A small social group is Small social group; understanding, types, structure. Small group characteristics

Tiki- lightning-fast involuntary muscle contractions, most often of the face and limbs (blinking, raising the eyebrows, twitching the cheek, corner of the mouth, shrugging the shoulders, wincing, etc.). By frequency tics occupy one of the leading places among neurological diseases of childhood. Tics occur in 11% of girls and 13% of boys. Under the age of 10 tics occur in 20% of children (i.e. every fifth child). Tics appear in children aged 2 to 18 years, but there are 2 peaks - these are 3 years and 7-11 years. A distinctive feature of tics from convulsive muscle contractions in other diseases: child can reproduce and partially control tics; tics do not occur during voluntary movements (for example, when taking a cup and while drinking from it). The severity of tics can vary depending on the time of year, day, mood, nature of the activity. Their localization also changes (for example, in child involuntary blinking was noted, which after a while was replaced by an involuntary shrug of the shoulders), and this does not indicate a new disease, but a relapse (repetition) of an existing disorder. Tick ​​amplification usually occurs when child watches TV, stays in one position for a long time (for example, sitting in class or in transport). Tics weaken and even completely disappear during the game, when performing an interesting task that requires full concentration (for example, when reading an exciting story). As soon as child loses interest in their activities tics reappear with increasing force. The child may suppress tics for a short time, but this requires great self-control and subsequent discharge.

Psychologically, children with tics are characterized by:

• attention disorders;
• impaired perception;
• in children with severe tics, violations of spatial perception are expressed.
• In children with tics, it is difficult to develop motor skills and coordinated movements, the smoothness of movements is impaired, and the performance of motor acts is slowed down.

Tick ​​classification:

• motor tics (blinking, twitching of the cheek, shrugging the shoulders, straining the wings of the nose, etc.)
• vocal tics (coughing, sniffing, grunting, sniffling)
• rituals(walking in circles)
• generalized forms of tics(when one child there is not one tick, but several).

In addition, distinguish simple tics , capturing only the muscles of the eyelids or arms or legs, and complex tics - movements occur simultaneously in different muscle groups.

The course of ticks

• The illness can last from a few hours to many years.
• The severity of tics varies from almost imperceptible to severe (resulting in the inability to go outside).
• Tick ​​frequency varies throughout the day.
• The effectiveness of treatment: from complete cure to ineffectiveness.
• Associated behavioral disturbances may be subtle or severe.

Causes of tics

There is a widespread point of view among parents and educators that "nervous" children suffer from tics. However, it is known that all children are “nervous”, especially during periods of the so-called crisis (periods of active struggle for independence), for example, 3 years old and 6-7 years old, and tics appear only in some children. Tics are often associated with hyperactive behavior and attention disorders (ADHD - attention deficit hyperactivity disorder), low mood (depression), anxiety, ritualistic and obsessive behavior (pulling out hair or winding it around a finger, biting nails, etc.). Besides, child with tics usually does not tolerate transport and stuffy rooms, quickly gets tired, tired of sights and activities, sleeps restlessly or falls asleep badly. The role of heredity Tics appear in children with a hereditary predisposition: Parents or relatives of children with tics may themselves suffer from obsessive movements or thoughts. It has been scientifically proven that tics:

• easier provoked in males;
• boys have more severe tics than girls;
• in children tics appear at an earlier age than their parents;
• if child tics, it is often found that his male relatives also suffer from tics, and female relatives from obsessive-compulsive disorder.

Parental Behavior Despite the important role of heredity, developmental characteristics and emotional and personality traits child, his character and ability to resist the influence of the outside world is formed within the family. An unfavorable ratio of verbal (speech) and non-verbal (non-speech) communications in the family contributes to the development of behavioral and character anomalies. For example, constant shouting and countless remarks lead to the restraint of free physiological activity. child(and it is different for each baby and depends on temperament), which can be replaced by a pathological form in the form of tics and obsessions. At the same time, children from mothers raising child in an environment of permissiveness, remain infantile, which predisposes to the occurrence of tics. Tick ​​provocation: psychological stress If child with a hereditary predisposition and an unfavorable type of upbringing, he suddenly encounters an unbearable problem for him (a psycho-traumatic factor), develop tics. As a rule, the surrounding child adults do not know what triggered the appearance of tics. That is, for everyone except himself child, the external situation seems normal. As a rule, he does not talk about his experiences. But at such moments child becomes more demanding of loved ones, seeks close contact with them, requires constant attention. Non-verbal types of communication are activated: gestures and facial expressions. The laryngeal coughing becomes more frequent, which is similar to such sounds as grunting, smacking, sniffing, etc., arising during thoughtfulness, embarrassment. The throaty cough is always aggravated by anxiety or danger. Movements in the hands appear or intensify - sorting through the folds of clothes, winding hair around a finger. These movements are involuntary and unconscious (a person may sincerely not remember what he just did), intensify with excitement and tension, clearly reflecting the emotional state. Teeth grinding during sleep may also appear, often combined with bedwetting and nightmares. All these movements, having arisen once, can gradually disappear by themselves. But if child does not find support from others, they are fixed in the form of a pathological habit and then transformed into tics. Parents often say that, for example, after a severe sore throat, their child became nervous, capricious, did not want to play alone, and only then appeared tics. Often, the onset of tics is preceded by acute viral infections or other serious illnesses. In particular, inflammatory diseases of the eye are often complicated by subsequent blinking tics; long-term ENT diseases contribute to the appearance of obsessive coughing, sniffing, grumbling. Thus, for the appearance of ticks, a coincidence of 3 factors is necessary:

