Ngokwesiko elidumile, ukunyakaza okuthile okuphindaphindayo kanye “nokuthuthumela” abanye abantu abakubonisa ngaphansi kwezimo ezihlukahlukene kuvezwa ngamancoko amaningi. Kodwa-ke, bambalwa abaqaphelayo ukuthi bayazibonakalisa mhlawumbe ngenxa yokuthi bahlushwa uhlobo oluthile lokuphazamiseka, njengoba kunjalo I-Tourette syndrome. Ngakho-ke, esihlokweni esilandelayo sethula incazelo ephelele yayo, kanye nemininingwane mayelana nayo izimpawu, izimbangela, i-comorbidity, ukuxilongwa kanye nokwelashwa.
Yini iTourette syndrome?
I-Gilles de la Tourette syndrome, eyaziwa kakhulu ngokuthi i-Tourette syndrome, ihlanganisa ukuphazamiseka kwengqondo lapho umuntu ebonisa khona ukukhuluma nokushukuma ngokuzenzakalelayo. Lezi zimpawu zingase zivele phakathi neminyaka eyi-10 yokuqala, kodwa zihlale ziphazamisekile impilo yakho yonke. Kwachazwa udokotela wezinzwa UGeorges Gilles de la Tourette yobuzwe baseFrance, ngonyaka we-1885, futhi kungokuhlonishwa kwakhe ukuthi leli gama linikezwe.
Isici salesi sifo sitholakala, njengoba sekushiwo, phakathi kwezimpawu zayo naphezu kwemvelo yayo engapheli. Lezi zingabonakala nganoma isiphi isikhathi phakathi kweminyaka engu-2 nengu-18 ubudala, zihlale zingashintshile isikhathi esingaba yiminyaka eyi-10. Ngemva kwalokho, lezi zingase zinyamalale isikhathi esisukela ezinsukwini kuye ezinyangeni, bese zibonakala futhi. Ngaphezu kwalokho, izimpawu zibonakala ngokuqina okukhulu ebuntwaneni.
Ngokuphathelene nokusabalala kwayo, izibalo zibonisa ukuthi izingane ezingu-30 kweziyizi-10.000 70 ziba ne-Tourette syndrome; Ngaphezu kwalokho, kubonakala kaningi kwabesilisa kunabesifazane. Ngakolunye uhlangothi, kulinganiselwa ukuthi cishe u-XNUMX% weziguli eziphethwe yiso zine- ilungu lomndeni eliseduze elinama-tics noma iziyaluyalu ezihlobene kulokhu, njengokuphoqayo.
Kuleli qophelo, akulimazi ukuchaza ukuthi iyini i-tic. A tic Kuyinto ukunyakaza okusheshayo, okwenziwa ngokuphindaphindiwe nangokungathandi, okuvame ukubhekwa njengesahlukaniso. I-tics ebonakala ku-Tourette syndrome ihlukaniswa njengento elula futhi eyinkimbinkimbi; kuye ngenani lemisipha ehilelekile kanye nesikhathi sokuphindaphinda phakathi kokunyakaza ngakunye. Achazwa ngezansi:
- I-Los tics elula Zihlanganisa lokho kunyakaza okufushane nokungalindelekile, ukuthuthukiswa okuncike enanini elincane lemisipha. Zivame ukuziphindaphinda, kodwa ngokuhamba kwesikhathi eside.
- I-Los tics eziyinkimbinkimbi Yilokho ukunyakaza okuhlelekile lapho amaqembu amaningana emisipha engenela khona. Ngokufanayo, banemvelo ephindaphindayo nelandelanayo, okungukuthi, babulawa phakathi kwezikhathi ezimfushane kakhulu.
Lesi yisifo esingavamile. Nokho, umlando ubonisa ukuthi abantu abadumile abafana noNapoleon noMozart baphathwa yiso. Ikakhulukazi laba bamuva, emlandweni wabo ochazwa njengomuntu othambekele ekwenzeni ubuso obuningi, wadlala ngokweqile ngezandla zakhe nangezenzo ezingalindelekile.
