It is a primary central nervous system extrapyramidal disease characterized mainly by multiple muscle tics and obscene language. The cause of the disease is unknown and may be related to neurotransmitter abnormalities.

bubble_chart Clinical Manifestations

1. Muscle twitching. Sudden involuntary rapid muscle twitches that affect different parts of the body, resulting in various types of movements, such as blinking, lip-licking, facial grimacing, neck-twisting, shoulder-shrugging, arm-throwing, leg-kicking, hiccuping, explosive vocalizations resembling throat-clearing or coughing, etc. Initially, it often involves one or two facial movements, but as the condition progresses, new movements may be added or replace the original ones. Involuntary twitching worsens with tension and excitement, improves when attention is diverted, and can be briefly controlled voluntarily, disappearing during sleep.
2. Coprolalia. Some patients develop obscene speech, repetitive speech, or echolalia during the course of the disease, with a minority exhibiting obscene behaviors, imitative movements, and socially inappropriate compulsive behaviors.
3. Neurological examinations may sometimes reveal mild positive signs.

bubble_chart Auxiliary Examination

The EEG may show grade I abnormalities.

bubble_chart Diagnosis

Medical history: Onset in childhood (ages 2-15), with slow progression and development, often persisting lifelong but with fluctuations.

Excludes minimal brain dysfunction, chorea minor, etc.

bubble_chart Treatment Measures

1. Haloperidol: Start with 0.25mg/day, increase by 0.25mg every 5 days until symptoms are relieved and side effects are tolerable. The usual dose range is 1.5–10mg/day, with an average of 5mg/day. Taking Artane concurrently can alleviate its side effects.
2. Tiapride: Start with 50mg twice daily, gradually increase to 150–300mg/day. After symptoms are controlled for 2–3 months, gradually reduce to a maintenance dose of 50–150mg/day. With minimal side effects, it can be the first-choice medication.
3. Pimozide: Start with 2mg/day, gradually increase to reach the therapeutic dose within 2 weeks. The dose range is 4–60mg/day, with an average of 8mg/day. Due to its relatively mild side effects, it is suitable for long-term use.
4. Others: Alternatives include clonidine, trifluoperazine, penfluridol, clomipramine, and tetrahydropalmatine.
5. In addition to medication, psychotherapy may also have some effect.