de Mattos J P, de Rosso A L
Universidade Federal do Rio de Janeiro (UFRJ), Brasil.
Arq Neuropsiquiatr. 1995 Mar;53(1):141-6. doi: 10.1590/s0004-282x1995000100022.
The concept of tic was developed at the end of the XIX century, emerging from the "chaos of choreas". Tic is defined as involuntary contractions of agonist and antagonist muscles in one or more parts of the body. It can be suppressed by voluntary efforts for seconds or hours, followed by exacerbations. Gilles de la Tourette's original article was published in 1885, in which he described nine patients with tics, and vocalisations. The pathogenesis of Gilles de la Tourette syndrome remained obscure. However, three factors have been considered: the neurochemical factor, related to the increased dopaminergic activity at the basal ganglia; the genetic factor and the non-genetic factors, for which environment more than genetic factors are involved. Pathologic examinations failed to reveal structural lesions, but PET studies showed metabolic hypofunction on the frontal, cingulate and possibly insular cortex, and on the inferior corpus striatum. The motor tics as well as the vocal tics can be simple or complex and are present in all patients. Other signs can be added to the previous tics: sensory tics, echophilia, coprophilia, obsessions, compulsions and impulsions. Diagnostic criteria of Gilles de la Tourette syndrome are based on: age of onset; presence of motor and vocal tics; voluntary suppression of the movements; variation in number, type, location and severity of tics; duration of more than one year. Haloperidol is the drug of choice for the treatment of Tourette's syndrome.
抽动的概念是在19世纪末从“舞蹈病的混乱”中发展而来的。抽动被定义为身体一个或多个部位的主动肌和拮抗肌的不自主收缩。它可以通过自主努力抑制数秒或数小时，随后会加重。吉尔斯·德拉图雷特的原始文章发表于1885年，他在文中描述了9例患有抽动和发声症状的患者。吉尔斯·德拉图雷特综合征的发病机制仍然不明。然而，有三个因素被考虑在内：神经化学因素，与基底神经节多巴胺能活动增加有关；遗传因素和非遗传因素，其中环境因素比遗传因素的影响更大。病理检查未能发现结构性病变，但PET研究显示额叶、扣带回以及可能的岛叶皮质和尾状核下部存在代谢功能减退。运动性抽动和发声性抽动都可以是简单的或复杂的，且在所有患者中都存在。还可能出现其他症状，如感觉性抽动、恋声癖、恋粪癖、强迫观念、强迫行为和冲动行为。吉尔斯·德拉图雷特综合征的诊断标准基于：发病年龄；运动性和发声性抽动的存在；运动的自主抑制；抽动的数量、类型、部位和严重程度的变化；病程超过一年。氟哌啶醇是治疗抽动秽语综合征的首选药物。
