Current approaches to the diagnosis and treatment of tic hyperkinesis in children
V.P. Zykov1, E.A. Kashirina2, Yu.V. Naugolnykh2, I.B. Komarova1, E.B. Novikova1
1Russian Medical Academy of Continuous Professional Education, Moscow
2Children City Clinical Hospital No. 110, Moscow
Tic disorders represent a relevant problem due to a high incidence, reaching 1–6% in children population, comorbidity with attention deficit disorder, stereotypes, anxiety, learning disorders, mood swings, and sleep disorders. The article deals with the ICD-11 new provisions on the tics and Tourette’s syndrome transfer from “Mental Diseases” section to “Neurology” section. The main pathogenetic model is the imbalance of dopamine, GABA and glutamate mediators in the cortex — thalamus — striatum — cortex system. For the first time, we have discovered tic electromyographic patterns, which include fusiform and rhomboid bursting activity, which allows objectifying the severity and prognosis of the disease, as well as to broaden the understanding of tic neurophysiological aspects. There were clear differences between the groups of patients with motor, motor-vocal tics, and Tourette’s syndrome according to electromyography; bioelectric muscle activity parameters of the baseline background and the number of serial (cluster) bursts and their amplitude showed a direct correlation with the hyperkinesis severity by Yale Global Tic Severity Scale (YGTSS). Aminophenylbutyric and gopantenic acids can be used as a first-line drug during the onset stage in children of preschool and primary school age. At the stage of symptom expression, it is advisable to use anticonvulsants and neuroleptics.
Keywords: hyperkinesis, motor tics, vocal tics, Tourette’s syndrome.
For citation: Zykov V.P., Kashirina E.A., Naugolnykh Yu.V. et al. Current approaches to the diagnosis and treatment of tic hyperkinesis in children. RMJ. Medical Review. 2019;3:43–48.
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2. Зыков В.П., Каширина Э.А., Наугольных Ю.В. Тики и коморбидные симптомы детского возраста. РМЖ. 2017;21:1581–1585. [Zykov V.P., Kashirina E.A., Nagalnykh Yu.V. Tics and comorbid symptoms of childhood. RMJ. 2017;21:1581–1585 (in Russ.)].
3. Зыков В.П. Тики у детей. М.: Триада-Х; 2003. [Zykov V.P. Tics in children. M.: Triada-X; 2003 (in Russ.)].
4. ICD-11 for Mortality and Morbidity Statistics (ICD-11 MMS) 2018 version. (Electronic resource). URL: https://icd.who.int/browse11/l-m/en (access date: 12.20.2018).
5. Eriguchi Y., Kuwabara H., Inai A. et al. Identification of candidate genes involved in the etiology of sporadic Tourette syndrome by exome sequencing. Am J Med Genet B Neuropsychiatr Genet. 2017;174(7):712–723.
6. Sarbassov D.D., Ali S.M., Kim D.H. et al. Rictor, a novel binding partner of mTOR, defines a rapamycin-insensitive and raptor-independent pathway that regulates the cytoskeleton. Curr. Biol. 2004;14:1296–1302.
7. Leckman J.F., Riddle M.A., Hardin M.T. et al. The Yale Global Tic Severity Scale; initial testing of a clinical-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry. 1989;28:566–573.
8. Делягин В.М. Тики у детей. РМЖ. Мать и дитя. 2013;14:784. [Delyagin V.M. Tics in children. RMJ. Mother and child. 2013;14:784 (in Russ.)].
9. Martino D., Ganos C., Pringsheim T.M. Tourette Syndrome and Chronic Tic Disorders: The Clinical Spectrum Beyond Tics. Int Rev Neurobiol. 2017;134:1461–1490.
10. Nordstrom E.J., Bittner K.C., McGrath M.J. et al. Hyperglutamatergic cortico-striato-thalamo-cortical circuit breaker drugs alleviate tics in a transgenic circuit model of Tourette´s syndrome. Brain Res. 2015;1629:38–53.
11. Singer H.S. Merging the Pathophysiology and Pharmacotherapy of Tics. Tremor Other Hyperkinet Mov (NY). 2019;8:595.
12. Caligiore D., Mannella F., Michael A. et al. Dysfunctions of the basal ganglia-cerebellar-thalamo-cortical system produce motor tics in Tourette syndrome. PLoS Comput Biol. 201;13 (3).
13. Rae C.L., Polyanska L., Gould van Praag C.D. et al. Face perception enhances insula and motor network reactivity in Tourette syndrome. Brain. 2018;141(11):3249–3261.
