• 제목/요약/키워드: 뚜렛 증후군

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뚜렛 증후군에서의 경두개 자기자극술 (Transcranial Magnetic Stimulation in Gilles de la Tourette Syndrome)

  • 이문수
    • 정신신체의학
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    • 제18권1호
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    • pp.3-10
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    • 2010
  • 뚜렛 증후군은 주로 아동기에 발생하는 만성적인 운동 및 음성 틱을 주소로 하는 질환이다. 기저핵-시상-피질 회로에서의 이상이 비자발성 틱의 병태생리에 중요한 역할을 하는 것으로 생각된다. 뚜렛 증후군은 흔히 주의력 결핍 과잉행동장애나 강박장애와 병존한다. 경두개 자기자극술은 연구용으로 많이 사용되는 신경생리학적 기법이다. 이 기법이 피질의 활성을 변화시킬 수 있다는 증거들이 많아서, 반복적 경두개 자기자극술은 피질의 활성도를 바꾸어서 결과적으로 내재한 서로 연결된 피질-피질하 회로에 영향을 주기 위하여 치료적 목적으로도 사용된다. 우리는 본 논문에서 경두개자극술의 여러 신경생리학적 변인들과 임상적 응용에 관하여 기존의 연구보고들을 고찰하여 보고자 한다.

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뚜렛 증후군 환자에서 자해로 인한 혀 손상 : 증례 보고 (Self-inflicted Tongue Ulceration in a Patient with Tourette Syndrome: A Case Report)

  • 이꽃님;김미애;황인경;박지현;마연주
    • 대한소아치과학회지
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    • 제43권3호
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    • pp.327-333
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    • 2016
  • 틱이란 불수의적이고 갑작스러운 소리냄과 리듬이 없는 근육의 움직임을 말한다. 다수의 운동틱과 한 가지 이상의 음성틱이 모두 존재하는 경우 뚜렛 증후군으로 분류되며, 운동틱에 의한 자해 행위는 뚜렛 증후군 환자에서 흔히 나타나는 증상 중 하나이다. 본 증례에서 9세 소년이 혀의 심각한 궤양을 주소로 신경정신과로부터 의뢰되었다. 두 달 전부터 시작된 반복적인 혀 씹기에 의해 궤양은 빠르게 진행되었으며, 환아는 그로 인한 식이 및 연하의 어려움을 호소하였다. 우리는 부드러운 실리콘 재질을 이용하여 상, 하악이 분리된 가철성 장치를 제작하기로 결정하였다. 장치의 지속적 사용이 고통을 줄일 수 있는 방법임을 강조하였기 때문에, 환아는 장치 장착에 동의하였으며 잘 적응하였다. 3주 후 혀의 병소가 상당히 개선된 것을 확인할 수 있었다. 현재 구강 내 자해 행위를 치료하기 위한 표준화된 지침은 없다. 따라서 임상가는 약물 치료를 비롯하여 구강 내 장치 적용이나 관련 치아의 연마 등 다양한 접근 방법을 고려하여야 한다.

뚜렛 증후군에서 보툴리눔 톡신의 임상 효과 : 증례보고 및 고찰 (The Clinical Effect of Botulinum Toxin in a Patient with Tourette's Syndrome: A Case Report and Review)

  • 현정근;이준형;이창민;임명호
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • 제24권2호
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    • pp.90-95
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    • 2013
  • Botulinum toxin, a neurotoxin, is known to be an inhibitor of cholinergic neuromuscular transmission. Recently, it was reported that the administration of botulinum toxin is effective for the treatment of focal neurological motor disorders such as cervical dystonia, blepharospasm, hemifacial spasm, spasmodic dysphonia, and writer's cramp. Several case studies reported that the botulinum toxin was administered for the treatment of motor tic or vocal tic. It was found that this toxin reduces the frequency and severity of the tic as well as the premonitory urge and symptoms. In our case study, a noticeable decrease of motor tic symptom was observed after an intramuscular injection of 300mg of botulinum toxin in an 18-year-old patient with Tourette's disorder who showed only a little improvement of motor tic and vocal tic symptoms after treatment with antipsychotic drugs for several years. This case is reported in our study and literature survey was undertaken for reviewing similar cases. In our study, an 18-year-old boy diagnosed with Tourette's disorder based on Diagnostic and Statistical Manual of Mental Disorders, fourth edition presented with the following scores : the Clinical Global Impression scale, Yale Global Tic Severity Scale (motor/vocal/severity), Premonitory Urge Score, Korean Attention-Deficit Hyperactivity Disorder Rating scale, and Kovac Depression scale which were performed prior to the treatment were 5, 21/5/50, 100, 17, and 18 points, respectively. Two weeks after the injection of botulinum toxin, the scores were 4, 17/5/40, 50, 16, and 19 points, respectively. Eight weeks after the injection of botulinum toxin, they had become 3, 15/5/30, 25, 16, and 20 points, respectively, which clearly indicates a noticeable decrease of motor tic symptom.