Izimpawu ze-Tourette Syndrome
Ngokuphathelene nezimpawu zalesi syndrome, kubalulekile ukuchaza izinhlobo ezimbili ezihlukene zama-tic ezivelayo: izwi kanye motor, okungase kube lula noma kube nzima. Konke lokhu akwenzeki ngokuzithandela, futhi nakuba isiguli singase sicindezele izikhathi ezithile, nakanjani ziphinde zivele.
I-Vocal tics:
Okulula:
- Flash ngokuqhubekayo.
- Anikine ikhanda.
- Shrug.
- Ama-grimaces kanye nokuthinta kobuso.
Izingqinamba:
- Gxuma, thinta abantu noma izinto.
- Jikeleza.
- Ukuhogela.
- I-Echopraxia, ithikhi equkethe ukuphindaphinda okungahleliwe kokuthinta nokunyakaza komunye umuntu.
- I-Copropraxia, i-tic ebonakala ngokuthambekela kokwenza ukuthinta okudelelayo noma okuyichilo.
I-Motor tics:
Okulula:
- Ukukhwehlela.
- Uklebe.
- Phefulela phezulu ngamakhala akho.
- Vuthela.
- Chofoza ngolimi lwakho.
Izingqinamba:
- Ukuvezwa kwamagama noma imishwana ngaphandle komongo wengxoxo.
- I-Coprolalia, eyenzeka phakathi kuka-10% no-30% wezigameko, futhi iqukethe ukusetshenziswa kwemishwana noma amagama athathwa njengokungafaneleki ezimweni ezithile. Ngokuvamile kugcinwa phakathi nesigaba esisodwa sokuphila.
- I-Palilalia, equkethe ukuphindaphindwa kwemicabango yomuntu.
- I-Echolalia, equkethe ukuphindaphinda okuqhubekayo kwamagama noma imishwana esanda kuzwakala.
- Ngokuvamile, izimpawu ngokuvamile zivela phakathi kweminyaka engu-7 ne-10 ubudala. Phakathi kwezinto zokuqala ezizobonakala kukhona ezilula ezingeni lekhanda nobuso, njengokucwayiza, ukwenza ukuthinta kobuso okuphindaphindiwe nokunikina ikhanda. Kodwa-ke, kuvamile ukuthi i-syndrome ivele ngokuzumayo, futhi umuntu abonise izimpawu eziningana zemoto nezwi.
- Kubalulekile ukugqamisa ukuthi mayelana ne-motor tics eyinkimbinkimbi, i-coprolalia, i-echolalia ne-palilalia imelela izimpawu ezimele kakhulu ze-syndrome. Ngaphezu kwalokho, yizona ezenza ukuhlanganiswa kwesiguli ezindaweni ezihlukahlukene zomphakathi kube nzima kakhulu, njengoba lezi zindlela zokuziphatha azijabulisi noma zicasula abantu abaningi.
I-Comorbidity
I-Tourette syndrome iveza izinga eliphezulu lokugula; okungukuthi, ukuhlangana kwayo namanye ama-pathologies angahlobene. Eqinisweni, iziguli ezinalesi sifo zingase zibe khona kanyekanye ukuphazamiseka okucindezelayo ngokweqile (60% wamacala), ukuphazamiseka kokunaka, noma ngaphandle kokusebenza ngokweqile (ama-50% wamacala), ngokuhambisana ne iziyaluyalu zokufunda, ngisho nokukhathazeka kanye namahlaya.
Izinkinga ze-Tourette syndrome
a) Izimbangela zofuzo:
Imbangela enkulu ye-TS ufuzo. Kukhona isakhi sofuzo esinamandla esidluliselwa ngamathuba angama-50%, ukusuka kubazali kuya enzalweni, okubangela ama-tics angabangela ukutholakala kwe-syndrome, noma ezinye izinkinga ezihlobene. Kodwa-ke, isiphetho siwukuthi amathuba okuyithuthukisa makhulu kulabo bantu abangamalungu emindeni osekuvele kukhona amacala.