14. Thomalla G., Rossbach D.P., Rosenkranz M. Negative fluid‐attenuated inversion recovery imaging identifies acute ischemic stroke at 3 hours or less. Ann Neurology. 2009;16:637.
15. Завадская Л.Н. Влияние GABA и ее производных на ионные каналы мембран выделенных нейронов Planorbarius corneus. Изв. АН КазССР. Серия биол. 1984;6:13–19. [Zavadskaya L.N. Effect of GABA and its derivatives on the ion channels of the membranes of isolated neurons of Planorbarius corneus. Izv. AN KazSSR. Biol Series. 1984;6:13–19 (in Russ.)].
16. Талалаенко А.Н., Панфилов М.Ю., Воздиган С.А. и др. Нейрохимический профиль прилежащего ядра перегородки в анксиолитическом действии транквилизаторов на различных моделях тревоги. Экспериментальная и клиническая фармакология. 1997;60(4):7–9. [Talalaenko A.N., Panfilov M.Yu., Vozdigan S.A. et al. The neurochemical profile of the adjacent septum nucleus in the anxiolytic action of tranquilizers on various models of anxiety. Experimental and clinical pharmacology. 1997;60(4):7–9 (in Russ.)].
17. Талалаенко А.Н., Гордиенко Д.В., Маркова О.П. Нейрохимический профиль хвостатого ядра в анксиолитическом действии бензодиазепиновых и небензодиазепиновых транквилизаторов на различных моделях тревоги. Эксп. и клин. фармакология. 2000;1:14–18. [Talalaenko A.N., Gordienko D.V., Markova OP Neurochemical profile of the caudate nucleus in the anxiolytic action of benzodiazepine and nonbenzodiazepine tranquilizers on various models of anxiety. Exp. and wedge. pharmacology. 2000;1:14–18 (in Russ.)].
18. Мехилане Л.С., Ряго Л.К., Алликметс Л.Х. Фармакология и клиника фенибута. Тарту; 1990. [Mekhilane L.S., Ryago L.K., Allikmets L. Kh. Pharmacology and Phenibut Clinic. Tartu; 1990 (in Russ.)].
19. Зыков В.П., Комарова И.Б., Назарова Е.К. и др. Состояние вегетативной сердечно-сосудистой регуляции у больных тиками и синдромом Туретта. Журнал неврологии и психиатрии им. С.С. Корсакова. 2003;11:10–14. [Zykov V.P., Komarova I.B., Nazarova E.K. and others. The state of vegetative cardiovascular regulation in patients with tics and Tourette syndrome. Journal of Neurology and Psychiatry named after SS Korsakov. 2003;11:10–14 (in Russ.)].
20. Зыков В.П., Айвазян С.О., Ширяев Ю.С. Дифференциальная диагностика гиперкинезов с эпилептическими приступами у детей. РМЖ. Педиатрия. 2012;2:41–14. [Zykov V.P., Ayvazyan S.O., Shiryaev Yu.S. Differential diagnosis of hyperkinesis with epileptic seizures in children. RMJ. Pediatrics. 2012;2:41–14 (in Russ.)].
21. Государственный реестр лекарственных средств. Инструкция по медицинскому применению препарата Анвифен®. (Электронный ресурс). URL: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=282a67f2-5003-4224-8ce8-d8b08aa8e440andt= (дата обращения: 22.03.2019). [State register of medicines. Instructions for medical use of the drug Anvifen®. (Electronic resource). URL: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=282a67f2-5003-4224-8ce8-d8b08aa8e440andt= (access date: 03.22.2019) (in Russ.)].
22. Зыков В.П., Каширина Э.А. Наугольных Ю.В. Современные подходы к терапии тикозных гиперкинезов с использованием препаратов антиконвульсантного ряда. Эпилепсия и пароксизмальные состояния. 2016;3:45–51. [Zykov V.P., Kashirina E.A., Uagolnykh Yu.V. Modern approaches to the treatment of tic hyperkinesis with the use of anticonvulsant drugs. Epilepsy and paroxysmal states. 2016;3:45–51 (in Russ.)].
23. European clinical guidelines for Tourette Syndrome and other tic disorders. Eur Child Adolesc Psychiatry. 2011;20:155–171.
24. Woods D.W., Piancentini J.C., Chang S.W. at al. Managing Tourette Syndrome. A Behavioral Intervention for Children and Adults. Oxford University Press; 2008.
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