Syndrome of compulsive movements in children: why it occurs and how it is treated

In pediatric psychoneurology - in the presence of involuntary movements that occur periodically in a child, regardless of his desire, and stop their attacks by effort of will is impossible - the syndrome of compulsive movements in children can be diagnosed.

Such repetitive stereotyped movements are either part of a general neurotic obsession, or are a manifestation of a paroxysmal neuropsychiatric disorder, or are considered a sign of extrapyramidal motor disorders.

Epidemiology

According to foreign experts, more than 65% of hyperactive children, whose parents consulted neuropathologists, had problems at birth or in the early infantile period. But in 12-15% of cases, the true cause of the compulsive motion syndrome in the child is not possible due to the lack of complete information.

Recent studies by School of Medicine Washington University and University of Rochester show that the prevalence of tics is about 20% of the population, and the incidence of chronic teak disorders among children is about 3% (with a ratio of boys to girls 3: 1).

Imperative muscle motor activity in the form of tics rarely appears before two years, and the average age of their onset is about six to seven years. 96% of tics are present up to 11 years. At a slight degree of severity of the syndrome in half of patients by 17-18 years of age, it becomes practically not noticeable.

Among pediatric patients with severe or deep retardation of intellectual development, the statistics of the compulsive motion syndrome is 60%, and in 15% of cases, these movements inflict damage on children themselves.

By the way, despite its connection with mental disorders, there are children and adults with normal intelligence and adequate care that this syndrome has.

[1], [2], [3], [4], [5], [6]

Causes of the syndrome of compulsive movements in children

In the prevailing number of clinical cases, specialists associate the causes of the compulsive movements syndrome in a child with neuroses of stress etiology, often defining this disorder as a  neurosis of obsessive movements.

This syndrome can be observed in the state of increased anxiety of the child, the  syndrome of early childhood autism, as well as  the Asperger syndrome in children.

In the prepubertal period, obsessive movements in adolescents may be a symptom of a developing  obsessive-compulsive disorder.

Motor disorders - a pattern of compulsive movements in adults - are discussed in detail in the publication  Nervous Tick  and the article  Tourette's Syndrome. In addition, with age, the factor of microcirculatory disturbances in cerebral vessels and the threat of cerebral ischemia increase due to atherosclerosis.

In childhood, the appearance of imperative stereotyped motions - as a sign of neurodegenerative disorders - is possible in cases of abnormal CNS activity due to perinatal damage to brain structures due to hypoxia and cerebral ischemia, as well as trauma during childbirth leading to various encephalopathies.

This complex of symptoms is considered a comorbid  hyperkinetic syndrome characteristic of violations of the extrapyramidal system: damage to motor neurons of the lateral horns of the spinal cord; trunk and cortex of the brain; basal ganglia of the cerebral subcortex; reticular formation of the midbrain; cerebellum, thalamus and subthalamic nucleus. As a result,  chorea, athetosis and hemiballism occur. More details see the material -  Hyperkinesis in children.

A number of neurodegenerative diseases are noted, the pathogenesis of which is caused by gene mutations and inherited neurological disorders associated with the appearance of the compulsive motion syndrome in children at a fairly early age. Among them note:

• genetic defects of the mitochondria cells (synthesizing ATP) contained in the plasma - mitochondrial diseases that disrupt energy metabolism in tissues;
• congenital lesions of the myelin sheaths of nerve fibers in metachromatic leukodystrophy;
• mutation of the PRRT2 gene (which encodes one of the transmembrane proteins of the brain and spinal cord tissues), which causes paroxysmal obsessive movements in the form of a kinesogenic choreoathetosis;
• pathological accumulation of iron in the basal nuclei of the brain (neurofertricinopathy), caused by a mutation in the FTL gene.

A specific place in the pathogenesis of the paroxysmal motor disorder under consideration is endocrine pathology, in particular, hyperthyroidism and  autoimmune thyroiditis in a child. And the origin of hereditary benign  chorea, as studies have shown, lies in mutations of the gene of the thyroid transcription marker (TITF1).

Among autoimmune diseases, the systemic lupus erythematosus also has an attitude towards the development of involuntary movements, leading to a number of CNS pathologies at a certain stage of development.

Specialists do not exclude the connection between the cause of the compulsive movements syndrome in a child with the state of catatonic excitation induced by some forms of schizoaffective states and schizophrenia; craniocerebral trauma; intracranial tumor formations; cerebral lesions of an organic nature with the development of gliotic changes in individual brain structures; infections - viral encephalitis, Neisseria meningitidis or rheumatic fever Streptococcus pyogenes.

[7], [8], [9], [10]

Risk factors

Key risk factors for the development of any group of symptoms of a neuropsychiatric nature, including the compulsive motion syndrome in a child, adolescent or adult - the presence of pathologies leading to movement disorders.

As clinical practice shows, this syndrome can affect anyone at any age, however, it affects boys much more than girls. Especially often obsessive movements are observed in children born with mental disability due to genetic abnormalities, with negative effects on the fetus during fetal development or due to the development of postnatal pathologies.

[11], [12], [13]

Pathogenesis

The pathogenesis of a part of hyperkinetic disorders may consist in the absence of a balance of the neurotransmitters of the central nervous system: responsible for muscle contraction and relaxation of acetylcholine, which controls the movements of the muscle fibers of dopamine, and also stimulates all the biochemical processes of norepinephrine and adrenaline. Due to the imbalance of these substances, the transmission of nerve impulses is distorted. In addition, enhances the stimulation of neurons of the brain high level of glutamic acid sodium glutamate. At the same time, gamma-aminobutyric acid (GABA) inhibiting this excitation can be in deficit, which also interferes with the motor zones of the brain.

