[우리문화신문=유용우 한의사] If a child shows symptoms of unconsciously blinking and coughing, there is no choice but to worry as we suspect that our child has a tic disorder. It is known that tic disorders are caused by the interaction between genetic and environmental factors. Although there are tic disorders that mainly develop in infancy and appear as adults, most of them are children’s tic disorders.
The main symptom of a tic disorder is that the muscles or voice organs move and unconsciously repeat actions regardless of the person’s will. It is not at will and may change in intensity or frequency over time. It can be temporarily suppressed by self-effort, but children’s tic disorder is a characteristic that is difficult to control. In particular, in the case of Korea, in 2019, the Supreme Court confirmed that Tourette’s syndrome patients with tics should also be applied to the Welfare Act for the Disabled. A tic is both a symptom and a disorder.
Tic disorder is a symptom of repetitive and rapid muscle movement or sound. However, the initial symptoms are not recognized as a tic disorder and the treatment time is missed, and the chronic tic disorder, Tourette’s syndrome, is often exacerbated.
Tic disorder, which usually begins at the age of 5-7 years, is diagnosed as transient tic disorder. Transient tic disorder, which occurs in 5-10% of all children, is a case in which symptoms appear for 1 week or more, disappear within 1 year and do not recur. In the case of such a transient tic disorder, it is recommended to watch under the parent’s attention without scolding or urging. This is a case where the old adults say, “Do not hold on to what passes by,” because the process of pointing out, scolding, and drying often fixes tic disorders.
However, it often worsens after the age of 10, entering puberty. If the symptoms persist for a long time or worsen, it is highly likely to progress to chronic tic disorder, adult tic disorder, Tourette’s syndrome, etc. .
1. Types of tic disorders
Symptoms of tic disorder in children can be broadly divided into motor tic disorder and vocal tic disorder.
Motor tic disorder (muscular tic disorder) is a tic disorder in which the body parts such as the neck, shoulder, and trunk move rapidly and repeatedly. Blinking of the eyes is a typical symptom, and it is a muscle-oriented symptom that shrugs the shoulder or shakes the head from side to side.
Vocal tic disorder is a symptom of repetitive, meaningless sounds, which start with sounds such as coughing, grunting, and tongue clicking, but can worsen into tic symptoms that affect daily life, such as repeating the same words or spitting out abusive language. can
When such motor tics or vocal tics appear and show a chronic course, it is called a tic disorder. Motor tic disorder and vocal tic disorder are further divided into simple tic disorder and complex tic disorder depending on the pattern. Complex tic disorder (Tourette syndrome) refers to a case in which several types of motor and vocal tics occur simultaneously.
* Tic Disorder Classification Checklist *
1. Repeat the same symptoms for more than 4 weeks.
2. Identify the location of the body where the tics are present.
This is because symptoms that only appear around the face, such as blinking eyes, sticking out the mouth, and sniffing the nose, may be simple habits or allergic symptoms such as rhinitis. However, if symptoms appear beyond the face and down the neck, tics may be suspected.
3. Others outside the family also recognize the symptoms. (friends, school teachers, etc.)
4. Lack of concentration and distraction like symptoms of Attention Deficit Hyperactivity Disorder (ADHD). If one or more of the above symptoms occur while repeating the same behavior, it is necessary to suspect a tic disorder and seek a diagnosis from a specialist.
2. Phenomenon of the body that is easily misunderstood as a tic disorder
A tic disorder is a reaction (involuntary) that basically occurs in the body but does not go as desired. However, although it looks like an involuntary action on the outside, there is a reaction out of necessity. In other words, to relieve the tension of the cells, it is trying to create a comfortable state by actively eliciting a response, and the typical examples are coughing and blinking.
① Healing cough and vocal tics due to rhinitis are different
In the case of children’s tic disorder, tic symptoms appear along with rhinitis, or tic disorder occurs after rhinitis. If the child coughs ‘umin’ or ‘kekk’ even though he does not have a runny nose, or continues sniffing, careful observation of the parents is necessary to determine whether these symptoms are due to rhinitis, a tic disorder, or a situation where the child is trying to be comfortable through stimulation of the throat. .
