O razlikama između Gilles de la Tourette sindroma i psihogenih/funkcionalnih tikova: Narativni pregled

master's thesis

• Title (english): On differences between Gilles de la Tourette Syndrome and Psychogenic/Functional Tics: A Narrative Review
• Author: Ante Periša
• Mentor: Srđana Telarović (mentor)
• Committee member: Zdravka Poljaković-Skurić (predsjednik povjerenstva)
• Committee member: Mario Habek (član povjerenstva)
• Committee member: Srđana Telarović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Neurology); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Neurology

Abstract

Tik je iznenadni, brzi, ponavljajući i neritmični motorički pokret ili vokalizacija. Glavna obilježja Gilles de la Tourette sindroma (GTS) su motorički i vokalni tikovi u trajanju duljem od godine dana s prvim pojavljivanjem prije 18-te godine. Dijagnoza psihogenih/funkcionalnih (P/F) tikova smatrala se dijagnozom koja se daje per exclusionem zbog nedostatka jasnih dijagnostičkih kriterija. Od nedavno se naglašava kako se prilikom postavljanja dijagnoze treba tragati za pozitivnim znakovima umjesto postavljanja dijagnoze metodom isključivanja. Nekoliko je obilježja u kliničkom tijeku ovih stanja važno prepoznati radi njihovog razlikovanja. Neki od obilježja P/F tikova su su nagli početak u odrasloj dobi, fizička aktivnost kao poticaj, negativna obiteljska anamneza, varijabilna, kompleksna i promjenjiva fenomenologija, sugestibilnost i distraktibilnost. S druge strane, premonitorna napetost, osjećaj prekomjerne energije i “nervoze” prije tika, obično su obilježja Gilles de la Tourette sindroma. Ukoliko je premonitorna napetost prisutna i kod P/F tikova, riječ je o kvantitativno i kvalitativno različitim obilježjima. Još jedan mogući dijagnostički alat je i tzv. Bereitshaftspotential (premotorički potencijal), uz događaj vezan električni potencijal povezan sa započinjanjem pokreta koji se dijeli u dvije faze - ranu (BP1) i kasnu (BP2). Rana faza čija se pojava opisuje prethodno P/F tikovima, izostaje prethodno tikovima u sklopu GTS-a. U svakodnevnom kliničkom radu razlikovanje GTS od P/F tikova često je vrlo izazovno, ali adekvatno uzeta anamneza, aktivnije traganje za pozitivnim simptomima i korištenje elektrofizioloških pretraga može pridonijeti donošenju prave dijagnoze.

Abstract (english)

A tic is a sudden, rapid, recurrent, nonrhythmic motor movement or vocalization. Motor and phonic tics in a course of over 1 year that first occured before 18 years are the main features of Gilles de la Tourette syndrome (GTS). Psychogenic/functional (P/F) tics were considered as a diagnosis made per exlusionem in a lack of agreement on diagnostic criteria. Recently, the emphasis is put on looking out for positive signs when making diagnosis of P/F tics. Several features in clinical course are important to differentiate GTS from P/F tics. Some of them are acute onset in adulthood, precipitation by physical event, absent family history of tics, variable, complex and inconsistent phenomenology, suggestibility, distractibility. On the other hand, premonitory urge, feeling of excessive energy and being 'wound up' prior tic are usual features of GTS. If present, such premonitory urge have different qualitative and quantitative marks. Another possible diagnostics tool could be the beireitshaftspotential (pre-motor potential), an event-related electrical potential associated to the initiation of movement which is divided in two phases, early (B1) and late (B2) phase. Early phase, whose occurence, in some papers, has been reported prior P/F tics, is absent prior performed tic in GTS. In everyday clinical practice differentiating GTS rom P/F tics is often very challenging but taking proper medical history, paying more attention to positive signs and possibly using electroneurophysiology tests could contribute in making the right diagnosis.

• Keywords: Gilles de la Tourette sindrom; tik; psihogeni tik; funkcionalni tik; premonitorna napetost
• Keywords (english): Gilles de la Tourette syndrome; tic; functional tic; psychogenic tic; premonitory urge
• Language: croatian
• URN:NBN: urn:nbn:hr:105:905495
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2022-03-25 12:33:50