Factors Related To The Prognosis Of Tic Disorder In Adulthood And The Influence Of Chinese And Western Medicine

Objective:1.This class is to explore the factors related to the prognosis of tic disorder in children after 18 years of age,and to understand the reality of tic symptoms after 18 years of age through a cross-sectional investigation of children who still have tic symptoms,so as to provide reference for children and clinical workers.2.By comparing the prognostic results of Chinese and western medicine treatment,the influence of Chinese and western medicine treatment on the long-term prognosis of tic disorders was discussed,providing appropriate reference for the treatment of children and clinical workers.Methods:A retrospective study was conducted to collect the medical records of children with tic disorders who visited the pediatric encephalopathy Outpatient department of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine and the psychological Outpatient Department of Tianjin Children’s Hospital from December 1,2000 to December 1,2019,and whose birth date was as late as December 1,2003.The children who met the requirements were followed up by telephone and wechat,so as to collect relevant information.Then they were divided into groups according to whether there were tic symptoms after 18 years of age,and the related factors were observed and analyzed.At the same time,they were divided into groups according to the way of medication,and the effect of each way of medication on their prognosis was observed.Result:1 status quo of tic disorder children after 18 years of adulthood(1)A total of 510 children were collected,of which 221 were successfully included,of which 140 were asymptomatic after adulthood,with a symptom disappearance rate of about63.35%;In the children with tic symptoms after adulthood,the degree of tic symptoms was mainly mild.After adulthood,the main tic symptoms were eyebrow twitch,vocal twitch and head and neck twitch.(2)Distribution of relapse causes after adulthood: the main causes were mental stimulation/emotional changes(shock,criticism,etc.),pressure from entering school/working and excessive use of electronic products.(3)Adult employment and learning: the existing tic symptoms after adulthood have an impact on adult employment and learning.2.Analysis results of factors related to tic disorder with or without tic symptoms(1)General situation: parents’ education level,whether they are the only child or not,and their parents’ occupation as police or teachers were correlated with the prognosis of tic,P<0.05;There was no correlation between gender,birth mode and diet habit on the prognosis of tic disorder(P>0.05).(2)History of allergy,past medical history and family history: there was no correlation between the prognosis of tic and the history of allergy,past history(such as history of rhinitis,surgical trauma,history of recurrent respiratory tract infection,history of neonatal jaundice and history of convulsion)and the history of neuropsychiatric family history(P >0.05).(3)Perinatal conditions: there was a correlation between perinatal abnormalities and the prognosis of tic(P<0.05),while umbilical cord around the neck,abnormal fetal position,premature rupture of amniotic fluid and history of hypoxia and asphyxia were not correlated with the prognosis of tic(P >0.05).(4)Psychosocial environmental factors: there was a correlation between the prognosis of tic disorder and whether the children had moved,changed schools and other environmental changes,and their parents often quarreled or divorced,all P <0.05;However,there was no correlation between poor parenting style/strict discipline and being ridiculed or discriminated by teachers or classmates(P >0.05).(5)Correlation analysis between the first onset and the prognosis of tic disorder(1)Onset age: the minimum onset age was 3 years old,the maximum onset age was 14 years old,and the average onset age was 8.58±2.70 years old.There was a correlation between onset age and prognosis,P<0.05.(2)Season of first onset: summer and winter accounted for the largest proportion of the first onset season,and there was no correlation between the first onset season and the prognosis of tic,P>0.05.(3)Pathogenic factors: the most common pathogenic factors in children are mental stimulation/emotional changes(shock,criticism,etc.),excessive use of electronic products and college/homework pressure.(4)First onset symptoms: the most common symptoms are eyebrow twitching,followed by vocal twitching,head and neck twitching;There was a correlation between multi-site tic and prognosis of tic(P<0.05),but there was no correlation between motor tic and prognosis of tic(P>0.05).(6)Correlation analysis of first visit and tic disorder prognosis(1)Age of first visit: the youngest was 3 years old,the oldest was 17 years old,and the average age was 10.04±2.77 years old.(2)The course of disease before the first visit: The course of disease before the first visit was divided into 0-6 months,half-a-year to 1 year,1-2 years and more than 2 years for statistical analysis.It was found that the course of disease between 0-6 months and more than2 years was statistically different,P<0.05.(3)Severity of symptoms at visit: There were statistical differences among mild,moderate and severe groups(P<0.05).(4)Classification of tic disorder at visit: there was a statistical difference between TTD and TS children,P<0.05.(7)Correlation analysis between treatment and tic disorder prognosis(1)Treatment time: the treatment time of the children was divided into three groups: less than 1 year,1～2 years and more than 2 years.Statistical analysis showed that there were statistical differences between the treatment time of more than 2 years and less than 1 year and 1～2 years,P<0.05,and there was no statistical difference between the treatment time of less than 1 year and 1～2 years,P>0.05;It was found that age at onset and symptom degree of tic children were correlated with treatment time(P<0.05),while gender,tic symptom type and treatment time had no difference(P>0.05).