1. hereditary predisposition
2. Wrong upbringing(the presence of intra-family conflict; increased demands and control (hyper-custody); increased adherence to principles, uncompromising parents; formal attitude towards to kid(hypo-custody), lack of communication)
3. Acute stress causing tics

Mechanism of tick development

If child internal anxiety is constantly present, or, as the people say, “restless in the soul”, stress becomes chronic. In itself, anxiety is a necessary protective mechanism that allows you to prepare for it before the onset of a dangerous event, accelerate reflex activity, increase the speed of reaction and sharpness of the senses, and use all the body's reserves to survive in extreme conditions. At child, often experiencing stress, the brain is constantly in a state of anxiety and anticipation of danger. The ability to arbitrarily suppress (slow down) unnecessary activity of brain cells is lost. Brain child does not rest; even in his sleep he is haunted by terrible images, nightmares. As a result, the body's adaptation systems to stress are gradually depleted. Irritability, aggressiveness appear, academic performance decreases. And in children with an initial predisposition to a deficiency in the inhibition of pathological reactions in the brain, harmful psychotraumatic factors cause the development of tics.

Tics and behavioral disorders

In children with tics, neurotic disorders are always noted in the form of low mood, internal anxiety, and a tendency to internal “self-digging”. Characterized by irritability, fatigue, difficulty concentrating, sleep disturbances, which requires the consultation of a qualified psychiatrist. It should be noted that in some cases tics are the first symptom of a more severe neurological and psychiatric illness that may develop over time. That's why child with tics should be carefully examined by a neurologist and psychologist.

Tick ​​Diagnostics

The diagnosis is established on the basis of an examination by a neurologist. At the same time, video filming at home is useful, because. child tries to suppress or hide his tics while talking to a doctor. Psychological examination is required child to identify his emotional and personal characteristics, concomitant disorders of attention, memory, control of impulsive behavior in order to diagnose tics variant of the course of ticks; identification of provoking factors; as well as further psychological and medical correction. In some cases, a neurologist prescribes a number of additional examinations (electroencephalography, magnetic resonance imaging), based on a conversation with parents and the clinical picture of the disease, and a consultation with a psychiatrist. Medical diagnoses Transient (transient) tic disorder characterized by simple or complex motor tics, short, repetitive, hardly controlled movements, and mannerisms. Tics occur in child daily for 4 weeks but less than 1 year. Chronic tic disorder characterized by rapid, repetitive, uncontrollable movements or vocalizations (but not both) that occur almost daily for more than 1 year.

Treatment of tics

1. To correct ticks, it is recommended first of all rule out precipitating factors . Of course, it is necessary to observe the sleep and nutrition regimen, the adequacy of physical activity. 2. Family Psychotherapy effective in those cases when the analysis of intra-family relations reveals a chronic psycho-traumatic situation. Psychotherapy is useful even with harmonious family relationships, because it allows to kid and parents to change negative attitudes towards tics. In addition, parents should remember that a well-timed kind word, touch, joint activities (for example, baking cookies or a walk in the park) help to kid cope with the accumulated unresolved problems, eliminate anxiety and tension. 3. Psychological correction .

• Can be carried out individually- for the development of areas of mental activity lagging in development (attention, memory, self-control) and reducing internal anxiety while working on self-esteem (using games, conversations, drawings and other psychological techniques).
• Can be carried out in the form of group lessons with other children (who have tics or other behavioral features) - for the development of the sphere of communication and playing out possible conflict situations. At the same time, child it becomes possible to choose the most optimal variant of behavior in a conflict (“rehearse” it in advance), which reduces the likelihood of exacerbation of tics. 4. Medical treatment ticks should be started when the possibilities of the previous methods have already been exhausted. Medications are prescribed by a neurologist depending on the clinical picture and additional examination data.
  • Basic therapy for tics includes 2 groups of drugs: anti-anxiety (antidepressant) - Phenibut, Zoloft, Paxil etc.; reducing the severity of motor phenomena - TIAPRIDAL, TERALEN etc.
  • As an additional therapy, drugs that improve metabolic processes in the brain (nootropic drugs), vascular drugs, and vitamins can be connected to the basic therapy.
  The duration of drug therapy after the complete disappearance of ticks is 6 months, then you can slowly reduce the dose of the drug until it is completely canceled. Forecast for children who have tics appeared at the age of 6-8 years favorable (i.e. tics pass without a trace). The early onset of tics (3-6 years) is typical for their long course, up to adolescence, when tics gradually decrease if tics appear before the age of 3, they are usually a symptom of some serious illness (for example, schizophrenia, autism, brain tumors, etc.). In these cases, a thorough examination is required child.

  See the article "Hyperactive child”, No. 9, 2004

  Electroencephalography (EEG) is a study that allows, using electrodes placed on the head, to register the electrical potentials of the brain and identify the corresponding changes.

  Magnetic resonance imaging (MRI) is one of the most informative diagnostic methods. tics(not associated with X-rays), which allows you to get a layered image of organs in different planes, to build a three-dimensional reconstruction of the area under study. It is based on the ability of some atomic nuclei, when placed in a magnetic field, to absorb energy in the radio frequency range and radiate it after the cessation of exposure to the radio frequency pulse.

Vocal tics belong to the group of neurological diseases and have a variety of causes. Most often they develop in childhood and over time can either pass or develop into a chronic form, weakening and intensifying. Vocal disorders are included in the group of neuroses, and the most common cause of their occurrence is the impact of stress on the emotional and mental component.

