Tourette Syndrome Treatments | CDC

Although there is no cure for Tourette Syndrome (TS), there are treatments to help manage the tics caused by TS. Many people with TS have tics that do not get in the way of their living their daily life and, therefore, do not need any treatment. However, medication and behavioral treatments like Comprehensive Behavioral Intervention for Tics (CBIT) are available if tics cause pain or injury; interfere with school, work, or social life; or cause stress. A recently developed behavioral treatment is the Comprehensive Behavioral Intervention for Tics (CBIT).

Educating the community (for example, peers, educators, and coworkers) about TS can increase understanding of the symptoms, reduce teasing, and decrease stress for people living with TS. People with TS cannot help having tics, and are not being disruptive on purpose. When others understand these facts, people with TS might receive more support, which might, in turn, help lessen some tic symptoms.

It is common for people with TS to have other conditions, particularly attention-deficit/hyperactivity disorder (ADHD), anxiety, and obsessive-compulsive disorder (OCD). People with additional conditions will require different treatments based on the symptoms. Sometimes treating these other conditions can help reduce tics. To develop the right treatment plan, people with tics, parents, and healthcare providers can work together and include teachers, childcare providers, coaches, therapists, and other family members. Taking advantage of all the resources available will help guide success.

Tool Kit for Families: Living with Tourette & Tic Disorders

Medications for Tourette Syndrome

Medications can be used to reduce severe or disruptive tics that might have led to problems in the past with family and friends, other students, or coworkers. Medications also can be used to reduce symptoms of related conditions, such as ADHD or OCD.

Medications do not eliminate tics completely. However, they can help some people with TS in their everyday life. There is no one medication that is best for all people. Most medications prescribed for TS have not been approved by the U.S. Food and Drug Administration (FDA) for treating tics.

Medications affect each person differently. One person might do well with one medication, but not another. When deciding the best treatment, a doctor might try different medications and doses, and it may take time to find the treatment plan that works best. The doctor will want to find the medication and dose that have the best results and the fewest side effects. Doctors often start with small doses and slowly increase as needed.

As with all medications, those used to treat tics can have side effects. Side effects can include weight gain, stiff muscles, tiredness, restlessness, and social withdrawal. The side effects need to be considered carefully when deciding whether or not to use any medication to treat tics. In some cases, the side effects can be worse than the tics.

Even though medications often are used to treat the symptoms of TS, they might not be helpful for everyone. Two common reasons for not using medications to treat TS are unpleasant side effects and failure of the medications to work as well as expected.

Learn more about medications »

Tool Kit for Care Providers: Managing Tourette & Tic Disorders

Behavioral Therapy for Tourette Syndrome

Behavioral therapy is a treatment that teaches people with TS ways to manage their tics. Behavioral therapy is not a cure for tics. However, it can help reduce the number of tics, the severity of tics, the impact of tics, or a combination of all of these. It is important to understand that even though behavioral therapies might help reduce the severity of tics, this does not mean that tics are just psychological or that anyone with tics should be able to control them.

Habit Reversal

Habit reversal is one of the most studied behavioral interventions for people with tics¹. It has two main parts: awareness training and competing response training. In the awareness training part, people identify each tic out loud. In the competing response part, people learn to do a new behavior that cannot happen at the same time as the tic. For example, if the person with TS has a tic that involves head rubbing, a new behavior might be for that person to place their hands on their knees, or to cross their arms so that the head rubbing cannot take place.

Comprehensive Behavioral Intervention for Tics (CBIT)

CBIT is an evidence-based type of behavioral therapy for TS and chronic tic disorders. CBIT includes habit reversal in addition to other strategies, including education about tics and relaxation techniques². CBIT has been shown to be effective at reducing tic symptoms and tic-related impairment among children and adults.

In CBIT, a therapist will work with a child (and their parents) or an adult with TS to better understand the types of tics the person is having and to understand the situations in which the tics are at their worst. Changes to the surroundings may be made, if possible, and the person with TS will also learn to do a new behavior instead of the tic (habit reversal). For example, if a child with TS often has a certain tic during math class, the math teacher can be educated about TS, and perhaps the child’s seat can be changed so that the tics are not as visible. In addition, the child also can work with a psychologist to learn habit reversal techniques. This helps to decrease how often the tic occurs by doing a new behavior (like putting their hands on their knees when an urge to perform the tic happens). CBIT skills can be learned with practice, with the help of an experienced therapist, and with the support and encouragement of those close to the person with TS.