[14], [15], [16], [17], [18], [19], [20]

Symptoms of the syndrome of compulsive movements in children

The most common  symptoms of  this disorder may include such non-functional (aimless) movements (repetitive and often rhythmic) involving the muscles of the tongue, face, neck and trunk, distal parts of the limbs:

• rapid blinking;
• cough (imitating "cleaning the throat");
• shaking hands, swinging or twisting;
• slapping on the face;
• beating your head (about anything);
• striking yourself (with your fist or palms);
• bruxism  (grinding of teeth);
• sucking fingers (especially often - large);
• biting of fingers (nails), tongue, lips;
• pulling by the hair;
• skin folding;
• grimaces (facial tics);
• uniform vibration of the whole body, bending of the trunk;
• similar chorey twitching of limbs and head (jerky nodding head first, in the sides);
• bending fingers (in many cases - in front of the face).

Forms

Types of repetitive movements vary widely, and each child can have his own - an individual manifestation. It can increase with boredom, stress, anxiety and fatigue. Some children, when they are directed attention or they are distracted, can stop their movements abruptly, while others are not capable of it.

In addition to those named, in children with the syndrome of compulsive movements, signs of attention deficit, sleep disturbances, mood disorders are possible. And the presence of bouts of rage and explosive outbreaks indicates the Asperger syndrome or obsessive-compulsive disorder.

[21], [22], [23]

Complications and consequences

Some aimless movements can cause self-harm. In addition, the syndrome can cause distress in the child, which leads to a certain decrease in the quality of life, hinders communication and socialization in the children's team; has a certain effect on the ability to self-service and limits the scope of joint activities outside the home environment.

[24], [25], [26]

Diagnostics of the syndrome of compulsive movements in children

First of all, the diagnosis of the compulsive motion syndrome in a child requires a qualitative assessment of the type of movement and the circumstances of its occurrence, which are often difficult to determine. However, motor stereotypes are often diagnosed in patients with mental disabilities and neurological conditions, but may also occur in mentally healthy children. For example, obsessive movements in adolescents that cause suspicion of a degenerative disorder (myoclonus) can be completely normal in infants.

A complete medical history and physical examination of the child is necessary, with an assessment of the symptoms present (which should be present for at least four weeks or longer). This will confirm the diagnosis of this syndrome.

To determine its cause, tests can be administered:

• general blood test (including determination of hematocrit, mass of circulating red blood cells, ESR);
• a blood test for the level of amino acids, thyroid hormones, antithyroid antibodies, lupus anticoagulant, anti-streptolysin, etc .;
• urine analysis for protein components;
• analysis of cerebrospinal fluid or genetic analysis of parents (if necessary).

Instrumental diagnostics can be used: electroencephalography; CT, MRI and ultrasound angiography of the brain, electromyography.

[27], [28], [29]

Differential diagnosis

Differential diagnosis is mandatory, since the difficulty in determining this condition is to distinguish it from other paroxysmal neurological problems associated with chorea, myoclonus, spasticity, dystonia, convulsions.

In addition, it is necessary to differentiate manifestations of the syndrome of compulsive movements and the symptoms of temporal epilepsy - in the form of attacks of stereotyped motility.

[30], [31], [32], [33]

Treatment of the syndrome of compulsive movements in children

No less problems are caused by the treatment of the compulsive motion syndrome in the child, since there are no stable effective drugs for this pathology, and there is no evidence of the effectiveness of therapy (especially when the movements do not interfere with daily life).

Than to be treated, what to drink at obsessive involuntary movements at children? If the child does not have significant deviations in the level of intellectual development, it may be useful to engage with a child psychologist and exercises aimed at correcting habits and behavioral changes. But when motor disorders can injure a child, certain physical limitations may be required (for example, if a child often knocks his head, he must wear a helmet).

There are medicines that are used with some success in the expressed forms of the syndrome. Since stress is a common trigger for the onset of an attack, antidepressants such as Thioridazine or Sonapax (only from the age of three), Clomipramine or Anafranil (only after five years) are used. More information on contraindications and side effects that may outweigh the benefits of these drugs in the material -  Tablets from stress, as well as in the publication -  Sedatives for children of different age groups.

Drug treatment may include cerebroprotective agents -  nootropics, most often Piracetam (children over one year old), as well as preparations based on hopentenic acid (Pantokaltsin, Pantogam).

It is recommended to give children vitamins: C, E, B1, B6, B12, R.

Physiotherapeutic treatment can give positive results: electrotherapy, massage, balneology, exercise therapy.

Alternative treatment is not designed to help with paroxysmal psychoneurological disorders, but the advice to walk barefoot on grass, sand or pebbles can be perceived positively, given the benefits of activating the reflex zones on the feet.

In some cases, herbal treatment is beneficial, for which plants such as valerian (roots and rhizomes), motherwort (grass), peppermint and lemon balm (leaves), lavender, etc. Are best used. Details in the publication -  Soothing collection.

Prevention

It is impossible to prevent the appearance of the compulsive movements syndrome in children. Nevertheless, early recognition of the symptoms and qualified help to minimize them help reduce the risk of the child getting injuries from their own actions.

[34], [35]

Forecast

The prognosis depends on the severity of the disorder. It should be borne in mind that periodic involuntary movements, according to neuropathologists, reach a peak in adolescence, then decrease and become less pronounced.

Although the adjustment of behavior can reduce the intensity of manifestation of this syndrome, it rarely passes completely, and in children with severe mental retardation it can even increase.

[36], [37], [38], [39], [40], [41]