There are 2 groups of vocal tics that differ from each other in complexity and symptoms:

• Simple forms. This category includes tics, the main symptom of which is involuntary sounds: whistling, grinding, clattering, yelping or coughing, as well as croaking and other similar sounds. They do not last long, can be combined with motor tics.
• complex forms. Such vocal tics may appear as shouts of entire phrases or individual words. Tourette's syndrome is a congenital disorder that accompanies the patient all his life and delivers severe discomfort. Complex tics are often associated with motor disturbances.

Among the causes of vocal tics, experts distinguish several groups of factors.

Causes of tics

Most vocal tics begin in childhood and remain with the child for some time. The hereditary factor affects the predisposition to this deviation. But the mechanisms of pathology are somewhat different:

• neuroses and experiences;
• excessive fatigue;
• strong fear, fright - one of the key mechanisms for triggering a tick;
• stress and nervous exhaustion;
• abuse of games on computers, smartphones;
• great emotional and psychological stress at school;
• secondary causes are diseases: brain pathologies, injuries, metabolic disorders, circulatory diseases.

In adults, tics provoke overstrain at work, family problems, and nervous exhaustion.

Important! A tick can be provoked by exposure to carbon dioxide, certain medications, and prolonged alcohol consumption.

Other causes are often distinguished: head injuries received during childbirth, VVD.

Things are more complicated with hereditary causes. Children prone to vocal or mimic disorders begin to suffer from tics with the constant action of bad ecology.

There is also a higher risk of getting a disorder when autoimmune disorders or infections- from influenza and SARS to tuberculosis. Pathology is activated when there is an imbalance of vitamins and minerals in the body, especially magnesium and B6.

Possible manifestations of tics

Vocal tics in children are associated with several groups of symptoms. All of them start from the main symptom of a neurological disorder - the involuntary pronunciation of sounds or dreams. Here is how the disease manifests itself:

• coprolalia - the child utters obscene phrases, words;
• echolalia - the same word is constantly repeated;
• palilalia - speech becomes illegible, in some places there is a cyclicity, sometimes there is no relationship in what was said;
• slurred speech - a child or adult grits his teeth and speaks through them.

The first signs of vocal tics appear at preschool age - at the age of 5-7 years. If the violation occurred earlier, this may indicate serious diseases of the organs or nervous system.

Symptoms of pathology may include other conditions: sniffing, coughing, biting nails or hair.

Tourette syndrome

A separate hereditary manifestation of vocal tics - Tourette syndrome. Pathology is not subject to complete cure, it manifests itself aggressively. In adults, the first signs are never found.

The syndrome belongs to the group of complex generalized tics, it can cover motor attacks, swearing, obsessive actions, as well as other motor and sound phenomena. The prevalence of the disorder is low - only 0.05% of the population throughout the Earth has this pathology identified.

The development of the disease occurs at the age of 2-5 years, rarely manifests itself at 13-18 years. Activation of the syndrome is associated with strong emotional and nervous experiences. Approximately 2/3 of cases are found in male adolescents.

Fact! Tourette syndrome was discovered by a French neurologist, after whom the disease was named.

Vocal-motor tic is included in the group of unexplained hereditary disorders. Even in the Middle Ages there were cases of pathology. The syndrome is usually treated by psychotherapists and neurologists.

Detailed Causes of Tourette's Disease

Via PAT And MRI brain, scientists were able to prove that a defect inherited from one of the parents is associated with a change in the correct structure of the basal ganglia, neurotransmitter and neurotransmitter spheres.

Doctors suggest that the increased secretion of dopamine leads to the appearance of pathology. Another theory believes that the role is not in the production of dopamine, but in the sensitivity of the human body's receptors to it. In the treatment of tics, almost complete suppression of symptoms is observed after the use of dopamine receptor antagonists.

Medical therapy

All vocal tics require a multicomponent approach to treatment, especially Tourette's syndrome. If such a diagnosis is not made, doctors recommend paying attention to the patient's lifestyle:

• it is necessary to normalize the conditions of rest and work, as well as the regime - a child needs to sleep at least 8 hours, an adult - at least 7;
• you can’t constantly be at a computer, tablet, smartphone - 2 hours before bedtime, you need to give up games and entertainment;
• the patient must eat right, the diet is balanced, with vegetables, meat, fruits and nuts, without too fatty foods;
• moderate physical activity should be enjoyable, not exhausting;
• you need to try to reduce the level of stress and tension;
• if the pathology of the baby appeared as a result of constant quarrels of the parents, they should reconsider their attitude.

Among the medicines for correcting vocal tics, B vitamins, magnesium and calcium are used.

Important! To correct the reaction, Biotredin, Glycine, as well as more powerful psychotropic substances Diazepam or Phenibut are used.

To relieve tension and irritation, herbal preparations such as Novo-Passita may be required. Physiotherapeutic procedures reinforce the effect of medicines: electrosleep, stone therapy, acupuncture, therapeutic massage.

Vocal tics are usually associated with hereditary factors, Tourette's syndrome is one of the most severe forms of the pathology. It is necessary to treat vocal disorders, but this should be done by a doctor.

Vocal tics in children are the involuntary pronunciation of various sounds, simple or complex in nature. Tics can be provoked by respiratory infections, after illness with bronchitis, tonsillitis, rhinitis. Mental overload, head trauma are additional external factors leading to the appearance of tics. It is important to exclude the possibility of concomitant diseases by contacting a psychotherapist and a neurologist for an accurate diagnosis.

