Patient's question:
I have a son, who is now 13 years and 9 months old and is in the first year of junior high school. Between the ages of 7-10, I noticed that he likes to touch things around him while eating. Between the ages of 11-13, I noticed that he often nods unconsciously. Since November of this year, I have observed that he frequently twists his neck unconsciously, as if aligning his gaze left and right. His academic performance is poor, and he has a short temper. When he was young, my wife and I often argued, and we even went through a brief divorce. When he was 6.5 years old, my wife and I got remarried. I would like to know:1. Is the current condition caused by the family environment?
2. Can this condition be cured?
3. Is there a specific medication for treating this condition?
First follow-up question: (2007-12-13 13:)
Doctor's answer:
I have a son, who is about to turn 14, and he has been experiencing involuntary head twisting for nearly a month. The doctor said it's tics. For this, I've been scratching my head, seeking medical help everywhere, reading various web pages, and looking into descriptions and treatment plans for tics, but I have a vague idea similar to the author's in the following text, that is, treating tics requires wise parents to comprehensively address psychological nutrition, lifestyle, educational methods, and the environment, rather than blindly believing in various online advertisements for Chinese herbal medicines that claim miraculous effects without any scientific validation (unfortunately, after my extensive research, I haven't found a single Chinese herbal medicine with an official approval number for treating tics!). Nor should we easily resort to Western medicine with certain side effects. The best doctors for treating tics are wise parents. I will firmly believe in my and share my pain and hope, as well as the process and results of my efforts. My contact information: samsoo@163.com. Everyone is welcome to communicate with me.---------------------------------------------------------------------
Wise Parents Self-Treat Tics
Source: http://rxdao.blog.shagdu.com/Log/ShowLog.aspx?LogId58540
Dear Anxious Parents and Parents-to-Be:
Hello!
Thank you very much for your trust in me. My son was preliminarily diagnosed with multiple tics on the evening of December 27, 2006. After visiting four places, going to four hospitals, and seeing six doctors, my husband and I decided not to use medication or acupuncture and to treat our son with physical therapy. By the end of January this year, my son's symptoms quickly improved and soon disappeared. I am not a professional doctor, but I don't know if my son's condition is representative. However, during this period of treatment, I found that many hospitals have been advertising the "cure" for tics, and some mainstream media have also been promoting related content. At the same time, the course of many tic patients has been prolonged, and their tics have worsened. This situation has led to some reflections. The following are my experiences and feelings, hoping to be helpful to everyone.
I. My Son's Situation
My son was born in October 2001. During the summer vacation last year, when he went back to the north with his grandma and grandpa, he developed a symptom of nose rubbing. His grandma said it might be because he watched too much of the TV series "Journey to the West." We didn't pay much attention to it at the time, reminding him to endure it. Later, we found that it didn't get better, so we took him to the hospital. The examination revealed erosion in his nasal cavity, and he was diagnosed with allergic rhinitis (apparently a hereditary disease in my husband's family). Oral medication and ointment were prescribed, and his symptoms improved significantly and soon disappeared. In November, possibly due to the dry weather or other causes, he developed the symptom of nose rubbing again. The hospital examination results were still allergic rhinitis, and the same medication was prescribed, but it was ineffective. Later, we gave up on it. In mid-December, my son's kindergarten held a charity sale together with the United Nations Children's Fund in a large shopping mall. My son and other children performed on stage. My husband was present and noticed that his nose rubbing had worsened.
On the evening of December 27, my grandma said, "You see, his hand is always scratching." Since there were no symptoms at the time, I said it was nothing. That evening, my son invited a friend to play at our house, and the two of them had a fierce argument. I severely scolded him and demanded an apology. When it was almost 9 o'clock, I asked him to drink a cup of milk on the table, and I found that his hand holding the cup was shaking uncontrollably. I immediately held his hand and noticed a very strong twitch. I asked if he was nervous, and he said no, he just wanted to move. I quickly called a taxi to the hospital. We first went to the Maternal and Child Health Hospital, where the nurse said the neurologist had already gone off duty, but there might be a night shift at the Children's Hospital. We then went to the Children's Hospital and found a doctor on duty. After giving my son a series of examinations, he said to go home and wait for two days. If he recovered after a good night's sleep, it would be a temporary condition. If not, we would need to check an electroencephalogram and CT. I asked what disease he suspected, and he said it was tics.
