• The Journal of Korean Medicine
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• v.42 no.3
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• pp.139-152
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• 2021

Objectives: The purpose of this review is to investigate the latest traditional Chinese medicine clinical studies on pediatric tic disorder with Tuina treatment and propose the directions of future studies and clinical applications. Methods: To obtain data from CNKI, set the field by '中醫學', '中藥', '中西醫結合' and used keywords '抽动障碍', '抽動穢語綜合', '小兒抽动', '兒童抽动' and '推拿', '導引', '按摩', 'Tuina', 'massage' in cross combination way. Results: 12 clinical studies were selected. These studies were analyzed by author & year, subjects, diagnostic criterion, evaluation criterion, syndrome differentiation, treatment period, methods& results, frequent acupoints and assessment of the quality of studies. All of reports achieved effective therapeutic results on the pediatric tic disorder with Tuina treatment. Conclusion: Tuina treatment has a positive effect and are easily accepted by children who have fear and rejection to traditional Korean Medicine such as acupuncture and Herbal remedy. It is also safe and simple to operate. So the Tuina treatment is worthy to disseminate potential for further development in the treatment of pediatric tic disorders.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.16 no.2
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• pp.183-191
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• 2005

Tic disorder including Tourette's disorder is a neurodevelopmental disorder that appears in childhood and characterized by the presence of motor and vocal tics. Childhood-onset obsessive-compulsive disorder (OCD) is suggested to be a phenomenologically and etiologically distinct subtype of OCD, bearing a close genetic relationship to tic-disorders. Tourette's disorder and OCD are comorbid in $40-75\%$ of patients initially diagnosed with either disorder. Basal ganglia and cortico-striato-thalamic circuits are implicated in the pathophysiology of both disorders and these disorders have similar clinical features. Over the past decades, the progress in research on Tourette's disorder and OCD has been extraordinary. This review describes some of important insights from these work, involving these areas : 1) clinical implication 2) genetics and epidemiology 3) brain imaging study 4) neuroche-mistry 5) pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS).

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.12 no.1
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• pp.149-156
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• 2001

After the fact that obsessive-compulsive symptoms or tic symptoms are common in Sydenham's chorea which is a sequale of rheumatic fever produced by group A beta-hemolytic streptococcus was reported, the association between group A beta-hemolytic streptococcus and a subgroup of obsessivecompulsive disorder(OCD) or tic disorder has been attentioned. This subgroup shared a unique clinical course, characterized by an abrupt onset of symptoms and/or dramatic exacerbations. And this subgroup was distinguished by pre-pubertal onset of symptoms, neurological abnormalities(choreiform movements and a unique pattern of motoric hyperactivity), as well as by relapsing and remitting symptom course. Acronym PANDAS(pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection) was used to denote a subgroup of OCD or tic disorder patients with these clinical characteristics. Then, there was a report suggesting that PANDAS category include some of attention-deficit/hyperactivity disorder(ADHD) and were two case reports of anorexia nervosa and body dysmorphic disorder with characteristics of PANDAS. This case is a patient who developed normally until age of 7, but after pharyngeal inflammation with high fever, he showed disturbance of cognition, social relationship, and language and communication, as well as tic symtoms and abnormal movement on face, hand, and foot. We report this case with review of literatures, because we think that this case belongs to the PANDAS category. Based on this observation, we suggest that PANDAS category include some of childhood disintegrative disorder as well as OCD, tic disorder, and ADHD.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.9 no.1
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• pp.39-41
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• 2013

Behavioral problems could be easily observed in patients with various mental disorders, and may be inevitable. Self-injurious behavior(SIB) can be defined as a deliberate or subconscious alteration or destruction of one's body without conscious suicidal intent. SIB frequently involves oral tissues and could vary from a trifling injury to damages that could lead to further disabilities. The cases presented in this report discuss oral SIB due to Tic disorder and ADHD and their treatments. Clinicians should be well aware of the possibility of oral SIB in various mental disorders as well as the diverse depths of such behaviors accordingly. Moreover, different treatment modalities should be prioritized according to the causative mental disorders.