The main causes of vocal tics in children are purely psychogenetic in nature:

• Heredity - the disease is more likely to occur in children whose parents are also prone to tics or "compulsive disorder." Symptoms may appear at an earlier age than the parents.
• Restless environment (at home, at school, kindergarten) - conflicting parents, overwhelming demands, prohibitions or a complete lack of control, lack of attention, mechanical attitude: wash, feed, sleep.
• Severe stress - the trigger for a tic can be fright, emotional trauma associated with abuse, news of the death of a relative.

Also, tics can have physiological causes, for example, serious diseases, lack of magnesium in the body, disruption of the central nervous system as a result of:

• circulatory disorders of the brain;
• head injury;
• transferred meningitis;
• intracranial hypertension.

If children suffer from depression, then the risk of their tics is high.

Symptoms

Simple vocal tics include grunting, coughing, whistling, noisy breathing, grunting. The child makes lingering sounds “ay”, “ee”, “u-u”. Other sounds such as screeching or whistling are somewhat less common.

Symptoms manifest themselves singly, serially, are status. If the day has been emotional, the patient is overworked, and the symptoms are worse in the evening. Simple tics in ¼ of patients are manifested with motor tics in low and high tones:

• At low - the patient coughs, clears his throat, grunts, sniffs.
• At high - the sounds are already more definite, some vowels. High tones are combined with shudders.

Also, children are diagnosed with complex vocal tics, the symptoms of which are:

• pronunciation of words, including abusive ones - coprolalia;
• constant repetition of the word -;
• fast, uneven, illegible speech - palilalia;
• repetition of words, mumbling - Tourette's syndrome (watch the video).

Such manifestations cause a lot of problems, because children cannot attend school normally due to outbursts of an uncontrolled flow of abuse and other speech disorders.

Treatment

The treatment of vocal tics in a child is carried out on an outpatient basis so that hospitalization does not increase the anxiety that will aggravate the disease. The child should be observed by a pediatric neuropathologist. In 40% of children, tics disappear on their own, the rest have to be treated for a long time and painstakingly. Very effectively conducts conversations with a psychologist, which organizes therapy for the child and his parents. Understanding by parents the insurmountable nature of the disease will only hasten recovery.

Attempts to suppress the tics with willpower usually lead to an aggravation of the child's anxiety, causing a new, even more pronounced wave of symptoms. Therefore, to pull back, to remind him to restrain himself, and even more so to punish him, is cruel and unacceptable.

If a child's tics are caused by psychological causes, it will be enough to normalize the family environment, create a benevolent, favorable atmosphere that will provide the most effective treatment.

• We recommend reading:

Remove excessive emotional stimuli from the child's environment. It doesn't matter if they are positive or negative - it's stress. Even an attempt to divert the child's attention from the problem by coaxing gifts, travel is a serious burden on the central nervous system. It is better to organize a sparing day regimen, a calm atmosphere in the house.

• Take note:

Analyze what is the "trigger" that provokes vocal tics in your child. Finding out the source of irritation, eliminate it.

Often the source is watching TV, especially if the lights are off. The flickering light on the TV screen changes the bioelectrical activity of the child's brain. Therefore, while the treatment lasts, "communication" with the TV and computer should be minimized.

To speed up the healing process, "forget" about the disease. Pay no attention to tics. If they are worried about the illness, explain that these troubles are temporary, they will soon pass. Children who suffer from tics become very vulnerable. They need to be helped to feel secure in order to be confident in their abilities.

Relieve stress with a relaxing massage, baths with coniferous extracts, essential oils, sea salt. Conduct physiotherapy and aromatherapy sessions for children.

• Actual information:

Medication treatment is the last option for solving the problem of hyperkinesis in children. It must be applied when the previous methods were powerless.

But, deciding on treatment with medications, self-medication is excluded. Even if they say that it helped someone with such a problem, this does not mean that it will help everyone.

In drug treatment, two groups of drugs are used: antidepressants (paxil) and antipsychotics or neuroleptics (tiapridal, teralen); they minimize the symptoms of motor phenomena - this is the basic treatment. But there may be additional drugs. They are designed to improve metabolic processes in the brain, provide additionally necessary vitamins.

Complications

Nervous tic- a type of hyperkinesis ( violent movements), which is a short-term, stereotyped, normally coordinated, but inappropriately performed movement of a certain muscle group that occurs suddenly and repeats many times. A nervous tic is characterized as an irresistible desire to perform a certain action, and although the child is aware of the very presence of a tick, he is not able to prevent his appearance.

According to recent studies, up to 25% of children of primary school age suffer from a nervous tic, with boys getting sick three times more often than girls. Often this disease does not cause serious harm to the health of the child and disappears without a trace with age, so only 20% of children with a nervous tic seek specialized medical care. However, in some cases, a nervous tic can have very pronounced manifestations, cause serious harm to the physical and psycho-emotional state of the child and manifest itself at an older age. In such cases, the help of a specialist doctor is necessary.

Nervous tics can be motor or vocal ( voice).

Motor tics are:

• blinking of the eye/eyes;
• frowning of the forehead;
• grimacing;
• wrinkling of the nose;
• lip biting;
• twitching of the head, arm, or leg.

Vocal tics are:

• sniffing in the nose;
• coughing;
• snort;
• hiss.

Interesting Facts

• A nervous tic, unlike other types of obsessive movements, is either not recognized by the child, or is recognized as a physiological need.
• When tics appear, the child himself may not notice them for a long time, without experiencing any discomfort, and the concern of the parents becomes the reason for going to the doctor.
• A nervous tic can be suppressed by the child's will for a short time ( A couple of minutes). At the same time, nervous tension increases and soon the nervous tic resumes with greater force, new tics may appear.
• A tic can involve several muscle groups at once, giving it the appearance of a purposeful, coordinated movement.
• Nervous tic is manifested only in the state of wakefulness. In sleep, the child does not show any signs of illness.
• Nervous tics suffered such famous personalities as Mozart and Napoleon.