The next day, my son showed no improvement, and we took him to the Children's Hospital again. Another doctor gave him a 12-hour electroencephalogram monitoring order. My husband has a sister who is a Ph.D. student at Peking University Medical College. While waiting, my husband called her and suggested going to Peking University First Hospital, as the pediatric neurology department there is world-leading, according to my husband, if it's not treated well there, it's no use going to the United States.
On the evening of December 30, we went to the Children's Hospital for the electroencephalogram, and on the morning of December 31, we were discharged. The doctor worked overtime to give us the report the same day, with the conclusion being "abnormal, non-epileptic event." On January 2, we flew to Beijing, and on January 4, we found an expert to see the doctor. Since my son's symptoms basically disappeared as soon as he arrived in Beijing, the doctor couldn't see much and asked us to go back and record his symptoms when they appeared and send them to her for diagnosis.
On January 6, we returned home, and my son's tics reappeared. The nose rubbing disappeared, but he developed symmetrical hand and foot tics, shoulder shrugging, eye blinking, and later, lip pursing. He was better during the day but worsened at night, especially before bedtime when storytelling. It was almost unbearable. The child himself also knew, and each time he used a blanket to cover his whole body, leaving only his head exposed, and said to us, "Tell a story."
We were frantic and secretly recorded his symptoms and sent them to Beijing. While waiting, we took the video to a local Peking University hospital to consult about ECT, but after consulting my husband's sister, we didn't do it. We then went back to the Children's Hospital and got a special consultation appointment. The pediatric neurology director of the hospital saw the video and said it could be diagnosed as multiple tics.
Here's what he said about the disease: If there is no obvious family history, this disease is generally caused by a gene mutation. But it's a good gene mutation, and tic patients are generally quite intelligent, sensitive, and prone to impulsive behavior due to external pressure, which means the current living environment is not suitable for their development. The most fundamental treatment for this disease lies in regulating the environment, and medication is optional. For example, some children have severe tics at home, and if it's unbearable, they might be hospitalized. However, after a week in the hospital, there was no twitching, and after returning home, it recurred. This shows that the disease is related to the environment. Therefore, the most important thing is to regulate the environment. If it's regulated well, it will improve quickly; if not, it might last a long time. He repeatedly emphasized that the family environment must be relaxed, and parents must not take the disease seriously. They should live as normal as possible, especially never asking the child to control the tics. It's correct to show the doctor the video of the child, but don't take the child to the hospital all the time.
The second day of seeing the doctor in Beijing, the diagnosis came out again, confirming multiple tics, and saying it was time to start medication, with Tiapride for a year.
After thorough discussion with my husband, we decided to follow the advice of the pediatric neurology director and try physical regulation without medication, starting with adjusting the adults' emotions and then influencing the child. After a month, my son's symptoms gradually improved from persistent to significantly reduced to completely disappeared. During the May holiday, his symptoms reappeared for the second time (different from the original symptoms), but we still followed this approach, and by mid-August, the symptoms disappeared.
II. Knowledge About Tics and My Experiences
Since my son was diagnosed with multiple tics, I have searched for relevant information online and in bookstores, and have had multiple exchanges with neurologists and other parents of tic patients. Here is a summary:
1. Knowledge of Multiple Tics in the Medical Community
(1) Western Medicine
There is a very good book I recommend everyone to read: "Developmental and Behavioral Pediatrics," written by an American doctor. According to the book, the cause of multiple tics is very likely related to the metabolism of dopamine in the brain. Clinically, it is mainly divided into two types: one is transient tics, generally occurring in children aged 4-7, with symptoms that change frequently and often shift, with a course generally not shorter than 2 weeks but not exceeding 1 year. It doesn't require treatment, and most children can recover within a year, with the rest possibly recovering during adolescence. The other is chronic tics, which often occur in adolescence, with facial tics as the main symptom, with a course exceeding 1 year. It doesn't require treatment, and some children can recover during adolescence, some can significantly improve, and some can persist for life.