주의력결핍 과잉행동장애와 뚜렛증후군 아동의 모발 중금속 분석 (Analysis of Heavy Metals in the Hair of Children with Attention-Deficit Hyperactivity Disorder and Tourette's Syndrome)

  • 조성연;옥선명;이명훈;강민희;김철응;배재남;이정섭
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • 제23권2호
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    • pp.63-68
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    • 2012
  • Objectives : The purpose of this study was to examine the association of exposures to heavy metals with positive diagnosis for attention-deficit hyperactivity disorder (ADHD) and Tourette's syndrome (TS). Methods : Study participants included 27 children diagnosed with ADHD ($9.9{\pm}2.9$ years of age), 21 diagnosed with Tourette's disorder ($10.7{\pm}2.2$ years of age), and 45 normal control children ($9.6{\pm}0.5$ years of age). A Perkin-Elmer mass spectrometer was used to measure the concentrations of 5 heavy metals (Pb, Cd, U, Be, Hg) in hair samples obtained from each participant. Each heavy metal concentration was compared among the groups by use of a Kruskal-Wallis test. Results : The levels of lead (p=.006) and cadmium (p=.037) observed in the hair of children diagnosed with ADHD were significantly higher than those found in the control subjects. There were no significant differences observed for heavy metal levels when comparing TS and control subjects. Conclusion : We confirmed that lead exposure is a risk factor for ADHD. We also identified that cadmium may be a new candidate risk factor for manifestation of ADHD. We did not find an association between heavy metals and manifestation of TS.

틱장애의 환경적 요인 (Environmental Risk Factors in Tic Disorders)

  • 정용우;박태원
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • 제21권3호
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    • pp.133-140
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    • 2010
  • Tic disorders, including Tourette syndrome, are known as neurobiologic disorders and as such, much emphasis has been placed on isolating genetic determinants. Although previous reports involving studies of discordance among monozygotic twins have shown the importance of genetic predisposition, they have also supported a role for environmental factors in the development of tic disorders. Therefore, it is important to consider that both genetic and environmental factors contribute to their clinical expression. The goal of this article was to review recent reports regarding the role of environmental factors in development and progression of tics. Specific environmental factors associated either with a more severe course of illness or improved outcomes were discussed. Given that accumulating evidence had suggested the usefulness of behavior therapies in the suppression of tic disorders, particular emphasis was placed on the impact of several contextual factors.

뚜렛 및 만성 틱 아동의 출생순위에 따른 특성 비교 (A COMPARISON OF THE CHARACTERISTICS OF CHILDREN WITH TOURETTE AND CHRONIC TIC DISORDER ACCORDING TO THEIR BIRTH ORDERS)

  • 김자성;홍강의
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • 제4권1호
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    • pp.124-132
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    • 1993
  • 45명의 틱 증상을 보인 아동들의 임상적 양상을 검토하였고 형제순위별로 나눠 비교하였다. 성비는 14:1로 남자가 압도적으로 많았고 형제순위로는 맏이가 46.7%, 막내가 33.3%. 외동아 15.6%, 쌍생아 4.4%로 맏이가 많았다. 기질성 시사소견은 37.8%에서, 초기발달 이상은 71.1%, 가족관계의 이상이 89.9%에서 보였고 동반 증상들로는 주의력결핍 과잉운동장애 46.7%, 강박장애 17.7%, 격려불안은 24.4%, 범불안, 수면불안은 17.8%, 신체화 증상 및 아뇨가 각각 13.3%, 말더듬 8.9% 외에 분뇨, 우울증 등을 보여 총 84.4%에서 최소한 하나 이상의 동반된 문제를 가졌다. 형제별로 나눠 특징을 비교했을 때 발병 시기에서 현저한 차이를 보였는데 막내 유형은 입학과 연관된 시기에 발병율이 의미있게 높았다.(p<0.01) 쌍생아의 경우는 저 출생체중아가 환아였다. 이들 소견을 종합해볼 때 틱 및 뚜렛 장애의 발현에는 선천적 기질적 요인뿐 아니라 상당한 환경적인 요인이 작용한다고 보겠다.