(2)Recurrence: recurrence was correlated with the prognosis of tic,P<0.05.(3)Distribution of aggravation and recurrence causes during treatment: The survey found that the most aggravation and recurrence causes during treatment were mental stimulation/emotional changes(shock,criticism,etc.)and college/homework pressure.(4)Distribution of prescriptions for the first TCM treatment in our hospital: The most commonly used were Tianma uncaria Decoction,Yinqiao powder,dongtan decoction,Dingshake decoction,Wind-soothing decoction and Chaihu,Guizhi,dragon bone and Oyster soup.(5)The effective time of the first TCM treatment in our hospital: the shortest effective time was 1 week,the longest effective time was 2 months,the average effective time was2.19±1.48 weeks;There was no statistical significance in the effective time of each agent(P>0.05).(8)Regression analysis of various influencing factorsAfter modified Poisson regression,perinatal situation,symptom degree,treatment time,whether the first symptom is multi-site twitch and twitch type are high risk factors,while only child is a protective factor.3.Influence of Chinese and Western medicine on the long-term prognosis of tic disorder(1)Match the comparison of the first three groups(1)General conditions: before matching,a total of 217 children were included in the three groups,including 76 children in the TRADITIONAL Chinese medicine group,60 children in the Western medicine group,and 81 children in the combined Chinese and Western medicine group.There were no statistical differences in gender and age of onset among the three groups(P>0.05),while there were statistical differences in symptom severity and treatment duration among the three groups(P<0.05).(2)Comparison of overall prognosis: there was no statistical difference in the overall prognosis of the three groups before matching(P>0.05),while there was statistical difference between the Chinese medicine group and the Combined Chinese and Western medicine group(P<0.05).(3)Comparison of the degree of tic in the three groups: there was no statistical difference in the degree of tic in the three groups before matching,P>0.05.(2)Comparison of the three groups after matching(1)General conditions: After matching,there were no statistical differences in gender,onset age,symptom severity and treatment time among the three groups(P>0.05).(2)Comparison of overall prognosis: after matching,there was no statistical difference in the overall prognosis of the three groups(P>0.05),and there was no statistical difference among all groups(P>0.05).(3)Comparison of the degree of convulsive prognosis: there was no statistical difference in the degree of convulsive prognosis among the three groups after matching(P>0.05),and there was no statistical difference between the three groups(P>0.05).(4)Comparison of the prognosis of tic types: there was no statistical difference in the prognosis of tic types among the three groups(P>0.05);However,in TTD type children,there was a statistical difference between the TCM group and the western medicine group(P<0.05);in CTD type children,there was a statistical difference between the TCM group and the combined Chinese and Western medicine group(P<0.05);there was no statistical difference between other groups(P>0.05).(5)Comparison of the prognosis of symptoms: there was no statistical difference in the prognosis of symptoms among the three groups(P>0.05);When symptoms were moderate and severe,there was statistical difference between the TCM group and the Western medicine group(P<0.05),while there was no statistical difference between the other groups(P>0.05).(6)The comparison of quality of life after adulthood: there was no statistical difference in the impact of the three constituent years on employment and learning,and the impact of communication with classmates and friends,P>0.05.Conclusion:(1)The rate of tic symptoms disappeared after 18 years of age was 63.35%;After adulthood,the main tic symptoms were eyebrow twitch,vocal twitch,head and neck twitch,and the degree of symptoms was mainly mild.After adulthood,tic symptoms have an impact on employment and learning.(2)In the correlation analysis of the tic prognosis of children,Parents’ education level,whether for the one-child,perinatal abnormal,parents occupation for teachers or police,with or without moving/in school environment change,such as parents often quarrel or has been divorced,onset age,whether for multiple parts twitch,see a doctor before the course for the first time,clinic symptom severity,visits the twitch of classification,treatment time and the prognosis of recurrence and twitch In correlation;After modified Poisson regression,perinatal situation,symptom degree,treatment time,whether the first symptom is multi-site twitch and twitch type are high risk factors,while only child is a protective factor.(3)This study also found that the onset age and the degree of symptoms of children with tic were correlated with the treatment time.(4)In the analysis of the influence of Chinese and western medicine treatment on the long-term prognosis of tic disorders,it was found that the long-term prognosis of TTD children was better than that of western medicine treatment,and the long-term prognosis of CTD children was better than that of Chinese and Western medicine combined treatment.In moderate and severe symptoms,the long-term prognosis of TCM treatment is better than that of western medicine treatment.