To put it simply, the most authoritative Western treatment plan for tics currently internationally is: no treatment (or is there no treatment?). Western medications like Tiapride and Haloperidol can only control symptoms for a period of time and cannot cure the disease.
(2) Traditional Chinese Medicine
According to my understanding, traditional Chinese medical literature has no record of multiple tics, let alone treatment plans. In recent years, many hospitals have started treating it as if it were epilepsy. From the perspective of treatment effects, it can be applied to what a certain expert said online last year, and so far, no drug has been reported to cure this disease.
2. My Personal Experiences with This Disease
From my observation of my son's condition and communication with other parents, I personally feel (this is purely my personal opinion), multiple tics may not be a disease at all; it's very likely a normal developmental process for a certain type of child, or as my husband's sister said, it can only be considered a symptom, not a disease. If it must be called a disease or abnormal, I personally feel that the factors or causes of its occurrence are: physical conditions + parenting style + external stimuli.
(1) Characteristics of Tic Patients
After collecting information for this period, I found that there are some remarkable similarities in physical conditions among tic patients, including:
-- Most are considered attractive, intelligent, and sensitive, with a significant proportion being introverted and perfectionistic children;
-- Most children have poorer coordination than their peers, especially in hands, feet, and eyes, such as playing ball or jumping rope;
-- Poor sleep, some have difficulty falling asleep, some have poor sleep quality, and some resist napping in the afternoon;
-- Dietary preferences for meat, and some children eat a lot of fast food and processed foods from stores (containing a lot of preservatives and additives).
Compare your child to see if they have the above characteristics?
The occurrence of symptoms must be based on physical conditions. Or, as that doctor said, it's a gene mutation.
(2) Parenting Style
Related to the above physical conditions, families unconsciously exacerbate these characteristics in the education process, such as eating more meat if they are willing, not playing ball if they don't like it, not sleeping if they don't sleep, and so on, gradually accumulating until one day, it erupts in the form of multiple tics.
(3) External Stimuli
Many children are clearly exposed to external stimuli before the onset of the disease, including viral infections and other diseases (such as my son's allergic rhinitis), severe criticism and fright (many parents recall having severely scolded their children before the onset), overwork, and prolonged TV watching.
III. Current Treatment Effects of This Disease
From the feedback information of various parents, I personally feel that the effects of Western medicine and Chinese medicine on treating this disease seem to be the same, that is, they can only control symptoms in the short term, and symptoms usually recur after stopping medication. It's possible that symptoms may also improve without medication (because the symptoms of this disease are naturally fluctuating, with ups and downs, as recorded in similar text in various medical books), but most parents are unwilling to try not taking medication. To fundamentally "cure" this disease, it can only rely on the child's own growth.
IV. My Physical Regulation Methods for My Son
In summary, the basic idea of my physical regulation for my child is: to loosen rather than block, to avoid external stimuli as much as possible during this sensitive period, and to help regulate the whole body and personality of the child through some measures in daily life, waiting for or promoting self-healing. The specific methods are as follows:
1. First, rectify the adults' concepts, which is the most fundamental. The family must act as if nothing has happened, and must be "familiar with the sight" of any tic symptoms. This must be done not only on the surface but also in the adults' psychology, because these children are very sensitive, and any subtle hint will be detected and ultimately form psychological suggestions leading to symptom aggravation. Also, never ask the child to try to control the symptoms, which is the most wrong approach. Tics themselves are not scary, but if not handled properly, the course of the disease will be prolonged, and it will finally be fixed as a behavioral habit. Therefore, it's best for the family to have a special meeting to align thoughts and actions.
2. Focus on cultivating the child's personality. Encourage the child to go out and play with other children more, to communicate more with others, and to develop a healthy and cheerful personality. When the child does something wrong, education through persuasion should be the main method, avoiding rough beating or scolding. Also, take the child out more to be close to nature.