Innervation of the muscles of the face

To understand the mechanism of occurrence of a nervous tic, certain knowledge from the field of anatomy and physiology is needed. This section will describe the physiology of skeletal muscles, since it is their contraction that occurs during a nervous tic, as well as the anatomical features of the innervation of the muscles of the face ( most often, a nervous tic in children affects the facial muscles).

Pyramidal and extrapyramidal systems

All voluntary human movements are controlled by certain nerve cells ( neurons), located in the motor area of ​​the cerebral cortex - in the precentral gyrus. The combination of these neurons is called the pyramidal system.

In addition to the precentral gyrus, motor zones are distinguished in other parts of the brain - in the cortex of the frontal lobe, in subcortical formations. The neurons of these zones are responsible for coordination of movements, stereotypical movements, maintaining muscle tone and are called the extrapyramidal system.

Each voluntary movement includes the contraction of some muscle groups and the simultaneous relaxation of others. However, a person does not think about which muscles need to be reduced and which to relax in order to make a certain movement - this happens automatically, thanks to the activity of the extrapyramidal system.

The pyramidal and extrapyramidal systems are inextricably linked with each other and with other areas of the brain. Recent studies have established that the occurrence of nervous tics is associated with increased activity of the extrapyramidal system.

Nerves that innervate the muscles of the face

The contraction of the skeletal muscle is preceded by the formation of a nerve impulse in the motor neurons of the precentral gyrus. The resulting impulse is carried along the nerve fibers to each muscle of the human body, causing it to contract.

To each muscle there are motor nerve fibers from certain nerves. The muscles of the face receive motor innervation mainly from the facial nerve ( n. facialis) and also, partially, from the trigeminal nerve ( n. Trigeminus), which innervates the temporal and masticatory muscles.

The zone of innervation of the facial nerve includes:

• forehead muscles;
• circular muscle of the orbit;
• cheek muscles;
• nose muscles;
• lip muscles;
• circular muscle of the mouth;
• zygomatic muscles;
• subcutaneous muscle of the neck;

Synapse

In the zone of contact of the nerve fiber with the muscle cell, a synapse is formed - a special complex that ensures the transmission of a nerve impulse between two living cells.

The transmission of a nerve impulse occurs through certain chemicals - mediators. The mediator that regulates the transmission of nerve impulses to skeletal muscles is acetylcholine. Being released from the end of the nerve cell, acetylcholine interacts with certain areas ( receptors) on the muscle cell, causing the transmission of a nerve impulse to the muscle.

Muscle structure

Skeletal muscle is a collection of muscle fibers. Each muscle fiber is made up of long muscle cells ( myocytes) and contains many myofibrils - thin filamentous formations that run parallel along the entire length of the muscle fiber.

In addition to myofibrils, muscle cells contain mitochondria, which are the source of ATP ( adenosine triphosphate) - the energy necessary for muscle contraction, the sarcoplasmic reticulum, which is a complex of tanks located in the immediate vicinity of the myofibrils, and depositing calcium necessary for muscle contraction. An important intracellular element is magnesium, which promotes the release of ATP energy and is involved in the process of muscle contraction.

The direct contractile apparatus of muscle fibers is the sarcomere - a complex consisting of contractile proteins - actin and myosin. These proteins are in the form of filaments arranged parallel to each other. The protein myosin has peculiar processes called myosin bridges. At rest, there is no direct contact between myosin and actin.

Muscle contraction

When a nerve impulse arrives at a muscle cell, calcium is rapidly released from its place of deposition. Calcium, along with magnesium, binds to certain regulatory regions on the surface of actin and enables contact between actin and myosin via myosin bridges. Myosin bridges attach to actin filaments at an angle of approximately 90° and then change their position by 45°, thereby causing mutual approach of actin filaments and muscle contraction.

After the cessation of the flow of nerve impulses to the muscle cell, calcium from the cell is quickly transferred back to the sarcoplasmic cisterns. A decrease in intracellular calcium concentration leads to detachment of myosin bridges from actin filaments and their return to their original position - the muscle relaxes.

Causes of a nervous tic

Depending on the initial state of the child's nervous system, there are:

• primary nervous tics;
• secondary nervous tics.

Primary nervous tics

Primary ( idiopathic) is commonly called a nervous tic, which is the only manifestation nervous system disorders.

Most often, the first manifestations of nervous tics occur in children aged 7 to 12 years, that is, during the period of psychomotor development, when the child's nervous system is most vulnerable to all kinds of psychological and emotional overload. The appearance of tics before the age of 5 years suggests that the tic is the result of some other disease.

The causes of primary nervous tics are:

• Psycho-emotional shock. The most common cause of nervous tics in children. The occurrence of a tick can be provoked as an acute psycho-emotional trauma ( fear, quarrel with parents), and a long-term unfavorable psychological situation in the family ( lack of attention to the child, excessive demands and strictness in education).
• Teak first September. In about 10% of children, a nervous tic will debut in the first days of attending school. This is due to the new environment, new acquaintances, certain rules and restrictions, which is a strong emotional shock for the child.
• Eating disorder. A lack of calcium and magnesium in the body, which are involved in muscle contraction, can cause muscle spasms, including tics.
• Abuse of psychostimulants. Tea, coffee, all kinds of energy drinks activate the central nervous system, forcing it to work "for wear and tear." With the frequent use of such drinks, a process of nervous exhaustion occurs, which is manifested by increased irritability, emotional instability and, as a result, nervous tics.
• Overwork. Chronic lack of sleep, prolonged stay at the computer, reading books in poor lighting lead to an increase in the activity of various areas of the brain with the involvement of extrapyramidal systems and the development of nervous tics.
• hereditary predisposition. Recent studies indicate that tics are transmitted in an autosomal dominant pattern of inheritance ( if one of the parents has a defective gene, then he will manifest this disease, and the probability of inheriting his child is 50%). The presence of a genetic predisposition will not necessarily lead to the development of the disease, but the chance of a nervous tic in such children is greater than in children without a genetic predisposition.

