokuphazamiseka kokuxhalaba kuye kwabonakala ngakumbi kubantu abadala abane-TS, ngokuchaseneyo nabantwana abancinci, apho i-ADHD inokuba ngumba ongundoqo wekliniki.

Njengayo nayiphi na ingxaki, kodwa ngakumbi nge-tics, unyango sele luqala ngexesha lokuxilongwa. Oku kuthetha ukuba kuninzi lwamatyala achaza imvelaphi ye-neurobiological ye-disorder kunye ne-spectrum yeziganeko ezinxulumene nazo kunye ne-comorbidities inokwanela. Ngaphaya koko, kwiimeko ezininzi ukubekwa phambili kweenjongo zonyango kunokukhomba kungenelelo olujolise ekunciphiseni impembelelo ye-comorbidities efana ne-ADHD, i-OCD okanye ukudakumba. Nangona kunjalo, xa ii-tics ziyingozi okanye ziphazamisa uluntu, iindawo zonyango, kubandakanywa nokuziphatha kunye ne-pharmacological ziyimfuneko. Kwimiba yonyango olukhoyo lwe-pharmacological, iiklasi ezimbini ezahlukeneyo zamayeza, i-a2-adrenergic agonists kunye ne-antipsychotics zicetyiswa ngokukodwa.

I-Clonidine kunye ne-guanfacine zi-a2-adrenergic agonists, kunye nokusebenza okuqinisekisiweyo ngokukodwa kwiimeko ezine-comorbid ADHD. I-titration kancinane kunye nokujongwa ngononophelo kuyafuneka kwimiphumo enokubakho, kuquka i-hypotension, i-bradycardia, isiyezi kunye nentloko. Kwakhona, isilumkiso kufuneka sisetyenziswe kwimeko yokuyeka unyango, njengoko uxinzelelo lwegazi olubuyelayo lunokwenzeka.

I-Atypical (umz. i-aripiprazole, i-risperidone, i-olanzapine, i-ziprasidone) kunye ne-antipsychotics yodidi lokuqala (umz. i-haloperidol, i-pimozide, i-fluphenazine) zombini zivavanyelwe unyango lwe-tics. Ngokusekwe kwiprofayile ye-comorbidities, i-atypical antipsychotics ihlala ikhethwa kune-antipsychotics yomgca wokuqala. Kuzo zonke iimeko, ukucotha okucothayo kunye nokujongwa ngononophelo kweziphumo ebezingalindelekanga ze-neuropsychiatric kunye nokuphazamiseka kwentshukumo, i-metabolic, kunye nokuphazamiseka kwehomoni kuyafuneka. Kwakhona, ngenxa yendalo eguquguqukayo ye-tics, unyango kufuneka luqaliswe ngexesha lexesha elide, ukuze kuhlolwe ukusebenza kokwenyani. I-Benzamides, njenge-tiapride kunye ne-sulpiride, zizinto ezihlala zithandwa eYurophu.

Ezinye i-pharmacological agents, ziquka i-tetrabenazine kunye ne-deutetrabenazine, kunye ne-cannabinoids yonyango lwabantu abadala abane-tics. Ityhefu ye-botulinum isenokuba luncedo, ngakumbi kwiimeko ezinomda we-somatotopically kwaye ngokukodwa ii-tics ezikhathazayo, ezibandakanya ubuso okanye intamo namagxa. Nangona, ukuvuselela ubuchopho obunzulu kubambe isithembiso sonyango, ngakumbi kwiimeko ezichasene nonyango, oku kufuneka kwenziwe kumaziko anamava amakhulu ekliniki zombini ukuphazamiseka kwe-tic / TS kunye nokuvuselela kwengqondo enzulu.

Kwintshayelelo yakhe kupapasho lukaMeige noFeindel olungo “Tics nonyango lwazo”, u-Édouard Brissaud utsalela ingqwalasela kumkhwa ongeyonzululwazi wokuseka “uluhlu lweengxaki zonyango olusekwe kubuqatha beempawu” kwaye ebalaselisa ukuba “akunakwahlulwa kwezifo zibe zinkulu nezincinci”. Enyanisweni, ii-tics kunye nonyango lwazo zihlala ziwela ngenxa yesimo esilungileyo sokuphazamiseka kwentshukumo kunye noluhlu olucelomngeni lwe-neuropsychiatric comorbidities ezinxulumene nazo. Nangona kunjalo, ii-tics kunye nemibutho yazo zihlala zilawuleka ngendlela eyanelisayo, ngakumbi kumaziko apho ubuchule bokuphazamiseka kwentshukumo budityaniswa nolwazi kunye nezakhono ezivela kwimimandla engabamelwane ye-neuropsychiatry, i-psychology kunye ne-pediatrics.

Ixhaswe nguHubert Fernandez, MD
ISebe leNeurology
Kliniki yaseCleveland
Cleveland, Ohio USA

Uhlaziyo luka-2019 lunikezelwe ngu:
UChristos Ganos, MD, ukuphazamiseka kweMovement kunye noLawulo loMzimba,
I-Movement Disorders kunye ne-Neuromodulation Unit, iSebe le-Neurology Charité, i-University Medicine
EBerlin, eJamani