When we experience excessive stress—whether from internal worry or external circumstance—a bodily reaction is triggered, called the "fight or flight" response. Originally discovered by the great Harvard physiologist Walter Cannon, this response is hard-wired into our brains and represents a genetic wisdom designed to protect us from bodily harm. This response actually corresponds to an area of our brain called the hypothalamus, which—when stimulated—initiates a sequence of nerve cell firing and chemical release that prepares our body for running or fighting.
When our fight or flight system is activated, we tend to perceive everything in our environment as a possible threat to our survival. By its very nature, the fight or flight system bypasses our rational mind—where our more well thought out beliefs exist—and moves us into "attack" mode. This state of alert causes us to perceive almost everything in our world as a possible threat to our survival. As such, we tend to see everyone and everything as a possible enemy. Like airport security during a terrorist threat, we are on the look out for every possible danger. We may overreact to the slightest comment. Our fear is exaggerated. Our thinking is distorted. We see everything through the filter of possible danger. We narrow our focus to those things that can harm us. Fear becomes the lens through which we see the world. We can begin to see how it is almost impossible to cultivate positive attitudes and beliefs when we are stuck in survival mode. Our heart is not open. Our rational mind is disengaged. Our consciousness is focused on fear, not love. Making clear choices and recognizing the consequences of those choices is unfeasible. We are focused on short-term survival, not the long-term consequences of our beliefs and choices. When we are overwhelmed with excessive stress, our life becomes a series of short-term emergencies. We lose the ability to relax and enjoy the moment. We live from crisis to crisis, with no relief in sight. Burnout is inevitable. This burnout is what usually provides the motivation to change our lives for the better. We are propelled to step back and look at the big picture of our lives—forcing us to examine our beliefs, our values and our goals. Source: http://www.thebodysoulconnection.com/EducationCenter/fight.html
Tourette syndrome (TS), also known as Tourette’s Disorder, is a neurodevelopmental disorder characterized by multiple motor tics and at least one vocal tic present for greater than one year. Among the neurodevelopmental disorders in the DSM-5, TS is the most complex of the spectrum of tic disorders, which includes:
Tourette’s disorder
Persistent motor or vocal tic disorder: one or more motor or vocal tics have been present for greater than one year
Provisional tic disorder: motor and/or vocal tics have been present for less than a year.
Psychiatric disorders, such as obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD) frequently co-occur in TS. Tic symptoms typically begin in early childhood, peak before puberty, and attenuate later in adolescence.
Symptoms and phenomenology
Tics are rapid, repetitive, non-rhythmic movements or vocalizations. Motor and vocal tics are divided into two classes: simple and complex. Simple motor tics are brief movements involving one muscle group. Simple vocal tics are characterized by simple sounds.
Simple motor tics include eye blinks, facial grimaces, head and neck jerks, and shoulder shrugs. Briefly sustained postures (e.g., blepharospasm, oculogyric movements, and sustained mouth opening) can also be classified as simple motor tics.
Simple vocal tics include coughing, sniffing, throat clearing, grunting, and squeaking.
Complex motor tics are more purposeful or orchestrated patterns of movement; complex vocal tics are longer, more orchestrated patterns of speech.
Examples of complex motor tics are turning while walking, echopraxia (imitating gestures) and copropraxia (obscene gestures).
Complex vocal tics include repeated words or phrases, echolalia (repeating another person's words or phrases) and coprolalia (uttering obscenities). Although coprolalia can cause considerable social distress, it is infrequent, and occurs in only approximately 10% of patients.
A distinguishing characteristic of tics are the sensations that may precede the movement or sound, termed premonitory sensations or "urges." Sometimes patients can localize these feelings to particular parts of the body from which the tic emerged.
Even if not localizable, patients often describe a feeling of inner discomfort, using words such as a “build up of tension," or describe an unexplainable urge or impulse to perform the tic. Most patients experience an intensification of these sensations or urges when they suppress their tics.
Patients also often describe a strong need to repeat the tic until it feels "just right". After performing the tic, a sense of relief is experienced, although sometimes brief.
Descriptions of these sensations may be difficult for younger patients to express, but there is a quantitative, pictorial rating scale of these urges that can be used with children.
Epidemiology
TS is reported worldwide, with prevalence from 0.3% to 0.9%. It affects boys 3 to 4 times more frequently than girls.The vast majority of individuals with TS have behavioral and/or emotional symptoms or disorders; only 12% across all ages are reported to have only tics without other associated conditions.
