Compulsive movement syndrome in children: what causes it and how it is treated

In pediatric neuropsychiatry, in the presence of involuntary movements that periodically occur in a child regardless of his desire, and it is impossible to stop their attacks by an effort of will, obsessive-compulsive disorder in children can be diagnosed.

Such repetitive stereotypical movements are either part of a general neurotic obsessive state, or are a manifestation of a paroxysmal psychoneurological disorder, or are considered a sign of extrapyramidal motor disorders.

Epidemiology

According to foreign experts, more than 65% of hyperactive children whose parents consulted neurologists had problems at birth or in early infancy. But in 12-15% of cases, it is impossible to determine the true cause of obsessive-compulsive disorder in a child due to the lack of complete information.

Recent studies from Washington University School of Medicine and the University of Rochester indicate that the prevalence of tics is approximately 20% of the population, and the incidence of chronic tic disorders in children is about 3% (with a 3:1 boy to girl ratio).

Imperative muscle motor skills in the form of tics rarely appear before the age of two, and the average age of their onset is about six to seven years. In 96% of cases, tics are present before the age of 11. At the same time, with a mild degree of severity of the syndrome in half of the patients, by the age of 17-18 it becomes practically unnoticeable.

Among pediatric patients with severe or profound intellectual disabilities, the prevalence of obsessive-compulsive disorder is 60%, and in 15% of cases, children injure themselves with such movements.

By the way, despite its connection with mental disorders, there are children and adults with normal intelligence and adequate care who have this syndrome.

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Causes of compulsive movement syndrome in children.

In the majority of clinical cases, specialists associate the causes of obsessive-compulsive disorder in children with neuroses of stress etiology, often defining this disorder as obsessive-compulsive disorder.

This syndrome can be observed in a state of increased anxiety in a child, early childhood autism syndrome, and also Asperger's syndrome in children.

In prepubertal adolescents, obsessive movements may be a symptom of developing obsessive-compulsive disorder.

Movement disorders – obsessive-compulsive disorder in adults – are discussed in detail in the publication Nervous tic and the article Tourette syndrome. In addition, with age, the factor of microcirculation disorders in cerebral vessels and the threat of cerebral ischemia increases – due to atherosclerosis.

In childhood, the appearance of imperative stereotypical movements - as a sign of neurodestructive disorders - is possible with disruptions in the functioning of the central nervous system due to perinatal damage to brain structures due to hypoxia and cerebral ischemia, as well as trauma during childbirth, leading to various encephalopathies.

This complex of symptoms is considered comorbid to hyperkinetic syndrome, which is typical for disorders of the extrapyramidal system: damage to motor neurons of the lateral horns of the spinal cord; the brainstem and cortex; basal ganglia of the cerebral subcortex; reticular formation of the midbrain; cerebellum, thalamus and subthalamic nucleus. As a result, chorea, athetosis and hemiballismus occur. For more details, see the material - Hyperkinesis in children.

There are a number of neurodegenerative diseases, the pathogenesis of which is caused by gene mutations and inherited neurological disorders associated with the appearance of obsessive-compulsive disorder in children at a fairly early age. Among them are:

• genetic defects of mitochondria (ATP synthesizing) contained in the plasma cells – mitochondrial diseases that disrupt energy metabolism in tissues;
• congenital lesions of the myelin sheaths of nerve fibers in metachromatic leukodystrophy;
• mutation of the PRRT2 gene (encoding one of the transmembrane proteins of the tissues of the brain and spinal cord), causing paroxysmal obsessive movements in the form of kinesogenic choreoathetosis;
• pathological accumulation of iron in the basal ganglia of the brain (neuroferritinopathy) caused by a mutation in the FTL gene.

A certain place in the pathogenesis of the paroxysmal motor disorder under consideration is occupied by pathologies of an endocrine nature, in particular, hyperthyroidism and autoimmune thyroiditis in a child. And the origin of hereditary benign chorea, as studies have shown, lies in mutations of the thyroid transcription marker gene (TITF1).

Among autoimmune diseases, systemic lupus erythematosus is also related to the development of involuntary movements, which at a certain stage of development leads to a number of CNS pathologies.

Experts do not exclude a connection between the cause of obsessive-compulsive disorder in children and a state of catatonic agitation induced by some forms of schizoaffective states and schizophrenia; craniocerebral trauma; intracranial tumors; organic cerebral lesions with the development of gliosis changes in individual brain structures; infections – viral encephalitis, Neisseria meningitidis or Streptococcus pyogenes, which causes rheumatic fever.

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Risk factors

The key risk factors for the development of any group of symptoms of a psychoneurological nature, including obsessive-compulsive disorder in a child, teenager or adult, are the presence of pathologies leading to movement disorders.

As clinical practice shows, this syndrome can affect anyone at any age, but it affects boys to a much greater extent than girls. Obsessive movements are especially often observed in children born with mental retardation due to genetic abnormalities, with negative impact on the fetus during intrauterine development, or as a result of the development of postnatal pathologies.

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Pathogenesis

The pathogenesis of some hyperkinetic disorders may be due to the lack of balance of CNS neurotransmitters: acetylcholine, which is responsible for muscle contractions and relaxation; dopamine, which controls muscle fiber movements; and norepinephrine and adrenaline, which excite all biochemical processes. Due to the imbalance of these substances, the transmission of nerve impulses is distorted. In addition, high levels of sodium glutamate, or glutamate, enhance the stimulation of neurons in the brain. At the same time, gamma-aminobutyric acid (GABA), which inhibits this excitation, may be in short supply, which also interferes with the functioning of the motor areas of the brain.