In recent years, more health professionals have recognized that behavioral therapy can be very effective in managing the symptoms of TS. So far, few clinicians have been trained in these types of treatments specifically for TS and tic disorders. The CDC and The Tourette Association of America have been working to educate more health professionals in this approach to managing TS symptoms. Learn more about CBIT.

Diagnosing Tic Disorders | CDC

Tics are sudden twitches, movements, or sounds that people do repeatedly. People who have tics cannot stop their body from doing these things. For example, a person with a motor tic might keep blinking over and over, or a person with a vocal tic might make a grunting sound unwillingly.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5-TR)¹ is used by health professionals to help diagnose tic disorders.

Three tic disorders are included in the DSM-5-TR:

• Tourette syndrome (TS, sometimes called Tourette disorder)
• Persistent (sometimes called chronic) motor or vocal tic disorder
• Provisional tic disorder

The tic disorders differ from each other in terms of the type of tic present (motor or vocal, or a combination of both), and how long the symptoms have lasted. People with Tourette syndrome have both motor and vocal tics and have had tic symptoms for at least 1 year. People with persistent motor or vocal tic disorders have either motor or vocal tics and have had tic symptoms for at least 1 year. People with provisional tic disorders can have motor or vocal tics, or both, but have had their symptoms less than 1 year.

Here are the criteria in shortened form. Please note that they are presented for your information only and should not be used for self-diagnosis. If you are concerned about any of the symptoms listed, you should consult a trained healthcare provider with experience in diagnosing and treating tic disorders.

Tourette Syndrome

To be diagnosed with TS, a person must

• have two or more motor tics (for example, blinking or shrugging the shoulders) and at least one vocal tic (for example, humming, clearing the throat, or yelling out a word or phrase), although they might not always happen at the same time.
• have had tics for at least a year. The tics can occur many times a day (usually in bouts) nearly every day, or off and on.
• have tics that begin before age 18 years.
• have symptoms that are not due to taking medicine or other drugs or due to having another medical condition (for example, seizures, Huntington disease, or postviral encephalitis).

Persistent (Chronic) Motor or Vocal Tic Disorder

To be diagnosed with a persistent tic disorder, a person must

• have one or more motor tics (for example, blinking or shrugging the shoulders) or vocal tics (for example, humming, clearing the throat, or yelling out a word or phrase), but not both.
• have tics that occur many times a day nearly every day or on and off throughout a period of more than a year.
• have tics that start before age 18 years.
• have symptoms that are not due to taking medicine or other drugs, or due to having a medical condition that can cause tics (for example, seizures, Huntington disease, or postviral encephalitis).
• not have been diagnosed with TS.

Provisional Tic Disorder

To be diagnosed with a provisional tic disorder, a person must

• have one or more motor tics (for example, blinking or shrugging the shoulders) or vocal tics (for example, humming, clearing the throat, or yelling out a word or phrase).
• have been present for no longer than 12 months in a row.
• have tics that start before age 18 years.
• have symptoms that are not due to taking medicine or other drugs, or due to having a medical condition that can cause tics (for example, Huntington disease or postviral encephalitis).
• not have been diagnosed with TS or persistent motor or vocal tic disorder.

In some children, tics may suddenly appear, or suddenly become worse, following a streptococcal (strep) infection, such as strep throat or scarlet fever. For more information, please visit the National Institute of Mental Health’s information on Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.

Sudden Onset of Tic-Like Behaviors

Sometimes people have tic-like behaviors that look like tics, but that are distinctly different from those typically seen in Tourette syndrome and other tic disorders. The people who develop these tic-like behaviors are often experiencing movement symptoms for the first time, with no reported history of tics. These types of tic-like behaviors are more common among teenagers and more often seen in girls than boys. Sometimes these tics can happen in groups of children. Many experts believe these sudden onset tic-like behaviors can happen for different reasons, and tic-like behaviors may need different treatment compared to tic disorders including Tourette syndrome. The best first step is usually to talk to a healthcare provider who is familiar with tics and get a thorough assessment. Read more about tic-like behaviors.

What to Do When Your Child is Diagnosed with Tourette Syndrome

Taking an active role, learning about TS, and understanding treatment and ways to manage symptoms can help you make the best possible choices for your child and for your family.

• Talk to a healthcare provider about any questions or concerns.
• Learn as much as you can about TS. You can start by reading our pages on the following topics:
  • Facts
  • Treatments
  • Other Concerns & Conditions
• Ask your provider about concerns and symptoms beyond tics. Most children with TS also have been diagnosed with at least one additional mental, behavioral, or developmental condition and these conditions often add to stress and difficulty in managing health care. Many children with TS also experience learning difficulties. Getting proper treatment and coordinated care is very important.
• Visit the website of the Tourette Association of America to find information, resources, newsletters, videos, and more. In addition, the Tourette Association can be helpful with finding local healthcare providers.