According to the severity of the primary nervous tic can be:

• local- one muscle/muscle group is involved, and this tick dominates throughout the entire period of the disease.
• multiple- manifests itself in several muscle groups at the same time.
• Generalized (Tourette syndrome) is a hereditary disease characterized by generalized motor tics of various muscle groups in combination with vocal tics.

The duration of the primary nervous tic is:

• Transient- lasting from 2 weeks to 1 year, after which it passes without a trace. After a certain time, the tick may resume. Transient tics can be local or multiple, motor and vocal.
• Chronic- longer than 1 year. It can be either local or multiple. During the course of the disease, tics may disappear in some muscle groups and appear in others, but complete remission does not occur.

Secondary nervous tics

Secondary tics develop against the background of previous diseases of the nervous system. The clinical manifestations of primary and secondary nervous tics are similar.

Factors contributing to the occurrence of nervous tics are:

• congenital diseases of the nervous system;
• traumatic brain injury, including congenital;
• encephalitis - an infectious and inflammatory disease of the brain;
• generalized infections - herpes virus, cytomegalovirus, streptococcus;
• intoxication with carbon monoxide, opiates;
• brain tumors;
• some medications - antipsychotics, antidepressants, anticonvulsants, central nervous system stimulants ( caffeine);
• trigeminal neuralgia - hypersensitivity of the skin of the face, manifested by pain with any touch to the facial area;
• hereditary diseases - Huntington's chorea, torsion dystonia.

Changes in the body of a child with a nervous tic

With a nervous tic, there are changes in the function of all body structures involved in muscle contraction.

Brain
Under the influence of the factors listed above, the activity of the extrapyramidal system of the brain increases, which leads to excessive formation of nerve impulses.

Nerve fibers
Excessive nerve impulses are conducted along the motor nerves to the skeletal muscles. In the zone of contact of nerve fibers with muscle cells, in the area of ​​synapses, there is an excessive release of the mediator acetylcholine, which causes contractions of the innervated muscles.

Muscle fibers
As mentioned earlier, muscle contraction requires calcium and energy. With a nervous tic, frequent contractions of certain muscles are repeated for several hours or throughout the day. Energy ( ATP), used by the muscle in the process of contraction, is consumed in large quantities, and its reserves do not always have time to recover. This can lead to muscle weakness and muscle pain.

With a lack of calcium, a certain number of myosin bridges cannot connect to actin filaments, which causes muscle weakness and can cause muscle spasm ( prolonged, involuntary, often painful muscle contraction).

The psycho-emotional state of the child
Constant nervous tics, manifested by winking, grimacing, sniffing and in other ways, attract the attention of others to the child. Naturally, this leaves a serious imprint on the emotional state of the child - he begins to feel his defect ( although before that, perhaps, did not attach any importance to it).

Some children, being in public places, for example, at school, try to suppress the manifestation of a nervous tic by force of will. This, as mentioned earlier, leads to an even greater increase in psycho-emotional stress, and as a result, the nervous tic becomes more pronounced, new tics may appear.

An interesting activity creates an activity zone in the child's brain, which drowns out pathological impulses coming from the extrapyramidal zone, and the nervous tic disappears.

This effect is temporary, and after the cessation of the "distracting" activity, the nervous tic will resume.

Rapid elimination of the nervous tic of the eyelids

• Moderately press with your finger in the area of ​​​​the superciliary arch ( exit point from the cranial cavity of the nerve that innervates the skin of the upper eyelid) and hold for 10 seconds.
• With the same force, press in the area of ​​\u200b\u200bthe inner and outer corners of the eye, holding for 10 seconds.
• Close both eyes tightly for 3-5 seconds. In this case, you need to strain your eyelids as much as possible. Repeat 3 times with an interval of 1 minute.

The implementation of these techniques can reduce the severity of a nervous tic, but this effect is temporary - from several minutes to several hours, after which the nervous tic will resume.

Geranium leaf compress

Grind 7-10 green geranium leaves and apply to the teak affected area. Cover with a pad of several layers of gauze and wrap with a warm scarf or handkerchief. After an hour, remove the bandage and rinse the skin in the area of ​​application of the compress with warm water.

Nervous tic treatment

Approximately 10-15% of primary nervous tics, being mild, do not have a serious impact on the health and psycho-emotional state of the child and disappear on their own after a while ( weeks - months). If the nervous tic is severe, causes inconvenience to the child and negatively affects his psycho-emotional state, it is necessary to start treatment as soon as possible in order to prevent the progression of the disease.


In the treatment of a nervous tic in children, there are:

• non-drug methods of treatment;
• medical methods of treatment;
• folk methods of treatment.

Non-drug treatments

They are priority methods of treatment for primary nervous tics, as well as for secondary nervous tics as part of complex therapy. Non-drug treatment includes a set of measures aimed at restoring the normal state of the nervous system, metabolism, and normalizing the psycho-emotional and mental state of the child.

The main directions of non-drug treatment of nervous tic in children are:

• individual psychotherapy;
• creating a favorable environment in the family;
• organization of the regime of work and rest;
• full sleep;
• complete nutrition;
• exclusion of nervous strain.