• Clinical and Experimental Pediatrics
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• v.51 no.9
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• pp.911-921
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• 2008

Learning disabilities (LD) are heterogeneous group of disorders with evidences of genetic or familial trait, intrinsic to the individual and presume to be due to central nervous dysfunction. Learning disabilities and attention deficit hyperactivity disorder (ADHD) are the two of the most common disorders in the population of school-age children. Typically academic achievements in children with learning disabilities are significantly lower than expected by their normal or above normal range of IQ. Although academic and cognitive deficits are hallmarks of children with LD, those children are also at risk for a broad range of behavioral and emotional problems. Almost all cases meet criteria for at least one additional diagnosis such as ADHD, developmental coordination disorder, depression, anxiety, obsessive compulsive disorder, tic disorder, among which ADHD is particularly predominant. Because of the response to the therapeutic intervention program is promising and positive when applied early, it is critical to recognize patients as early as possible. Pediatricians often are the first to hear from parents worried about a childs academic progress. It is not the responsibility of pediatrician to make a diagnosis, referring children for a diagnostic evaluation of LD is a reasonable first step. Pediatricians can make early referral of suspicious children by asking some serial short questions about basic and processing skills. With a basic knowledge about the clinical characteristics, diagnostic and therapeutic procedures of LD, pediatricians also can provide primary counseling and education for parents at their outpatient clinical settings.

• The Journal of Pediatrics of Korean Medicine
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• v.14 no.2
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• pp.149-168
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• 2000

The Purpose of this study was to investigate the new effective oriential medicine tretments in pediatric disease and its clinical applicability The study was composed of 1245 new patients who had been treated at the all unit in the Dong-Seo oriential Medicine Hospitial for 1 year, from 1 April 1999 to 31 March 2000, and aged between 0 and 18 years. The chief complaint was mainly categorized by oral examination on patients and their care-givers. Result 1. The numbers of children who involved in this study is total 1245: Male children are 668 and female children are 577 children. The sex rate between male and female is 1.15 to 1. 2. Most of the above patients came to the hospital at first time from diseases such as musculoskelectal disease, weakness, asthma, cough, anorexia, common cold, rhiorrhea, sweating, dyspepsia, dematitis, night terror, obesity, stomach, short stature, Besides, they also came to the hospital at first time from various diseases such as epistasxis, pyrexia. Bell's palsy, nocturia, contipation, cerebral palsy, disorder, CVA. diarrhea. stress disease, Allergic disease, Tic disorder. Visual disorder, Kawasaki disease, Pierre Robin's syndrom, hematuria, edema and so on. 3. Looking at the frequent diseases, Respiratory dis. children including asthma, cough, rhiorrhea, sweating, common cold, pyrexia covers 36%, in 399 numbers. digestive dis. children including anorexia, dyspepsia, stomach, diarrhea, constipation, indigestion covers 19%, in 211 numbers. cadiovasculary disease children including arrthymia, terror in frequency, night crying, sediation, Tic disorder covers 8%, in 85 numbers. Hepatobiliary disease children including short stature, dizziness, visual difficulty, sprain, disorder of nail covers 21%, in 238 numbers. renal disease. children including nocturia, hematuria, hemation, disorder of hair, menorrhea, cerebral palsy, edema in 44 numbers. Fatigue children covers 13%. in 143 numbers. 4. In case of respatory disease children. total number is 399 children. dematitis children are 108 numbers and asthma children are 96 numbers. These show that children seem to the best have dematitis and asththma. The age from 0 to 6 is 290 numbers, covering 73 percentage. The others are covering 27 percentage. These data demonstrate that the age from 0 to 6 age could easily get these kinds - of diseases. The 29 percent of children had these kinds of diseases in spring. The 28 percent of children had these kinds of diseases in autumn. These show that children seem to frequently have these kinds of diseases in both spring and autumn season.(inter-season) 5. In case of digestive disease, anorexia covers 39%, in 83 numbers, dyspepsia covers 28%, in 59 numbers, anorexia and dyspepsia were the lagest group in digestive disease and the age from 0 to 6 covers 59%, in 125 numbers and the other age covers 39%. According to these data, infant seems to be vulnerable to these kinds of diseases. The 24 percent of children had these kinds of diseases in spring and summer. The 33 percent of children had these kinds of diseases in winter, which means that children mostly had winter. but decreased significant in autumn. 6. In case of cadiovasculary diseases, it can be divided into two categories: night covers 73% and nervous characteristics covers 27%. The age from 0 to 6 occupies 75%, and the other age occupies 25%. These data also show that infants can easily infected with these kinds of diseases. Analyzing by the season, summer could be the most frequent season that children have these kinds of diseases. but decreased in autumn. 7. In case of hepatobiliary children, sprains covers 166 numbers, fatigue covers 32 numbers, epistasxia covers 24 members, the reasion which sprain occupyied most of % were sprain covered ages. The age from 0 to 14 covers 59% and from 15 to 18 covers 41%. In the conclusion the adolescent seems to be vulnerable to sprains. In spring 29%, insummer 31%, in autumn 23%, and in winter 28% of children got these kinds of diseases, which show that children seems to have this kinds of disease in summer season. and decreased in autumn. 8. In case of renal disease. nocturia and hematuria covers 52%(occupied overhalf). The age from 0 to 6 covers 52%(occupied overhalf). Analyzing by season, in spring increased in summer(59%), decreased in autumn(45%) Conclusion 1. The chief complant in pediatric diseases that needed an oriental medical tretment was mainly the disease that tends to take iong time and the weakness. and appeared frequency in respiratory disease : 2. The oriential medical tretment was still preferred as a way to improve the weakness by patients, rather than a way to overcome their disease. In paticular, the study shows that the oriental medical tretment should be emphasized in terms of preventing the disease 3, The new disease, which were developed with the change of human life and envir oment(just like seual disorder, short stature, obesity, dynamic disorder, examinee disease), should be in vestigated as a new field of oriental medical tretment.

