Integrative treatment for tics and tourette syndrome in Malaysia - By Hiro Koo

INTRODUCTION

Human brain can be trained at any age and new neurons are produced throughout our life. The term of neuroplasticity is well accepted nowadays.  EEG biofeedback or neurofeedback is based on the concept of neuroplasticity that trains the brain like a muscle. It is safe, non-invasive, with no known side effects. It is basically based on the principle of operant conditioning which utilizes the reinforcement concept to change the brain.

When it comes to neurological or mental disorders, pharmaceutical intervention is usually recommended to deal with the brain by improving neurochemical or brain structure components. Interestingly, the electrical component which is brainwaves has been neglected most of the time. Even a person with perfect neurochemical and brain structure but without any noticeable brainwaves, this can be certified as brain death by a qualified neurologist or physician. Thus, brainwaves intervention such as EEG biofeedback training should be included as one of the treatment plans while dealing with issues related to our brain and mind. In fact, EEG biofeedback is not something new as it has more than 50 years of established scientific studies. It is proven to be helpful in cases such as Attention Deficit Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD), anxiety, insomnia, depression, and tics and Tourette Syndrome. EEG biofeedback for tic disorder is worth investigating as it directly deals with the brain. Another major benefit is the hope that it can help patients avoid pharmaceutical intervention which might cause side effects. As mentioned earlier, a healthy state of brain includes the component of electrical, brain structure and neurochemical. EEG biofeedback alone might not be sufficient to get rid of the entire problem as it primarily improves the brain function to perform better. In this case, integrative treatment approach such as combining with psychotherapy, hypnotherapy, and nutritional therapy can be recommended to get the best therapeutic outcome.

Neuro-hypnotherapy on the other hand, is the first of its kind in Malaysia. It is a technique by combining EEG biofeedback technology and the science of hypnosis. Hypnosis is a skill which involves the use of words and suggestions to achieve therapeutic outcome, while the clinical hypnotherapy is a technique which utilizes the concept of hypnosis to achieve clinical outcomes (Kaya & Alladin, 2012). Clinical hypnotherapy has been acknowledged as an evidence based therapy tool by various medical councils in the world and it has been proven to be helpful for various medical conditions (Abbot NC, Stead LF, White AR, Barnes J, Ernst E., 2008). Clinical hypnotherapy is considered as the oldest form of psychotherapy as well as complementary medicine (Lam, 2013). By utilizing this technique, we can combine self-hypnosis method with other psychotherapy method such as habit reversal training. Habit reversal training (HRT) is evidence based non-pharmaceutical interventions for tics and Tourette syndrome, which has been found to alleviate motor and vocal tics (Piacentini & Chang, 2006). Once patients learn the self-hypnosis technique, they learn to deal with their stressors and healthier ways to remain calm. 

Tourette Syndrome (TS) or Gilles de la Tourette Syndrome is one type of Tic disorder. TS is characterized by involuntary tics, repetitive movements, and vocalizations. Normally it will start between the ages of 5-7 years old and becoming more severe between the ages of 8-12 years old. Motor tics (simple or complex motor tics) and vocal/phonic tics (simple and complex vocal tics) are two common characteristics of tic disorder. Simple motor tics include eye blinking, head jerking, jaw movements, shoulder shrugging, neck stretching, and arm jerking. Complex motor tics include hopping, twirling, and jumping. Simple vocal tics include sniffing, throat clearing, grunting, hooting, and shouting. Complex vocal tics include words which may or may not be recognizable or it could be socially unacceptable words. Tic disorder can be differentiated into three types which is Tourette Syndrome, Chronic Tic Disorder (Vocal or motor type), and Provisional Tic Disorder. Individual with at least two motor tics and at least one vocal/phonic tics over the course of more than 1 year can be classified as TS. One suffered with either motor tics or vocal/phonic tics for more than 1 year can be classified as Chronic Tic Disorder. If the tics were presented less than 1 year, it can be classified as provisional tics disorder. Patients with TS are at high risk of having comorbid major neurodevelopmental and neuropsychiatric conditions such as Attention Deficit Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD), Learning difficulties, behavior problems, anxiety, mood issues, social skills deficits, or sleep related problems.

Author: Hiro Koo

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