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妥瑞症

維基百科,自由的百科全書
(已重新導向自 妥瑞氏症)
前往: 導覽搜尋
Tourette syndrome
同義詞 Tourette's syndrome, Tourette's disorder, Gilles de la Tourette syndrome (GTS)
Head and shoulders of a man with a shorter Edwardian beard and closely cropped hair, in a circa-1900 French coat and collar
Georges Gilles de la Tourette英語Georges Gilles de la Tourette (1857–1904), namesake of Tourette syndrome
醫學專科 小兒科神經內科精神醫學
症狀 抽動綜合症[1]
常見發病年齡 常見於童年[1]
病程 長期[1]
肇因 基因因素環境因素[1]
診斷方法 根據歷史和症狀[1]
治療 衛教、行為治療[2][1]
藥物 通常沒有、有時候會使用抗精神病藥[1]
預後 青春期後期症狀可能消失[1]
盛行率 大約 1%[3]
Tourette syndrome
Gilles de la Tourette, Georges (1857-1904) CIPA0179.jpg
法國醫師Georges Gilles de la Tourette
(1857-1904)
分類和外部資源
醫學專科 神經內科小兒科
ICD-10 F95.2
ICD-9-CM 307.23
OMIM 137580
DiseasesDB [1]
MedlinePlus [2]
eMedicine [3] neuro/664
MeSH D005879
影片介紹(英文)

妥瑞症(英語:Tourette SyndromeTS}}),又稱抽動症托雷氏症杜雷氏症,是一種抽動綜合症(tics)。這是一種遺傳性的神經內科疾病,通常發生於學齡前至青春期前。有一部份的患者會在青春期後大幅減輕症狀。

妥瑞氏症的症狀包含了聲音型和運動型抽動綜合症,會不受自主控制地發出清喉嚨的聲音或聳肩、搖頭晃腦等。患者本身並非故意或習慣性做出這些動作,其症狀乃肇因於腦內多巴胺不平衡。治療方式一般採取抗精神病藥抑制症狀,或行為治療等。症狀通常時好時壞,與患者所處環境造成的心理壓力有一定的相關性,家庭、學校與社會對此疾病的不認識或多或少會加深正常人與妥瑞症患者間的誤解,進而誘發更強烈的症狀。常見的誤解例如:把妥瑞氏症患者當成調皮搗蛋的壞習慣,進而要求患者以接受體罰等方式刻意矯正其抽動症狀[7]

抽動症在單一妥瑞氏症患者身上亦非一成不變,聲音型抽動症患者有可能轉變或合併成為運動型抽動症。

通常,妥瑞症不會以單一抽動症狀出現,常伴隨強迫症穢語症注意力缺失與過動症等。其確診亦不能以單一抽動症狀的發生而斷言之。另外,妥瑞氏症常被誤診為氣喘、眼睛過敏或呼吸道綜合症等,在(被)診斷時需格外留意。

分類 Classification[編輯]

診斷[編輯]

1885年,妥瑞症首先由法國醫生Georges Gilles de la Tourette發現並描述,是一種非常嚴重的抽動性疾病,包括運動抽動、聲音抽動以及綜合抽動。診斷標準包括:在18歲以前發病,有不斷復發、無法由意志控制、快速且盲目的影響大部分肌肉群的動作痙攣或多種聲音痙攣。在一個階段內,可能的嚴重程度可以有變化,而症狀會持續一年以上。

值得注意的是,該診斷標準是相對於個人,並不是絕對的。很少有妥瑞症的發病在21歲後,且「無法由意志控制」的標準很難定義。實際上,有些病人會有一種內部意志驅使運動的感覺,並伴隨著心理緊張以及焦慮。該診斷標準裡,並沒有提及妥瑞症病人經常會表現出來的其他缺陷,例如:注意力問題、強迫症以及ADHD問題。

症狀(Characteristics)[編輯]

範例

外顯症狀[編輯]

內隱症狀[編輯]

病因[編輯]

遺傳性因素[編輯]

環境性因素[編輯]

病理生理學[編輯]

The basal ganglia are at the brain's center; related nearby structures are the globus pallides, thalamus, substantia nigra, and cerebellum.
Brain structures implicated in Tourette syndrome

The exact mechanism affecting the inherited vulnerability to Tourette's has not been established, and the precise cause is unknown. Tics are believed to result from dysfunction in cortical and subcortical regions, the thalamus, basal ganglia and frontal cortex.[36] Neuroanatomic models implicate failures in circuits connecting the brain's cortex and subcortex,[27] and imaging techniques implicate the basal ganglia and frontal cortex.[37]

診斷[編輯]

Screening[編輯]

治療/管理 (Management)[編輯]

藥物治療[編輯]

西藥[編輯]

常用於控制妥瑞氏症的藥物有Haldol(好度液)、Ziprasidone、Pimozide、Resperidol(理思必妥)、Ablify(安立復)等藥物[54]。皆有其效果及副作用。上述抗精神病藥物多需搭配對應的抗副作用藥物使用,例如Ablify常需配合Benzhexol使用。

分類 適應症 藥品學名 藥品商品名 作用機轉 副作用
正腎上腺素致效劑 抽動綜合症
典型抗精神病劑

(多巴胺受體 D2拮抗劑)

抽動綜合症
非典型抗精神病劑

(多巴胺受體 D2及血清素5-HT2拮抗劑)

抽動綜合症
非典型抗精神病劑

(多巴胺受體 D2及血清素5-HT2部份致效劑)

抽動綜合症
多巴胺消除劑 抽動綜合症

中藥[編輯]

中藥治療常用補中益氣湯抑肝散等藥物調理,見效較緩慢。

行為治療[編輯]

認知行為治療習慣反轉訓練可以用來訓練妥瑞氏症(合併強迫症)患者來察覺與自我管理抽動綜合症,此兩種訓練需要由專業的心理師負責執行,其效度尚待大規模統計資料來確立。

坊間有許多民俗療法如氣功等,尚無大規模統計資料來確立其效度。

一些醫學研究指出[55]正念減壓(MBSR)課程有對於妥瑞症的症狀減輕來說有一定的統計學顯著性。

手術[編輯]

已知的手術治療方式有腦深層刺激手術,為實驗性質侵入性治療方式,醫師通常不會主動建議使用手術治療妥瑞氏症。

正常人與妥瑞氏症患者相處的方式[編輯]

社會層面[編輯]

加強在公共場所看到妥瑞氏症患者時的體諒及關懷,例如:用餐或搭乘大眾運輸時如遇到類似患者,不要加以指指點點

教育層面[編輯]

在相關課程中可以大略提到該疾病的介紹,畢竟妥瑞氏症患者不在少數,加強這方面宣導或教育也可以增加對於患者的了解跟體諒。

家庭層面[編輯]

家人往往是最大的支持,若家裡有妥瑞症患者,父母和家人要更加深入了解,不要使患者感覺到連家人都不支持、不了解自己。

相關併發症[編輯]

預後及復發率[編輯]

社會與文化層面的影響[編輯]

盛行率[編輯]

相關影劇[編輯]

相關書籍及出版物[編輯]

  • 《站在學生前面》,遠流出版。
  • 《勇氣之歌》,智園出版。
  • 《又抖又叫——鬥陣妥瑞症》,新迪出版。

參考來源[編輯]

書目
引用
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  113. ^ US media:
  114. ^ UK media:
  115. ^ 開眼電影網上《Vincent will Meer 文生去看海》的資料(繁體中文)[2015-12-20]

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