This condition is also known as progressive spasm disorder, tic-coprolalia syndrome, or multiple tic disorder. It is more common in boys and typically occurs between the ages of 2 and 12. The disease cause is not yet fully understood, and sometimes there are similar cases within the same family. Pathophysiological generation and transformation studies suggest that the disorder is caused by abnormal membrane receptor function in the target cells of dopaminergic neurons in the basal ganglia of the brain, but the specific pathological changes in the brain remain unclear.

bubble_chart Diagnosis

(1) Clinical Features Tics in children are involuntary, sudden, rapid, recurrent, non-rhythmic, and stereotyped movements or vocalizations. Tics can generally be classified into simple motor tics and complex motor tics. The former includes actions such as blinking, raising eyebrows, opening the mouth, puckering lips, baring teeth, extending the neck, turning the head, shrugging shoulders, and other similar movements. The latter involves more elaborate actions like repeatedly and rapidly shaking hands, hitting oneself in certain areas, jumping, touching, or bringing hands or objects to the nose to mimic smelling. Vocalizations can also be divided into simple vocal tics and complex vocal tics. Simple vocal tics include monotonous, short sounds such as "ah," "oh," "shh," or "tsk," as well as throat-clearing or sniffing noises. Complex vocal tics involve the inappropriate repetition of certain words or phrases, mimicking others' speech or the last few words of a sentence, or repeatedly uttering offensive language (coprolalia). Initially, the condition often manifests as abnormal facial movements, with one or multiple actions occurring simultaneously or alternating. Over time, it may progress to involve the neck, shoulders, or other parts of the body. The location, number, frequency, complexity, or severity of tics can vary over time. Although tics occur involuntarily, they can be consciously suppressed for short periods. The frequency of these abnormal movements varies daily, often occurring frequently but not interfering with normal daily activities—for example, shrugging or shaking arms does not cause the child to drop objects, nor does kicking movements lead to falls. The abnormal movements disappear during sleep. This condition does not affect intellectual development. (2) Laboratory Findings Most laboratory tests show no specific abnormalities. Electroencephalograms (EEGs) may reveal nonspecific slow waves, and approximately 10% of affected children exhibit central spikes, though without clinical epileptic seizures.

﹝Treatment﹞

(1) Psychotherapy Reduce psychological burden; excessive tension and anxiety from parents and the child are detrimental to recovery. People around should care for and love the child, and avoid scolding or reprimanding the child due to tics. Maintain a regular lifestyle and a cheerful mood. (2) Drug Therapy

1. Haloperidol Start with a small dose, 0.5mg each time, twice a day, and gradually increase the dosage. The maximum daily dose should not exceed 4mg. Side effects of Haloperidol may include catatonic states and dystonia. Reduce the dose or discontinue use if side effects occur. To avoid side effects, an equivalent dose of Artane can be taken. 2. Tiapride 50mg each time, twice a day, gradually increasing to 300–400mg per day. Side effects may include drowsiness.

bubble_chart Differentiation

This disease needs to be differentiated from the following conditions: (1) Habitual spasm often involves only one group of muscles, such as blinking, wrinkling the nose, or coughing sounds. There are often certain triggers before onset, such as conjunctivitis, and the blinking action may persist even after the conjunctivitis has healed. This condition is generally mild and short in duration. However, there is no strict boundary between this condition and multiple tics, and some children may develop multiple tics. (2) Wind-dampness chorea often manifests as various abnormal movements of the face and limbs. These movements are irregular in form and interfere with normal daily life. For example, abnormal hand movements may affect writing, and involuntary movements of the lower limbs may cause falls. The abnormal movements of wind-dampness chorea rarely persist for more than 2 months. Additionally, there is other evidence of Bi disease. (3) Hepatolenticular degeneration (Wilson’s disease) presents with abnormal movements due to extrapyramidal system involvement. Common manifestations include dystonia, dysarthria, and abnormal posture and gait. Slit-lamp examination of the eyes may reveal K-F rings at the corneal margin. The plasma ceruloplasmin concentration is reduced.