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Symptoms of compulsive movement syndrome in children.

The most common symptoms of this disorder may include the following nonfunctional (purposeless) movements (repetitive and often rhythmic) involving the muscles of the tongue, face, neck and trunk, and distal extremities:

• rapid blinking;
• coughing (imitating “throat clearing”);
• shaking, waving, or twisting of hands;
• slapping the face;
• banging your head (against something);
• self-inflicted blows (with fists or palms);
• bruxism (grinding of teeth);
• sucking fingers (especially thumbs);
• biting fingers (nails), tongue, lips;
• hair pulling;
• gathering of skin into a fold;
• grimaces (facial tics);
• monotonous oscillation of the whole body, bending of the torso;
• chorea-like twitching of the limbs and head (abrupt nodding of the head forward, to the sides);
• bending of fingers (in many cases – in front of the face).

Forms

The types of repetitive movements vary widely, and each child may have their own individual manifestation. It may increase with boredom, stress, excitement, and fatigue. Some children, when they are given attention or distracted, can stop their movements abruptly, while others are unable to do so.

In addition to the above, children with obsessive-compulsive disorder may have signs of attention deficit, sleep disorders, and mood disorders. And the presence of rage attacks and explosive outbursts indicates Asperger's syndrome or obsessive-compulsive disorder.

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Complications and consequences

Some aimless movements may cause self-harm. In addition, the syndrome may cause distress in the child, which leads to some reduction in the quality of life, complicates communication and socialization in a children's group; in some way affects the ability to self-care and limits the scope of joint activities outside the home environment.

Diagnostics of compulsive movement syndrome in children.

First of all, diagnosing obsessive-compulsive disorder in a child requires a qualitative assessment of the type of movement and the circumstances of its occurrence, which are often difficult to determine. Moreover, motor stereotypes are often diagnosed in patients with mental retardation and neurological conditions, but can also occur in mentally healthy children. For example, obsessive movements in adolescents that raise suspicion of a degenerative disorder (myoclonus) can be completely normal in infants.

A complete history and physical examination of the child is necessary - including an assessment of the presenting symptoms (which must be present for at least four weeks or longer). This will confirm the diagnosis of this syndrome.

To find out its cause, tests may be prescribed:

• general blood test (including determination of hematocrit, circulating red blood cell mass, ESR);
• blood test for amino acid levels, thyroid hormones, antithyroid antibodies, lupus anticoagulant, antistreptolysin, etc.;
• urine analysis for protein components;
• cerebrospinal fluid analysis or genetic analysis of parents (if necessary).

Instrumental diagnostics can be used: electroencephalography; CT, MRI and ultrasound angiography of the brain, electromyography.

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Differential diagnosis

Differential diagnosis is essential because the difficulty in identifying this condition lies in the need to distinguish it from other paroxysmal neurological problems associated with chorea, myoclonus, spasticity, dystonia, and seizures.

In addition, it is necessary to differentiate the manifestations of obsessive-compulsive disorder and the symptoms of temporal lobe epilepsy – in the form of attacks of stereotypical motor skills.

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Treatment of compulsive movement syndrome in children.

Treatment of obsessive-compulsive disorder in children is no less problematic, since there are no consistently effective medications for this pathology, and there is no evidence of the effectiveness of therapy (especially when the movements do not interfere with everyday life).

What to treat, what to drink for obsessive involuntary movements in children? If the child does not have significant deviations in the level of intellectual development, classes with a child psychologist and exercises aimed at correcting the habit and behavioral changes can be useful. But when motor disorders can injure the child, certain physical restrictions may be required (for example, if the child often hits his head, he should wear a helmet).

There are medications that are used with some success in severe forms of this syndrome. Since stress is a common trigger for the onset of an attack, antidepressants such as Thioridazine or Sonapax (only from the age of three), Clomipramine or Anafranil (only after the age of five) are used. More information about contraindications and side effects that may outweigh the benefits of these drugs is in the material - Pills for stress, as well as in the publication - Sedatives for children of different age groups.

Drug treatment may include cerebroprotective agents - nootropics, most often Piracetam (for children over one year old), as well as drugs based on hopantenic acid (Pantocalcin, Pantogam).

It is recommended to give children vitamins: C, E, B1, B6, B12, P.

Physiotherapeutic treatment can give positive results: electrical procedures, massage, balneology, exercise therapy.

Traditional medicine is not designed to help with paroxysmal psychoneurological disorders, but the advice to walk barefoot on grass, sand or pebbles can be perceived positively, given the benefits of activating the reflex zones on the feet.

In some cases, herbal treatment can have a positive effect, for which it is best to use plants such as valerian (roots and rhizomes), motherwort (herb), peppermint and lemon balm (leaves), lavender, etc. Details in the publication - Soothing collection.

Prevention

It is not possible to prevent obsessive-compulsive disorder in children. However, early recognition of symptoms and qualified help to minimize them can help reduce the risk of a child getting injured by his own actions.

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Forecast

The prognosis depends on the severity of the disorder. It should be taken into account that periodic involuntary movements, as neurologists claim, reach their peak in adolescence, then decrease and become less pronounced.

Although behavior modification can reduce the severity of this syndrome, it rarely goes away completely, and in children with severe mental retardation it may even get worse.

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