b) Izimbangela ze-Neurological:
Njengamanje, kuye kwaphakanyiswa ukuthi Izinkinga ze-Tourette syndrome Basuka ekungasebenzi kahle kwe-basal ganglia ebuchosheni; Lezi yizindlela ezibhekele ukulawulwa kwezimoto. Ngaphezu kwalokho, kubangwa futhi izinguquko ezinhlelweni i-dopaminergic, i-serotonergic ne-adrenergic.
c) Ubulili:
Kuyi-syndrome enezinga eliphezulu kwabesilisa kunakwabesifazane. Ngakho, amathuba okuba umfana abe ne-TS makhulu ngokuphindwe kane kunelowesifazane womkhaya ofanayo.
d) Ezinye izifo:
Okokuqala, kunezimo lapho lesi sifo siqala khona kanyekanye ne-cortical-striatal-pallidal-thalamo-cortical disorder, okubangelwa isilonda sokuzivikela komzimba ku-putamen. Kulokhu, lokhu kulimala kungase kube ufuzo. Okwesibili, kungenzeka ukuthi ithuthuke ngenxa ye-autoimmune disorder ngenxa ye-pharyngitis ebangelwa amagciwane afana neqembu A beta-hemolytic streptococci.
Ukuxilongwa kwe-Tourette syndrome
Ukuxilongwa kwe-Tourette syndrome kusekelwe ngokuyinhloko ekuqapheliseni ngokucophelela ukuziphatha komuntu othintekayo; Ngokuhambisana nophenyo ngomlando wabo, kuthatha ukucabangela iminyaka lapho ama-tics aqala ukubonakalisa.
Izindlela eziyinhloko zokuxilongwa kwalesi sifo yilezi:
- Ukubonakaliswa kwama-motor tics ahlukahlukene, namanye ama-Vocal tics.
- Ukuqala kwezimpawu eminyakeni yobudala engaphansi kwengama-20.
- Isiguli kufanele sethule i-motor ne-vocal tics yeqiniso, okufanele ihlukaniswe nokunye ukunyakaza okungavamile, njenge i-dystonia, i-chorea, i-ballismus, i-athetosis, i-hemifacial spasm, i-myokymias noma i-myoclonus. Ama-tic ukunyakaza okuzumayo nokuphindaphindayo, kuyilapho lezi ezinye zisuka kwesinye isitho ziye kwenye, ngesivinini esikhulu kodwa hhayi ngokuphindaphindiwe. Okuhlukile lapha i-hemifacial spasms, ephindaphindayo, kodwa ku-Tourette syndrome grimaces awenzi.
- Ukuqina, imvamisa kanye nesimo se-tics kuye kwahluka phakathi nokuphila kwesiguli.
- Ama-tic akufanele abe nomsuka wawo ekuphathweni kwemithi, kanye nokunye ukuphazamiseka okufanayo.
Kubalulekile ukuqaphela ukuthi lesi simo asikwazi ukutholakala ngokuhlolwa kwegazi noma ezinye izifundo zaselabhorethri. Nokho, ngenxa yohlobo lwezimpawu ezivezwayo, uchwepheshe angase asikisele izifundo ze-neurological; Lokhu kungase kuhlanganise i-electroencephalogram noma i-MRI, ukuze kugwenywe ezinye iziyaluyalu ezinjengokungasebenzi kahle, ukuphazamiseka okuphoqelekile, noma ukuphazamiseka kokunaka.
Uma lezi ezinye izifo sezikhishiwe ngokuhlolwa nokutadisha ngokucophelela izimpawu, siqhubeka nokukhipha iziyaluyalu ezihlobene kakhulu nama-tics. Iziguli ezihlakulela i-vocal noma i-motor tics unyaka wonke zitholakala ukuthi zine-neural tic disorder. Kodwa-ke, uma ubude bawo budlula unyaka owodwa, khona-ke ukuxilongwa kungase kube i-Tourette syndrome noma isifo esingelapheki se-tic.
Ukwelashwa kwe-Tourette syndrome
Ukwelashwa kwe-TS kusekelwe ekusetshenzisweni kwezidakamizwa ezihlukahlukene ezizosiza ukuvimbela izimpawu ezivelele kakhulu.