Even if the cough occurs unconsciously, it is necessary to distinguish and observe whether this phenomenon is a movement to relieve tension in the respiratory mucosa, especially the throat, or whether it is revealed regardless of the condition of the bronchial mucosa. This is because, even in the same unconscious action, the phenomenon that occurs as a way to relieve tension is a daily action necessary to relax the body and maintain homeostasis.
Therefore, it is necessary to first observe the child’s condition to understand the manifestation, sometimes directly ask the child why he or she coughs, and to confirm the child’s intention about the condition before and after the coughing.
In reality, there are many cases where the distinction is vague, but it is helpful to understand that a clear vocal tic or Tourette’s syndrome is a sound that is revealed even in the process of inhaling air. This is because ‘eumyin’ or ‘kekkek’, which is revealed as a way to relieve tension, is made in the process of exhaling, but a tic disorder, an involuntary reaction that cannot be controlled, is also revealed regardless of the flow of air. In such a case, if the goal is to treat rhinitis rather than tic disorders, and the symptoms of rhinitis improve, tic disorders will naturally be sorted out.
② Blinking is more frequent in allergic reactions and atopic conjunctivitis
Blinking is a symptom that accounts for the absolute proportion of patients who visit for suspected tic disorder. Our eyes constantly blink to protect the conjunctiva and maintain the meninges. However, the fact that blinking is particularly recognized is because the frequency of blinking is frequent and a sense of discomfort is felt.
Therefore, perceived blinking means blinking more often than normal, which is revealed when the conjunctiva of the eye is easily dry or swollen.
Swelling of the conjunctiva is often revealed when atopic diseases, allergic reactions, and stagnant flow of energy in the oriental medicine, i.e., the flow of energy, is not achieved. The other is a feeling of dryness of the eyes, which often occurs when heat poisoning becomes severe and pressurizes the eyes and head, and when rhinitis worsens and affects even frontal headaches.
At this time, basically, there is a foreign body feeling or itching in the eyes, so they often blink spontaneously and, in severe cases, rub their eyes. Therefore, when blinking is severe, it is necessary to first suspect and treat allergic diseases, atopic conjunctivitis, rhinitis and sinusitis rather than tic disorders.
3. How to treat tic disorders
In oriental medicine, tic disorders are broadly classified into two categories. One is a seemingly involuntary tic symptom, but fundamentally, it is an active life activity to relieve tension, and the other is an actual tic disorder that is out of nerve control, an area that requires active treatment.
Therefore, the area that needs treatment is the tic phenomenon in which the nerve control is out of order. In oriental medicine, it is said that it is because of the stagnation of qi due to tension and overload, and it is expressed that gasosis has occurred in the upper part of the brain. Therefore, the goal of treatment is to create a cycle of smooth qi and blood circulation by relieving gasosis. In other words, since gaseous syndrome is expressed in the upper part of the brain centered on the brain, the neurotransmission flow is not smooth, and the point where gasosis is expressed is outside the normal circadian rhythm. Due to this, a tic disorder develops.
In addition to the treatment to relieve gasosis, you must first check whether there is an environment that gives excessive tension or stress in the child’s life to prevent it from getting worse. This is because, in any treatment, it is always a priority to eliminate the progressive factors that get worse. Therefore, after defending so that it does not progress further, with the help of oriental medicine, the accumulated stagnation is released, and by relaxing with exercise and deep sleep in daily life, the tic disorder will disappear by itself.
Therefore, correct sleeping habits along with herbal treatment are the basis for treating and preventing tic disorders. If you get a good night’s sleep by going to bed early and getting a good night’s sleep, your head will be clearer and your brain’s ability to control will become more active. In addition, it is necessary to bring out the harmony of the body through a clean-up process to achieve a state of complete relaxation through a deep sleep process and to restore the parts that cannot be relaxed through deep sleep.
To do this, it is necessary to work together with the child and family so that they can sleep well, create a home environment where they can sleep early, relax the body and mind with regular exercise, prepare a healthy and digestible diet, and avoid overeating. do.
It is also a problem to misunderstand a tic disorder and overtreat it, but if a tic disorder is suspected and left unacknowledged, the golden hour of treatment may be missed. Also, if you think that it is an abnormal habit and strongly discipline you not to act, rather than obsessive and obsessive, the tic symptoms will get worse and you may develop rebelliousness.