• Journal of the korean academy of Pediatric Dentistry
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• v.43 no.3
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• pp.327-333
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• 2016

Tourette's syndrome is a chronic neuropsychiatric disorder characterized by the presence of vocal and multiple motor tics. Tics are defined as brief, intermittent, repetitive, unpredictable, purposeless, and stereotyped movements or sounds. Some patients experience physical pain from intense and complex tics. In addition, motor tics can result in self-injury which is a common feature of Tourette's syndrome. A 9-year-old boy was referred by the department of neuropsychiatry because of a severe tongue laceration. His parents reported that he had been biting his tongue irregularly for 2 months before referral and suffered from an intense burning sensation. The repeated biting resulted in ulcers on the tongue, which quickly worsened and led to progressive difficulty chewing and swallowing food. We offered to give him a two-piece removable appliance to limit tongue biting; it was made of soft silicone and fitted to both the maxillary and mandibular arches. As we emphasized that the device could help alleviate his pain, he agreed to accept it and adapted well. Just 3 weeks later, his tongue lesions had healed significantly.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.15 no.2
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• pp.143-151
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• 2004

Objectives : Child and adolescent onset obsessive compulsive disorder(C-OCD) is known to be associated with poor drug response, high comorbid rate and strong genetic tendencies. Till now studies for C-OCD have been very rare in Korea. We conducted this study to investigate the informations about clinical features, familial psychiatric loading, treatment profiles and course of server C-OCD from the retrospective analysis of inpatient data of Seoul National University Children's Hospital. Method : Retrospective chart review and data analysis was performed. Twenty(male 16 : female 4) patients with final C-OCD diagnosis by DSM-IV at discharge from 1994 to 2002 were found and their medical chart, psychological data, family interview data and nursing reports were collected and analyzed. Results : 1) The sex ratio of C-OCD was male dominant(4:1). 2) Phenomenological, most common obsession was pathologic doubt, contamination fear, followed by aggressive obsession, need for symmetry, sexual obsession, most common compulsion was checking and washing, followed by breathing, movement, symmetry, repetitive asking, hoarding, mental compulsion. 3) Most common comorbid diagnosis was depression. Other axis-I diagnosis associated OCD were anxiety disorder, tic disorder, conduct and oppositional defiant disorder and psychosis. 4) Regarding psychiatric familial loadings, 17 patients(85%) had relatives with psychiatric disorders, OC-spectrum disorders(OCD or OCPD) were found in 9 patients(45%). 5) The majority of patients(75%) have received SSRI and antipsychotics treatment. The response rate above 'moderate improved" by CGI was 75%. 6) During follow-up period in outpatient clinic, five patients(25%) showed continuous complete remission, 10 patients (50%) did residual symptoms with chronic course. Conclusion : This seems to be the first systemic investigation of severe pediatric OCD patients in Korea. The children & adolescents with severe OCD in inpatient-setting showed the high comorbid rate, familial psychiatric loading, and combined pharmacotherapy with antipsychotics, As for symptoms, high rate of aggressive-sexual obsession and atypical compulsions like breathing and moving was reported in this study. Severe pediatric OCD patients, however, responded well to the combined SSRI and antipsychotics regimen.