Finding Support

Parenting is often challenging and parenting a child with a chronic condition like TS can add additional stress to the day-to-day challenges. If you are the parent of a child with TS, it might be helpful to talk with other parents who have a child with the same condition, to share concerns and information. Similarly, if you are an adult with TS, talking to other adults with TS might be helpful.

Remember that the choices for another family might not be best for your family, so it’s important to understand all options and discuss them with your healthcare providers.

• Your local Tourette Association chapter can help you connect with other families through conferences, support groups and other events.
• Parent-to-Parent Programs provide information and emotional support to families of children who have special needs.

For More Information

• Tourette Association of America
• American Academy of Child and Adolescent Psychiatry: Facts for Families – Tic Disorders
• Academy of Child and Adolescent Psychiatry (AACAP) – Practice Parameter
• American Academy of Neurology – Practice Guideline Recommendations

Reference

1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision. Washington, DC: American Psychiatric Association, 2022.

Treatment of tonsillitis | TC Clinic – Krasnodar

TONSILLITIS is an infectious disease, which is expressed in inflammation of the palatine tonsils. The disease is acute and chronic.

The source of infection is a sick person. The disease is transmitted by airborne droplets. Tonsillitis can be caused by various infections, for example, staphylococci, streptococci, pneumococci, Haemophilus influenzae, Moraxella, adenoviruses and others.

Effective treatment of tonsillitis using the TONSILLOR 9 device0009

• helps to quickly cope with an aggravation
• Significantly reduces the number of relapses
• eliminates the symptoms of tonsillogenic intoxication and cervical lymphadenitis
• in the complex treatment of chronic tonsillitis using the Tonsillor device allows achieving stable remission in most patients for a long time!

Symptoms of tonsillitis

• Sore throat, reddening of tonsils
• Cervical lymph nodes may enlarge
• Fever, chills
• Extreme fatigue
• A white-gray coating forms on the tongue, a putrid odor from the mouth appears

The most characteristic symptom is sore throat and high temperature (up to 40-41 C). If you or your loved ones have similar symptoms, do not delay a visit to the doctor, tonsillitis is dangerous with complications.

Chronic tonsillitis leads the list of diseases of the pharynx according to research on people’s appeals. Do you know what this disease is?
Chronic tonsillitis is a long-term inflammation of the pharyngeal, palatine tonsils. It develops after suffering a sore throat, as well as other infectious diseases, accompanied by inflammation of the mucous membrane of the pharynx or without a previous acute illness. It is characterized by inflammation, hypertrophy of the palatine tonsils due to frequent tonsillitis and other acute infectious diseases in the oral cavity. The disease occurs in adults and children.
Do not confuse the chronic and acute form, called angina. Acute tonsillitis occurs instantly, its development is most often caused by group A streptococci and a whole bunch of viruses from the ARVI group. However, a sore throat can easily develop into a chronic form, which will later say “thank you” and will, in turn, provoke the appearance of a sore throat.

When is it worth considering that this is no longer a simple sore throat?

In addition to redness and sore throat, chronic tonsillitis has the following symptoms:

• enlarged regional lymph nodes;
• increased fatigue;
• elevated temperature for many months, which indicates the progression of the inflammatory process, which wears out the body;
• prolonged recovery from common respiratory diseases and increased risk of developing infectious complications.

Note to parents and not only.

The disease is very dangerous with complications: possible manifestation of disorders in the heart, liver, kidneys, joints. May develop: acquired heart disease, infectious arthritis and rheumatism.

Why do we need tonsils?

Tonsils is an accumulation of lymphoid tissue in the nasopharynx and oral cavity. By the way, the tonsils are just a small part of the lymphoid tissue, which is distributed throughout the body.
Tonsils are organs of the human immune system and, accordingly, they perform a protective function. The second, no less important task of lymphoid cells is hematopoietic. They supply lymphocytes to the blood stream and control their content in the required amount.

The question arises, why is surgical treatment prescribed for diseases – removal of the tonsils (tonsillectomy)?
The thing is that the palatine tonsils are involved in the fight against infections, but do not play a significant role and the benefits of surgical treatment will be significant. Do not worry that a person will get sick more often: the immune system will not suffer.

: diagnosis and treatment at the TC Clinic

Diseases of the gastrointestinal tract are one of the most common groups of diseases in the modern world, every person would encounter once in a lifetime.

