Showing posts with label Movement. Show all posts
Showing posts with label Movement. Show all posts

Monday, August 01, 2016

Tourette's Syndrome - Tic Disorders

What is a tic?
A tic is an involuntary movement. A muscle or group of muscles move - tic - when you don't want them to or you make a noise or grunt rather like the throat-clearing some people do when they get nervous.
 
Tics can be divided into four categories. You can have:
 
1) A transient tic, which can be a movement or making a noise that lasts for more than four weeks but less than twelve. 
2) A chronic tic, which is either a movement or sound (but not both) that is present for more than a year.
3) Tourette's syndrome, which is movement and sounds together for more than a year.
4) A tic disorder (not otherwise specified) that does not fit into any of the other categories.
 
The classic picture of Tourette's syndrome often seen portrayed in films is the exception rather than the rule. The vast majority of children and adults have a variety of minor motor (movement) tics and/or vocal tics.

Although these motor and vocal tics are described as involuntary movements (you can't control them), they can to a certain extent be held back. Some sufferers can stop the tics for a period of time and release them when they are in the privacy of their own home. Therefore, it can come as something of a surprise for a teacher or employer to learn that a child or employee has a tic disorder. Some sufferers can disguise their tics by building them into what might be considered to be normal movements. However, holding back tics comes at a cost. Often when the child gets home his or her behaviour can become very disturbed or they suffer terrible guilt when they finally have to give in to the overwhelming urge.

History 
Tourette's Syndrome was originally described by Gilles de la Tourette as 'maladie des tics convulsifs avec coprolalie' (an illness of convulsive tics with the involuntary use of obscene words). The early documented cases of Tourette's syndrome were of adult patients and it was not until the 1930s that the tics were described in normal children. However, Tourette did note that as well as the involuntary movement tics, vocal tics and swearing, the disorder began in childhood, (usually between the ages of seven and ten), affected males more than females and was, in his opinion, hereditary. He also noted that the tics usually started in the face or upper extremities and that the symptoms waxed and waned and were made worse by stress. 


Disorders associated with Tourette's Syndrome
Some common signs of Tourette's are:
- excessive blinking
- head turning
- throat-clearing
- grimacing
- grunting
- squeaking
- one-sided facial tics
- eyes rolling up

The cause of Tourette's
The exact cause of Tourette's syndrome is unknown, but it appears to be linked to the gene or genes that control certain neurotransmitters, notably dopamine and serotonin. Where these symptoms begin not only goes a long way towards explaining the underlying cause but also presents an opportunity to provide effective treatment. About a third of people with the disorder have relatives with Tourette's syndrome, while another third have family members with milder tic disorders. There is also more obsessive-compulsive disorder and attention deficit hyperactivity disorder in families of people with Tourette's syndrome. Further, because Tourette's is much more frequent in men, the role of hormones has been considered and it has been suggested that the male foetus might be vulnerable to a spike in the female hormone oestrogen from the mother, during a specific stage during pregnancy.

What makes tics worse?
- Just talking about a person's tics - or habits as they are often called - in front of them can set off motor (movement) tics in seconds.
- Being overtired can make a big difference to the occurrence of tics. Children are often worse at the end of term.
- Lack of sleep can cause an upsurge in symptoms.
- Drinking alcohol can make symptoms worse the next day.
- Stress is certainly a big factor. In children the build-up to exams or in adults the period leading up to a big presentation can see an increase in symptoms.
- Diet has also been implicated on numerous occasions. The Mental Health Foundation has suggested that food additives and insufficient omega-3 can play a role in the generation of anxiety and signs of ADHD.

What helps reduce tics?
- Being distracted by something enjoyable or engaging in an activity (e.g. playing piano) can see a complete cessation of tics.
- Getting enough sleep and taking exercise in the fresh air can help prevent a build-up.
- Taking alcohol in moderation.
- A healthy diet as free from artificial sweeteners and additives as possible has been shown to help.
- Supplementing your diet with omega-3 can also provide significant benefits.
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~ The above is from Pauc, R. (2008) Could It Be You? , a well worth reading book for anyone interested in the area of learning difficulties. It's written in a very reader friendly format, detailed but not too taxing on the mind, and covers a range of issues from dyslexia, dyspraxia, ADHD, OCD, Tourette's syndrome, and autism. Recommended.  

Thursday, May 01, 2014

Neuroleptic-Induced Dystonia

Dystonia is a neurological movement disorder which may affect anyone at any age. It is characterised by involuntary muscle contractions which force certain parts of the body into abnormal, sometimes painful, movements or postures. Dystonia can affect any part of the body including the arms and legs, trunk, neck, eyelids, face, or vocal cords.


The disordered tonicity of muscles that occurs in dystonia can also be associated with neuroleptics, a dopamine antagonist drug. This secondary, or acquired dystonia, can be a problem encountered specifically with the use of antipsychotic medication (Hansen, 1997), as one side effect of these drugs is debilitating movement disorders known as extrapyramidal symptoms (Yamamoto & Inada, 2012). Drugs that decrease the effectiveness of neurotransmission are known as antagonists. Antipsychotic medication blocks dopamine receptors and this in turn can lead to the dystonic reactions.


With Parkinson’s, the disease is caused by cell death in the substantia nigra, which has dopamine producing functions. This loss of dopamine activity results in a decreased stimulation of the motor cortex which can lead to movement disruptions in the body. Similarly, the dopamine blockade effect of neuroleptic antagonists reduces the activity of transmitters in the synapse causing involuntary muscle contractions (Hansen, 1997). Therefore the severe disturbances of motor behaviour are often caused by the drug-induced dysfunction of the dopaminergic extrapyramidal system, which plays a vital role in movement control (Smelser & Baltes, 2001).

Extrapyramidal symptoms can be categorised as acute and tardive. Acute dystonia has a sudden onset and is often seen within the first five days of starting an antipsychotic course of treatment. Conversely, tardive begins after a long-term use of dopamine antagonist medication (Van Harten & Kahn, 1999).


Neuroleptic-Induced acute dystonia can result in abnormal positioning or spasm of muscles in the head, such as the eyes (oculogyric), neck (impaired swallowing), limbs, and trunk. Acute dystonic reactions generally disappear once the drug dose is lowered or there is complete cessation of the antipsychotic (Yamamodo & Inada, 2012). With tardive dystonia there is currently no established course of treatment, however administration of clozapine has been cited as the only drug helpful if it is tolerated by the patient.
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''Life has many twists and turns.
But when it literally involves your body, then the above saying takes on a whole different meaning''