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뚜렛 증후군에 대한 중의학 임상연구 동향 (Review of Clinical Studies on Traditional Chinese Medicine for Tourette Syndrome)

  • 김종환;조희근;설재욱
    • 동의신경정신과학회지
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    • 제28권4호
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    • pp.303-318
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    • 2017
  • Objectives: To establish a base for further research by reviewing studies on traditional Chinese medicine treatment for Tourette Syndrome. This is the purpose of this study. Methods: Clinical studies involving the effects of traditional Chinese medicine treatment for Tourette Syndrome, published January 2010~June 2017, were obtained from CNKI, Pubmed. Selected Studies were evaluated by the Jadad Scale. Results: Among a total of 252 articles, 39 articles that meet the criteria were selected. 'Diagnostic and Statistical Manual for Mental Disorders, 4th edition (DSM-IV)' was most frequently used as diagnosis criteria. 'Yale Global Tic Severity Scale (YGTSS)' was primarily used for outcome measurements. Most of the studies showed effective results of traditional Chinese medicine therapy. However, the quality of a selected clinical studies was low. Conclusions: Despite several limitations, various studies to prove limited yet effective traditional Chinese medicine treatment on Tourette Syndrome provides much significance. Subsequent studies conducted by the complementary systematic review and well-designed clinical trials using the methodological quality will be needed to more firmly validate the effect of traditional Chinese medicine therapy.

Haloperidol로 치료한 Tourette 장애에서 발생한 항정신병약물-퇴행 증후군 1례 (A Case of Antipsychotic-Regression Syndrome in Haloperidol Treated Tourette's Syndrome)

  • 정희연;조현주;권영준;박인준;진혁희
    • 생물정신의학
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    • 제5권1호
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    • pp.134-137
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    • 1998
  • Authors report a case of separation anxiety disorder, which developed as a side effect during haloperidol treatment of Tourette syndrome(TS). In this case, 14 years old boy developed attention deficit symptoms during his infancy. At 4th grade of primary school, he developed vocal tic, motor tic, and coprolalia. With 5mg/day of haloperidol treatment his symptoms of TS were subsided. During the treatment, he developed features of separation anxiety disorder, including dependence, pleading, clinging, and sadness. Symptoms of attention deficit and separation anxiety disorder were improved by 25mg/day of imipramine treatment. During haloperidol treatment of TS, careful observation may be needed whether separation anxiety disorder-like symptom develops.

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틱장애와 도파민 D2 수용체 유전자와의 연합 연구 (Association Study between Tic Disorder and Dopamine D2 Receptor Gene Polymorphism in Korean Population)

  • 이소영;조인희;김선미;이민수;정한용
    • 생물정신의학
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    • 제13권4호
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    • pp.299-304
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    • 2006
  • Objectives : The purpose of the present study was to investigate whether the TaqI A polymorphism of dopamine receptor D2 gene(DRD2) is associated with Tourette syndrome(TS) and chronic motor tic disorder(CMT) in Korean population. Methods : DRD2 TaqI A RFLP genotyping was carried out with DNA extracted from blood samples of 75 patients with tic disorders(47 with TS and 28 with CMT) and 90 healthy subjects. Genotype and allelic frequencies for the DRD2 gene polymorphisms of the tic disorder group as a whole were compared to those of the control group. Separating the TS group, thereafter, the frequency of genotypes and alleles were compared to those of the controls. Results : The results demonstrated that genotype and allele distributions for the DRD2 gene polymorphism in the tic disorder as a whole, TS, and control groups were not significantly different. Conclusion : No association was found for DRD2 gene, TS and CMT. The data suggest that DRD2 gene may not be a useful marker for the prediction of the susceptibility of tic disorder.

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네트워크 약리학 분석을 통한 뚜렛 증후군에 유용할 것으로 예측되는 한약 자원 탐색 (Discovery of Herbal Medicine Resources through Network Pharmacology Analysis Predicted to Be Useful for Tourette Syndrome)

  • 이병호;조수인
    • 턱관절균형의학회지
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    • 제10권1호
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    • pp.12-20
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    • 2020
  • Objectives: Tourette syndrome (TS) is a disease that occurs evenly in many social classes. Despite the long experience of drug treatment, the preference is low due to various side effects. The aim of this study was to discover herbal medicine resources through network pharmacology analysis predicted to be useful for Tourette syndrome. Methods: We used Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) to identify herbal medicines that can be used for TS by using network pharmacology research methods and to predict the mechanism of action. After evaluating compounds of each identified herb, molecular target proteins and mechanisms of action were analyzed, focusing on compounds that are likely to exhibit clinical activity in consideration of the pharmacokinetic parameters of these individual compounds. Results: Fifty nine ingredients such as atropine, veraguensin, and nuciferin among the compounds contained in 48 types of medicinal herbs such as Daturae Flos (洋金花), Salviae Radix (丹参), and Nelumbinis Plumula (蓮子心) act on the D(2) dopamine receptor, which is a protein involved in the development of TS. It has been found that atropine, veraguensin, and nuciferin are highly likely to exhibit activity by acting on the G protein-coupled receptor signaling pathway. Conclusions: It can be used in conjunction with non-invasive treatment means such as FCST Yinyang Balancing Appliance with herbal therapy to bring about a significant therapeutic effect, and it will be possible to develop a treatment that can replace drug therapy used in Western medicine.