3. In terms of diet, encourage the child to eat more vegetables and fruits, completely avoid fast food and processed foods with additives. Avoid seafood, chocolate, sugar, and cold drinks, and drink more milk. In addition, you can use dietary therapy: cooking porridge with lotus seeds and lily bulbs, or cooking porridge with jujubes and goji berries, or cooking soup with pig brain, which is good for calming the mind and nourishing the brain.
4. Create all conditions for the child to sleep more. Sleeping is the best way to treat neurological diseases.
5. Increase physical coordination training, including playing ball, jumping rope, walking on balance beams, playing the drum, skating, badminton, etc. Any training of large muscle groups is beneficial to this disease.
6. Pay attention to preventing complications. Tics are prone to complications such as ADHD, depression, anxiety, and other psychological diseases. Parents should observe more and prevent small problems from becoming big ones. During my son's illness, he had obvious symptoms of ADHD, so I trained him to concentrate by playing international chess. In addition, activities such as doing handicrafts, painting, calligraphy, and playing the piano are also effective, and parents can choose appropriate ways according to their child's situation. I know a chronic tic patient (who is now 40, so not a child anymore) who can only control tics when painting and has now become a well-known painter.
7. Try to take the child to the hospital less often, and don't discuss the condition in front of the child. If necessary, just record the child's symptoms and show them to the doctor. The diagnosis of this disease mainly relies on clinical observation, and tests can only rule out other diseases, which is basically useless for diagnosing this disease. If you feel it's not enough, you can create a tic symptom record book and record the situation every day. I set scoring standards for my child at the time to find out the of the disease, but later, because the child recovered quickly, I didn't use it.
8. Avoid tic triggers. If there are various allergic diseases, they should be treated as soon as possible, avoid viral infections such as colds, don't frighten the child, don't take the child to exciting and stimulating places, and control the time spent watching TV (it's best not to watch it during periods of worsening symptoms).
9. When is medication necessary? I think it should only be used when the child's tics have obviously attracted the attention of others, possibly leading to social discrimination and psychological harm to the child. For example, if the tic symptoms worsen during the school term and attract the attention of classmates, then the child should stay home and rest until the symptoms improve before going back to school. Therefore, it's essential to communicate well with the teacher, and the family and school should work together.
10. All the above principles must be adhered to consistently, and for some children, it may be necessary to persist for a lifetime. Because the most fundamental factor causing tics—physical factors—is basically unchangeable. Even if this period of tics improves, it may recur after encountering bad stimuli after several years. For example, someone who developed tics at the age of 34, recovered in their teens, but during their university or working years, they played with friends all night and got drunk, which triggered the tics again.
Below is the nursing points I wrote for the whole family during my son's illness, for your reference:
1. Don't talk about the disease, tics, or any other topics, and don't make any suggestive movements.
2. Eat a light diet, avoid fried foods, cold foods, and foods that cause allergic reactions. Definitely don't eat sugar, and try to eat less ice cream.
3. Definitely don't watch TV or cartoons, listen to strong rhythm music, tell scary stories, or look at scary images.
4. Practice balancing training for 15 minutes every day, gradually increasing to half an hour: standing on one leg or jumping, walking on balance beams, skating, walking in a straight line (toe to heel), using trampolines, walking on tiptoes.
5. Drink at least 400ml of milk every day (two bottles of yogurt and one bottle of goat milk).
6. Pay attention to keeping warm and preventing colds and viral infections.
7. If there is persistent and severe twitching, try to distract the child, such as handing them something or asking them to get a glass of water.
8. Eat a bowl of porridge cooked with lotus seeds and lily bulbs every day.
The above are some of my practices, hoping to be helpful to everyone.
2007 August 109th
"To overcome intellectual shortcomings, education must be the main means, not just medicine." Changing the traditional biased approach of treating mentally retarded children with medication alone, in 1898, Montessori delivered a speech at an education conference in Turin, Italy, proposing her unique insights: "The mental illness of children with psychological defects is mainly an educational problem, not a medical problem. Education and training are more effective than medical treatment."