Treatment of Gilles de la Tourette's syndrome.

Gilles de la Tourette syndrome is a genetically determined disease that occurs in childhood and is characterized by motor tics, shouting, echolalia and coprolalia, which are violent in nature. There are familial cases of the disease in brothers, sisters, fathers, parents and close relatives of patients. Factors that increase the risk of Gilles de la Tourette syndrome include toxicosis, stress during pregnancy, use of anabolic steroids, drugs, alcohol, intrauterine hypoxia, prematurity, and birth trauma. Symptoms of Gilles de la Tourette syndrome. The first manifestations of Tourette's syndrome occur at the age of 5-6 years, when strange behavior appears in the child: grimacing, sticking out the tongue, frequent blinking, clapping of palms, involuntary spitting, sneezing. Subsequently, hyperkinesis spreads to the muscles of the trunk and lower extremities and becomes more complex (sudden movements of the arms, jumping, legs and sudden abdominal movements). The phenomena of echopraxy (repetition of other people's movements) and copropraxy (reproduction of offensive gestures) are also noted. Sometimes tics are dangerous (hitting the head, biting lips, pressing on the eyeballs, etc.) and, as a result, patients with Tourette syndrome can cause serious injury to themselves. Vocal tics are varied, as are motor ones. Simple vocal tics are manifested by the repetition of meaningless sounds and syllables, whistling, puffing, screaming, mooing, hissing. Sound phenomena accompanying the course of the syndrome also include echolalia (repetition of heard words), palilalia (multiple repetition of the same own word), coprolalia (shouting obscene, swear words). Patients with Tourette's syndrome note that before the onset of a tic, they feel increasing sensory phenomena (sensation of a foreign body in the throat, itching of the skin, pain in the eyes, etc.), forcing them to make a sound or perform one or another action. After the tic ends, the tension subsides. With Tourette's syndrome, the child's intellectual development does not suffer. Other disorders may include impulsivity, emotional lability, aggression, and obsessive-compulsive syndrome. Degrees of manifestation of Gilles de la Tourette's syndrome: 

• 1. (mild) degree - patients manage to control the manifestations of the disease well, so the external signs of Tourette's syndrome are not noticeable to others.
• 2. (moderately expressed) degree - hyperkinesis and vocal disturbances are noticeable to others, but the relative ability to self-control is preserved. There is no “bright” interval during the course of the disease.
• 3. (severe) degree – manifestations of Tourette’s syndrome are obvious to others and are practically uncontrollable.
• 4. (severe) degree – vocal and motor tics are predominantly complex, pronounced, and their control is impossible.

Gilles de la Tourette syndrome is more pronounced in adolescence and stops in older age. But in some patients they persist throughout life. Dynamics of the appearance of Gilles de la Tourette syndrome. The onset of symptoms of the disease occurs from top to bottom. First, tics of the eyelids and eyeballs appear, then sniffing, sneezing, then twitching of the mouth and facial muscles. After some time, twitching of the head, sound tics, twitching of the shoulders, movements of the abdomen, body and amplitude twitching of the upper and lower extremities occur. In addition to sweeping twitching of the limbs, sharp small-amplitude twitching of the arms and legs also occurs, reminiscent of convulsive twitching in the form of short serial discharges. Treatment of Gilles de la Tourette syndrome. Treatment of the syndrome is decided on an individual basis, based on the patient’s age and the severity of the disease.

 Treatment methods:

• 1. music therapy,
• 2. animal therapy.
• 3. acupuncture,
• 4. massage,
• 5. exercise therapy.
• 6. psychotropic drugs
• 7. psychotherapy 

But the main method of treating Gilles de la Tourette syndrome is psychotherapy. Pharmacological Therapy is indicated for severe manifestations of Gilles de la Tourette syndrome. Antipsychotics (haloperidol, pimozide, risperidone), benzodiazepines (phenazepam, diazepam, lorazepam), adrenergic agonists (clonidine) are used, but side effects are possible when taking them. Own experience in the treatment of Gilles de la Tourette syndrome. Based on my many years of experience, I can say with confidence that the most effective treatment was the combined use of hypnotherapy with small doses of haloperidol. With this combination, it was possible to completely eliminate all the symptoms of the disease and achieve many years of remission (practical recovery). I have developed a new method of psychotherapeutic treatment of Gilles de la Tourette syndrome; it can be called “mental therapy”. Its essence lies in deep mental concentration on the patient’s condition in order to transfer mental energy to the patient’s nervous system. The first use of this technique made it possible to relieve up to 80% of the symptoms of a severe form of the disease, in which not only tics were expressed, but also neurotic disorders and depression. I believe that the new technique has a great therapeutic future. But the use of this new method of treating Gilles de la Tourette syndrome requires the presence of special emotional-volitional qualities and other mental properties from a psychotherapist and many years of experience working with such patients.