Peptic ulcer of the stomach and duodenum is a chronic disease that is replaced by periods of remissions and exacerbations. This is a recurrent disease, which is manifested by the formation of an ulcerative defect of the gastric mucosa.

The disease greatly impairs the quality of life due to the symptoms that accompany the disease. Peptic ulcers of the stomach and duodenum can affect people of all ages.

Symptoms of gastric ulcer of the duodenum are very diverse, often, before the appearance of complications, they are completely absent. The main symptoms that accompany the disease:

• Pain that exhausts a person. In most cases, painful sensations appear in the upper abdomen, which intensifies when a person feels hungry. The pain is aching. If severe pain appears, this indicates the onset of serious complications.
• Decreased appetite
• There is frequent heartburn and belching
• Sometimes sickness may be accompanied by nausea and vomiting
• In some patients accompanied, in others, by diarrhea
• The disease is very exhausting for patients, there is a strong permanent fatigue

No generally accepted classification of peptic ulcer is shared. But still, it must be borne in mind that peptic ulcer can be:

Caused by the presence of H. pylor infection or develop without it

• Peptic ulcer can be an independent disease or symptomatic (when PU develops under the influence of stress, after injury, with diseases of the endocrine system, PU can develop with improper use of drugs, for example, non-steroidal anti-inflammatory drugs)
• Ulcers may be single or multiple

Causes of gastric and duodenal ulcers

1. Certain medications

One of the main reasons for the development of ulcers is the presence of infection with Helicobacter pylori (Helicobacter pylori) and the use of medications that can contribute to the development of ulcers. Such drugs are called ulcerogenic. If you neglect the dosage prescribed by your doctor, or even prescribe treatment on your own, you should understand that ulcers do not have any symptoms for a long time and may first manifest themselves as gastric bleeding and / or perforation of the ulcer. The most dangerous drugs with long-term use that can lead to the development of zav are non-steroidal anti-inflammatory drugs (NSAIDs). As far as you know, they are prescribed as antipyretic, anti-inflammatory and pain relievers. The biggest problem when taking this group of drugs is those cases when they cannot be canceled (for example, in rheumatological diseases, traumatology and a number of other areas of medicine).

Be careful! Do not exceed the dosage and do not violate the regimen! It’s dangerous to health!

2. If you suffer from gastritis or duodenitis – these pathologies can also provoke the development of peptic ulcer
3. Prolonged stress, emotional exhaustion: if you are in a state of stress for a long time, you are very worried – this also contributes to the development of PU
4. You regularly eat malnutrition, drink alcohol and smoke – you are at risk of being among patients with PU
5. Have a genetic predisposition – if your relatives have a history of PU, you also need to carefully monitor your health, undergo examinations and, if even the most minor symptoms appear, consult a gastroenterologist.

What is important for the patient to know

The most important thing that you should do when you have a diagnosis of PU is to strictly follow the recommendations of your doctor and monitor nutrition. Do not eat spicy, too hot or, conversely, too cold food. Exclude pickled, salty, smoked foods. Try to drink tea and coffee as little as possible, fatty broths are also not for you. It is necessary to exclude alcohol and smoking.

What examinations can be prescribed by a doctor in case of suspected ulcer

1. If such a diagnosis is suspected, the doctor may prescribe a gastroscopy (FEGDS) – this is an endoscopic examination that allows you to examine the condition of the mucosa in detail, determine the presence of an ulcer, while accurately determining the location of the ulcer , its depth and other parameters. During the study, the doctor may take a small affected fragment in order to exclude the development of cancer.
2. You may have an X-ray (sometimes a CT scan) of your abdomen.
3. Test for H. pylor infection
4. General analysis and biochemical analysis of blood
5. Additional studies to clarify the diagnosis.

Treatment of peptic ulcer of the stomach and duodenum

Treatment of PU can only be prescribed by a doctor after diagnosis. Depending on the condition, stage of the disease, etiology, medical and / or surgical treatment can be carried out. Your doctor will give you a nutrition plan and lifestyle recommendations. It depends on how soon you feel better and the effectiveness of treatment. Surgery for PU is prescribed when complications develop and when drug treatment is not effective.

Complications of peptic ulcer of the stomach and duodenum: when to see a doctor urgently

1. Bleeding . Such a complication can develop very quickly, the patient’s condition deteriorates sharply. The presence of blood may be in vomit or feces. The condition may be accompanied by severe pain, weakness, shortness of breath, pressure drops sharply, dizziness appears, a person may lose consciousness.