From a worldwide dataset, ADHD is the most common comorbid psychiatric disorder, and accounts for about 55% of the behavioral findings. Other disorders, such as mood and anxiety disorders and learning disorders, are also frequently present.
Etiology
The cause of TS remains unknown, although evidence from genetic studies suggests that TS is inherited. Genetic factors seem to be the most important etiology, given significant familial aggregation and supporting twin studies.
Monozygotic twin studies show 53% concordance for TS and 77% for persistent (chronic) motor tics, whereas dizygotic twins show 8% and 23% concordance, respectively.
Environmental factors, including perinatal insults, sex-hormone exposure during brain development, and psychosocial stressors, are also thought to contribute, and thus the overall expression of TS is thought to be multifactorial.
Diagnosis
Diagnosis is made by a comprehensive clinical history from reliable sources, most often parents. Currently there is no identifiable biological marker for a TS diagnosis. A thorough, detailed history focusing on onset, time course, phenomenology such as urges or sensations, exacerbating and ameliorating factors, family history, and comorbid symptoms is essential. A general medical and neurological exam is indicated.
When eliciting history from the parent and patient, inquiry regarding onset of tics is important, as they typically begin in early childhood, followed by a waxing and waning course. Often tics worsen in late childhood prior to puberty.
Although tics tend to wax and wane, with one tic replacing another, sometimes tics can present abruptly or in acute bursts. Explosive, acute onset over 24 to 48 hours, particularly of OCD symptoms, may be suggestive of infectious or autoimmune etiology.
Potential day-to-day exacerbating factors, such as medications (stimulants in some patients, including caffeine and over-the-counter decongestants or cold remedies), fatigue, boredom, and stressors should be noted.
Tic symptoms may be difficult to disentangle from other common childhood symptoms of allergies or cough-variant asthma. Inquiry regarding seasonal patterns, and presence of other allergy-associated symptoms such as rhinitis and post-nasal drip, can be helpful in the differential diagnostic process.
Additionally, at times it may be difficult to differentiate complex motor tics from compulsions, as OCD symptoms frequently co-occur in children with TS. Repetitive behaviors preceded by urges or sensations are more likely to be complex tics, whereas repetitive behaviors that are preceded by a cognition, often a worry, are more likely to be compulsions.
At newmindcentre.com, we provide help by using intervention such as:
1) EEG biofeedback training for Tics and Tourette Syndrome
2) Habit Reversal Therapy combined with Clinical Hypnotherapy
We are one of the international contacts of Tourette Association of America. We provide information and support to families in Malaysia.
For information on the latest treatment options, please visit the Tourette Association of America's treatment page or contact us via email: [email protected]
EEG biofeedback/Neurofeedback training (Brain entrainment) is a safe, painless and non-invasive training method to improve your brain function. Brain entrainment falls under the jurisdiction of the Association of Hypnotherapy Practitioners, Malaysia (AHPM) - clause 3(b). EEG biofeedback method is not a medical diagnostic tool but a training device. It is designed to give the client’s subconscious mind a voice, and allow the Clinical Hypnotherapist to reveal the various underlying factors that shape the client’s cognitive abilities, emotional responses, and automatic behavior.
It is based on operant conditioning concept, a reward system for the brain, to change the amplitude of brainwaves within a given frequency. There is no input of energy or drugs in the EEG biofeedback that we provide. What is the purpose of that? It can change the way you function... for example if you are too anxious we reward reduction of high-frequency waves which relate to tension and anxiety. This will train your brain to calm itself, and after repeated training, the calm state becomes more of a trait. EEG biofeedback training can be used to improve concentration, calmness, focus, stability of mood and to address many symptoms. Many patients with ADHD or anxiety or depression find neurofeedback to be a very useful alternative to drug treatments. Many people struggle to cope with cravings due to addictions... EEG biofeedback training can assist with the process of recovering from addictions. We train children, adolescents, and adults. Many people use neurofeedback training to reduce or terminate reliance on medications (with medical doctor supervision). Most people find meaningful changes in the short term in a few sessions and longer term changes in 20-40 sessions.
Disclaimer: Brain Entrainment method (Neurofeedback/EEG biofeedback) is not a diagnosis tool or a cure for any diagnosed conditions. It works by resolving the underlying imbalances and brain dysregulation. It is clearer viewed as personal training rather than a treatment.