Individual psychotherapy
This is the most preferred method for the treatment of primary nervous tics in children, since in most cases their occurrence is associated with stress and an altered psycho-emotional state of the child. A child psychiatrist will help a child understand the causes of increased excitability and nervousness, thereby eliminating the cause of a nervous tic, and teach the correct attitude to a nervous tic.

After a course of psychotherapy in children, there is a significant improvement in the emotional background, normalization of sleep, reduction or disappearance of nervous tics.

Creating a favorable family environment
First of all, parents should understand that a nervous tic is not pampering, not the whims of a child, but a disease that requires appropriate treatment. If a child has a nervous tic, you should not scold him, demand that he control himself, say that he will be laughed at at school, and so on. The child is not able to cope with a nervous tic on his own, and the wrong attitude of the parents only increases his internal psycho-emotional stress and aggravates the course of the disease.

How should parents behave if a child has a nervous tic?

• do not focus on the nervous tic of the child;
• treat the child as a healthy, normal person;
• if possible, protect the child from all kinds of stressful situations;
• maintain a calm, comfortable atmosphere in the family;
• try to find out what problems the child has or had recently and help in solving them;
• if necessary, contact a pediatric neurologist in a timely manner.

Organization of the regime of work and rest
Improper distribution of time leads to overwork, stress and nervous exhaustion of the child. With a nervous tic, it is extremely important to exclude these factors, for which it is recommended to follow certain rules regarding work and rest.

Climb	7.00
Morning exercises, toilet	7.00 – 7.30
Breakfast	7.30 – 7.50
Road to school	7.50 – 8.30
Study at school	8.30 – 13.00
Walk after school	13.00 – 13.30
Dinner	13.30 – 14.00
Afternoon rest/sleep	14.00 – 15.30
Walks in the open air	15.30 – 16.00
afternoon tea	16.00 – 16.15
Studying, reading books	16.15 – 17.30
Outdoor games, housework	17.30 – 19.00
Dinner	19.00 – 19.30
Rest	19.30 – 20.30
Preparation for sleep	20.30 – 21.00
Dream	21.00 – 7.00

Full sleep
During sleep, the nervous, immune, and other systems of the body are restored. Violation of the structure of sleep and chronic lack of sleep leads to an increase in nervous tension, deterioration of the emotional state, increased irritability, which can be manifested by nervous tics.
Complete nutrition
The child must observe the time of the main meals, the food must be regular, complete and balanced, that is, contain all the substances necessary for the growth and development of the child - proteins, fats, carbohydrates, various vitamins, minerals and trace elements.

Particular attention should be paid to products containing calcium, since the lack of this element reduces the threshold for excitation of muscle cells and contributes to the manifestation of nervous tics.

Depending on age, the need for calcium in children is as follows:

• from 4 to 8 years - 1000 mg ( 1 gram) calcium per day;
• from 9 to 18 years - 1300 mg ( 1.3 grams) calcium per day.

Product name	Calcium content in 100 g of product
processed cheese	300 mg
white cabbage	210 mg
cow's milk	110 mg
Black bread	100 mg
Cottage cheese	95 mg
Sour cream	80 - 90 mg
Dried fruits	80 mg
Black chocolate	60 mg
White bread	20 mg

Eliminate nervous tension
Classes that require the utmost concentration of the child's attention lead to rapid fatigue, poor sleep and an increase in nervous tension. As a result, the manifestations of a nervous tic intensify, new tics may appear.

With a nervous tic in a child, the following should be excluded or limited:

• computer and video games, especially at bedtime;
• long TV viewing, more than 1 - 1.5 hours a day;
• reading books in inappropriate conditions - in transport, in poor lighting, lying down;
• listening to loud music, especially 2 hours before bedtime;
• tonic drinks - tea, coffee, especially after 18.00.

Medical treatment of a nervous tic

Drug treatment is used to treat primary and secondary nervous tics. For the medical treatment of nervous tics in children, sedatives and antipsychotic drugs are used, as well as drugs that improve blood circulation and metabolic processes in the brain. You should start with the most “light” drugs and with the minimum therapeutic dose.

Medications prescribed for children with a nervous tic

Name of medication	Mechanism of action	Methods of application and dosage in children
Novo-Passit	Combined sedative preparation of plant origin. Reduces psycho-emotional stress, facilitates the process of falling asleep.	It is recommended to try on 1 teaspoon 2-3 times a day to normalize the psycho-emotional state.
Thioridazine (Sonapax)	Antipsychotic drug. eliminates the feeling of anxiety and fear; relieves psycho-emotional stress.	It is applied inside, after eating. from 3 to 7 years - 10 mg in the morning and evening; from 7 to 16 years - 10 mg three times a day, every 8 hours; from 16 to 18 years - 2 tablets of 20 mg three times a day, every 8 hours.
Cinnarizine	A drug that improves cerebral circulation. Reduces the flow of calcium into the muscle cells of blood vessels. Expands cerebral vessels, increasing blood flow to the brain.	Take 2 times a day, morning and evening, 12.5 mg 30 minutes after meals. Treatment is long - from several weeks to several months.
Phenibut	A nootropic drug that acts at the level of the brain. normalizes brain metabolism; improves blood supply to the brain; increase the resistance of the brain to various damaging factors; eliminates the feeling of anxiety and anxiety; normalizes sleep.	Regardless of food intake. up to 7 years - 100 mg 3 times a day; from 8 to 14 years - 200 - 250 mg 3 times a day; over 15 years - 250 - 300 mg 3 times a day.
Diazepam (Seduxen, Sibazon, Relanium)	A drug from the group of tranquilizers. relieves emotional tension, anxiety and fear; has a calming effect; reduces motor activity; speeds up the process of falling asleep; increases the duration and depth of sleep; relaxes muscles through action on the brain and spinal cord.	With severe manifestations of nervous tics, regardless of food intake. from 1 to 3 years - 1 mg in the morning and evening; from 3 to 7 years - 2 mg in the morning and evening; older than 7 years - 2.5 - 3 mg in the morning and evening. The course of treatment is no more than 2 months.
Haloperidol	A potent antipsychotic drug. to a greater extent than sonapax eliminates anxiety and relieves psycho-emotional stress; stronger than diazepam suppresses excessive motor activity.	It is used in severe cases of nervous tics, with the ineffectiveness of other drugs. The dose is determined by the neuropathologist, based on the diagnosis and general condition of the child.
Calcium Gluconate	A calcium preparation that compensates for the lack of this microelement in the body. Normalizes the processes of muscle contraction and relaxation.	Take before meals. Grind before use. Drink a glass of milk. from 5 to 7 years - 1 g 3 times a day; from 8 to 10 years - 1.5 g 3 times a day; from 11 to 15 years - 2.5 g 3 times a day; over 15 years old - 2.5 - 3 g three times a day.