Kunemithi ehlukene esetshenziswa ekwelapheni i-Tourette syndrome. Kodwa-ke, akukabikho umbandela othize osuselwe ekutheni ungawabeka kuphi, ngaphezu kokuhambisana nezinye izifo. Izinhlanganisela ezivame kakhulu ama-antipsychotics, ama-alpha-2 autoreceptor blockers, ama-cyclic antidepressants kanye/noma ama-benzoadiazepines.
ama-antipsychotics
Ngokuvamile, iqembu lama-antipsychotics anconywa kakhulu yilawa: I-olanzapine, i-risperidone, i-ziprasidone, i-haloperidol ne-pimozide. Ekuphathweni kwayo, imvamisa iqalwa ngemithamo emincane, ezobese yenyuswa kancane kancane kuze kufinyelelwe imithamo ephezulu noma imithamo esebenzayo emaphakathi.
Ama-Antipsychotics asetshenziswa kakhulu ukwelashwa kwalesi sifo, njengoba bebonise ukuphumelela okukhulu ekwelapheni izimpawu, noma kunjalo, kunemiphumela emibi ehambisana nokuphatha kwabo. Eqinisweni, ukukhetha kwabo kuyinkimbinkimbi ngandlela-thile, njengoba kuhilela ukuhlola ukubekezelela kwesiguli ukunciphisa, ngangokunokwenzeka, imiphumela engemihle.
Isibonelo, ukwelashwa ngokuvamile kuqalwa nge-olanzapine ne-risperidone, enengozi ephansi yokubangela i-akathisia ne-tardive dyskinesia esigulini, kodwa futhi ingabangela ukuzuza kwesisindo, ingozi yesifo sikashukela, kanye ne-dysphoria nokucindezeleka , esimweni esikhethekile ukusetshenziswa kwe-risperidone.
I-Alpha-2 autoreceptor blockers
Kuleli qembu kukhona i-guanfacine ne-clonidine, eyokugcina okuyiyona esetshenziswa kakhulu. I-Clonidine, uma kuqhathaniswa nama-antipsychotics, inempendulo encane kakhulu engabonakala ngisho nezinyanga ngemva kokuqala ukuphathwa kwayo. Yingakho imithamo yayo ivame ukukhuphuka kancane kancane; Kodwa-ke, lokhu kwenziwa ngokumisa kusukela ekuqaleni, ukuze kuqinisekiswe imiphumela yayo, futhi uma sebezinzile, qhubeka nokwelashwa ngomthamo ophezulu, uphinda le ndlela. Umthamo ojwayelekile uhlanganisa i-0,5 mg.
I-Tricyclic antidepressant
Ngokuqondene nama-antidepressants we-cyclic, i-desipramine isetshenziswa, inconywa kakhulu ezigulini ezikhulile, kodwa hhayi ezinganeni, ngoba kubo iphumela ku-cardiotoxicity. Imithamo yayo iqala ngo-25 mg, futhi inyuswa phakathi nezinsuku ize ifinyelele cishe ku-100 mg, okuyisilinganiso esimaphakathi. Kuleli qophelo ukunakwa okukhethekile kukhokhwa ekuziphendukeleni kwemvelo komuntu ngamunye.
I-Benzoadiazepine
I-benzodiazepine esetshenziselwa Ukwelashwa kwe-Tourette syndrome i-clonazepam, umthamo wayo wokuqala uvame ukuba ngu-0,5 mg. Lokhu kwanda phakathi nezinsuku, kuze kube yilapho imiphumela oyifunayo noma, ngokuphambene nalokho, imiphumela emibi ibonakala. Umthamo wayo ojwayelekile ngu-2 mg, kanti umkhawulo ngu-4 mg.
Sithemba ukuthi lesi sihloko mayelana nalesi syndrome sinemininingwane ngokwanele ukuze sishiye ngaphandle kokungabaza. Nokho, ukhululekile ukushiya noma yimiphi imibuzo, imibono noma ulwazi ebhokisini lokuphawula; Sizozama ukukuphendula ngokushesha okukhulu.