| Objective:To study the effects of genetic factors on tic disorders(TD)at pathogenesis,clinical curative effect of TCM,period of treatment and prognosis,to explore whether the tic disorders with genetic factors is relatively difficult to treat.Methods:1.The study was divided into two parts:retrospective study and prospective study.2.Retrospective study:To investigate children with TD who ever been to Guang’anmen hospital of China Academy of Chinese Medical Sciences from November 2008 to December 2016,they were all stop taking medicine after symptoms are controlled after treatment with traditional Chinese medicine(jingxinzhidong decoction)and have the retained medical records can refer to.Children aged 3-18 years were included according to the diagnostic criteria of TD in DSM-5,call their parents to make a return visit to investigate the onset of neuropsychiatric disorders among their family members,record the results in the TD genetics questionnaire.According to the investigation results,the children were divided into observation group(with family history)and control group(without family history).The two groups of children were observed and compared statistically to study the effect of genetic factors on TD at pathogenesis,period of treatment and prognosis.3.Prospective study:To investigate children with TD who see a doctor in Guang’anmen hospital of China Academy of Chinese Medical Sciences from January 2017 to July 2018.Children aged 3-18 years were included according to the diagnostic criteria of TD in DSM-5,investigate the onset of neuropsychiatric disorders among their family members,record the results in the TD genetics questionnaire.According to the investigation results,the children were divided into observation group(with family history)and control group(without family history),the children in both groups were treated with jingxinzhidong decoction for 3 months before follow-up.The two groups of children were observed and compared statistically to study the effect of genetic factors on TD at pathogenesis and clinical curative effect of TCM.4.To explore whether the TD with genetic factors is relatively difficult to treat according to the results of retrospective and prospective studies.Result:1 Retrospective Study:1.1 There were 135 children with TD were effectively followed up,28.15%of children with TD have family history of neuropsychiatric disorders,19.26%of children with TD have family history of TD.According to inclusion,there were 36 cases in the observation group(with family history),there were 87 cases in the control group(without family history).1.2 There was no significant difference in gender,age of onset,age at visit,type of TD,the severity of tic,other symptoms,and previous anti-TD western medicine treatment between the observation group and the control group(P>0.05).The sex ratio of the two groups was(2.27-4.12):1;The age of onset was highest between 4 and 9 years(85.37%);The most patients were aged 6-11(78.05%);TS and CTD are the most type of TD[(75-100)%];The severity of tic was the most moderate and severe[(79.31-83.33)%].1.3 The average course of treatment in the observation group was(2.94±1.33)years,most children are treated for two to four years.The average course of treatment in the control group was(2.21±1.11)years,most children are treated for one to three years.The treatment course difference between the two groups was statistically significant(P<0.05).1.4 Other symptoms of the children in the observation group and control group:short temper,timid,excessive sweating,sleep problems,nasal congestion,eat less,dry stool,dry mouth and oral ulcer,the differences before and after treatment were statistically significant(P<0.05).1.5 There was no statistically significant difference in the recurrence of tic symptoms between the observation group and the control group(P>0.05),the tic symptoms recurred in 46.34%of children with TD.Most(84.21%)children’s recurrent tic symptoms was spontanequs remission,the duration of symptoms was less than or equal to 1 week.The factors affecting the recurrence of tic symptoms were electronic products,mental stimulation,snacks,learning pressure and so on.1.6 All children with TD did not complain of discomfort during and after treatment with jingxinzhidong decoction,there was no abnormality in liver and kidney function and urine routine examination during the treatment,no other adverse events were reported.2 Perspective Study:2.1 A total of 701 children with TD were investigated,20.39%of children with TD have family history of neuropsychiatric disorders,15.69%of children with TD have family history of TD.According to stochastic indicator and inclusion criteria,there were 40 cases in the observation group(with family history),there were 80 cases in the control group(without family history).2.2 There was no significant difference in gender,age of onset,age at visit,type of TD,the severity of TD,other symptoms,and previous anti-TD western medicine treatment between the observation group and the control group(P>0.05).The sex ratio of the two groups was(2.33-3.71):1;The age of onset was highest between 4 and 9 years(83.33%);The most patients were aged 6-11(70.00%);TS and CTD are the most type of TD[(75.00-90.00)%];The severity of tic was the most moderate and severe[(79.31-83.33)%].2.3 The YGTSS score of the children in the observation group before treatment was(46.00±11.22),while that of the control group before treatment was(41.76±9.31).The difference in YGTSS score between the two groups before treatment was statistically significant(P<0.05).2.4There was no significant difference in YGTSS score reduction rate between the observation group and the control group before and after the treatment with jingxinzhidong decoction(P>0.05).The total effective rate of the children in the observation group was 77.50%,total effective rate in children with different severity of tic:mild<moderate<severe.The total effective rate of the children in the observation group was 93.33%,total effective rate in children with different severity of twitch:mild<moderate<severe.2.5 Other symptoms of the children in the observation group and control group:short temper,timid,inattention,excessive sweating,sleep problems,nasal congestion,eat less,abdominal pain,dry mouth and oral ulcer,the differences before and after treatment were statistically significant(P<0.05).2.6 All the children were reexamined for liver and kidney function and urine routine after treatment with jingxinzhidong decoction for 3 months,and there were no abnormal results of liver and kidney function and urine routine caused by drug factors.All children did not complain of discomfort during treatment.Conclusion:1.The onset of tic disorders is usually between 4 and 9 years old,more boy than girl;they are mostly pre-school age and school-age when go to see a doctor;The TD type is mainly CTD and TS,and the tic severity is mostly moderate and severe.2.(20.39-28.15)%of children with TD have a family history of neuropsychiatric diseases,(15.69-19.26)%of children with TD have a family history of TD,it is speculated that the family history of TD is not the main factor affecting the incidence of TD.3.Compared with non-genetic children with TD,children with genetic factors have longer course of treatment and more difficult to treat.4.Jingxinzhidong decoction has a significant effect on the improvement of children’s tic symptoms,especially on moderate and severe children with TD,at the same time can significantly improve other symptoms.Moreover,it has high safety and long-term efficacy.5.The improvement of Jingxinzhidong decoction on the tic symptoms and other clinical syndromes of children with TD is not affected by the genetic factors.the emotional abnormalities of the children with genetic factors and the non-genetic children are quite obvious,it is speculated that the mental disorders are the basis of the onset of TD. |
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