Folk methods for the treatment of a nervous tic

It has been proven that the use of sedatives, decoctions and infusions has a beneficial effect on the child's nervous system and reduces the manifestations of a nervous tic.

Sedatives used for nervous tics in children

Tool name	Cooking method	Application rules
motherwort tincture	2 tablespoons of chopped dry grass plants pour a glass of boiling water ( 200 ml); refrigerate for two hours at room temperature; strain through cheesecloth several times; store the resulting infusion in a place protected from the sun at room temperature.	Take 3 times a day, 30 minutes before meals. from 7 to 14 years - 1 teaspoon; over 14 years old - 1 dessert spoon. Duration of application is not more than 1 month.
Valerian Root Infusion	Pour 1 tablespoon of crushed plant root with a glass of hot boiled water; heat for 15 minutes in a boiling water bath; cool at room temperature and strain several times through cheesecloth; store at a temperature not exceeding 20ºС in a place protected from the sun.	Give children 1 teaspoon of the resulting infusion 4 times a day 30 minutes after meals and at bedtime. It is not recommended to take the infusion for more than a month and a half.
Infusion of chamomile flowers	Place 1 tablespoon of dried flowers in a thermos and pour 1 glass ( 200 ml) boiling water; insist for 3 hours, strain thoroughly; store at a temperature not exceeding 20ºС.	Children are advised to take a quarter cup of decoction ( 50 ml) three times a day, 30 minutes after meals.
Infusion of hawthorn fruit	1 tablespoon of dried and crushed fruits of the plant pour a glass of boiling water; insist for 2 hours; carefully strain through cheesecloth.	Children over 7 years of age take 1 tablespoon 3 times a day, 30 minutes before meals. The recommended duration of use is no more than 1 month.

Other Treatments for Nervous Tics in Children

In the treatment of nervous tics in children, successfully used:

• relaxing massage;
• electrosleep.

Relaxing massage
Properly performed massage reduces the excitation of the nervous system, reduces psycho-emotional stress, improves blood circulation in the brain and muscles, restores mental comfort, which can reduce the severity of tics. With a nervous tic, a relaxing massage of the back, head, face, legs is recommended. Acupressure of the tick area is not recommended, as this creates additional irritation and can lead to more pronounced manifestations of the disease.

electrosleep
This is a physiotherapy method that uses weak, low-frequency electrical impulses. They enter the cranial cavity through the eye sockets and act on the central nervous system ( central nervous system), enhancing the processes of inhibition in the brain and causing the onset of sleep.

Electrosleep effects:

• normalization of the emotional state;
• calming effect;
• improvement of blood supply and nutrition of the brain;
• normalization of the metabolism of proteins, fats and carbohydrates.

The electrosleep procedure is carried out in a special room of the clinic or hospital, equipped with a comfortable couch with a pillow and a blanket. The room should be isolated from street noise and sunlight.

The child should remove outer clothing and lie down on the couch. A special mask is put on the child's eyes, through which an electric current is supplied. The current frequency usually does not exceed 120 hertz, the current strength is 1 - 2 milliamps.

The procedure lasts from 60 to 90 minutes - during this time the child is in a state of drowsiness or sleep. To achieve a therapeutic effect, 10-12 sessions of electrosleep are usually prescribed.

Prevention of recurrence of a nervous tic

Modern living conditions in big cities inevitably lead to increased nervous tension and stress. Children, due to the functional immaturity of the nervous system, are especially sensitive to overstrain. If a child has a predisposition to nervous tics, then the probability of their occurrence at an early age is very high. However, today a nervous tic is a curable disease, and subject to certain rules and restrictions, you can not remember this ailment for many years.

What should be done to avoid a recurrence of a nervous tic?

• maintain a normal psycho-emotional environment in the family;
• provide adequate nutrition and sleep;
• teach the child the right behavior under stress;
• do yoga, meditation;
• exercise regularly ( swimming, athletics);
• spend at least 1 hour outdoors every day;
• ventilate the child's room before going to bed.

What can trigger a recurrence of a nervous tic?

• stress;
• overwork;
• chronic sleep deprivation;
• tense psycho-emotional situation in the family;
• lack of calcium in the body;
• abuse of tonic drinks;
• long time watching TV;
• spending a lot of time at the computer;
• long video games.