• Journal of the korean academy of Pediatric Dentistry
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• v.35 no.1
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• pp.47-56
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• 2008

Risperidone is a widely prescribed atypical antipsychotic agent. Approved by the FDA as the first drug to treat irritability associated with autism in children, it is also used to treat tic disorder and Tourette's syndrome. Its adverse reactions related to dentistry include dry mouth, the mechanism of which is yet to be identified. The aim of this study is to identify, at the cellular level, how and to what extent risperidone affects intracellular free calcium concentration ($[Ca^{2+}]_i$), an primary intracellular factor in the regulation of fluid secretion in salivary gland cells. The human salivary gland cell line (HSG) was grown in MEM supplemented with 10% BCS. In order to measure $[Ca^{2+}]_i$, Fura-2/AM was loaded in the HSG, and fluorescence at 340 nm/380 nm excitation was measured in the 500 nm emission ratio. After every experiment, a calibration experiment was conducted in order to readjust the ratio to the actual $[Ca^{2+}]_i$. Changes in $[Ca^{2+}]_i$ were measured in the presence of carbachol, ATP and histamine. The researcher then explored how the pretreatment of risperidone affected such changes. Findings of this study include: 1. In HSG, $[Ca^{2+}]_i$ increased due to the addition of carbachol, ATP and histamine. The presence of risperidone inhibited the action of histamine on this process, while making little effect on that of carbachol and ATP. 2. A quantification of $[Ca^{2+}]_i$ in relation to histamine of different concentrations indicates that the effect of histamine was concentration dependent with an $EC_{50}$ of $3.3{\pm}0.5\;{\mu}M$. 3. The inhibitory effect of risperidone on histamine-induced $[Ca^{2+}]_i$ was concentration-dependent with an $IC_{50}$ of $104.4{\pm}14\;nM$. 4. Risperidone inhibits histamine-induced Ca2+ release from endoplasmic reticulum and influx of extracellular $Ca^{2+}$ in HSG cells(p<0.05).

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.1 no.1
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• pp.117-129
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• 1990

35 children(17 boys, 18 girls) with Recurrent Abdominal pain(RAP) without apparent organic causes, referrd from pediatric department of Seoul National University Children's Hospital were studied during 1988. 7. 1 ${\sim}$ 1989. 2. 28. The aims of this study are to examine clinical characteristics of the patients with RAP, to find possible factors influencing the onset and the course of the disorder, to evaluate the psychological status and the relationship with psychiatric diagnoses. The study subjects were compared with the age and sex matched control subjects on measures of social and school functioning, family-environment, behavior traits by CBCL and parent-environment rating scale. All patients and their mothers were interviewed by a child psychiatrist. The results were as follows ; 1) Abdominal pain was found to be more frequent when with a care taker, and related with traumatic life stresses such as separation from parents, death of family members. 2) Family members of the patients with RAP also had a high rate of a history of gastrointestinal dysfunctions with could not be attributed to organic etiologies. 3) Among 35 patients with RAP, 16 were diagnosed as psychiatric disorders. They were adjustment disorders (4), overanxious disorders (4), depression (2), tic disorders (2), attention deficit disorders (2), separation anxiety disorders (1), enuresis (1). 4) On CBCL, the patients with RAP were more internalized, socially less competent and less active compared with the control subjects. 5) According to the parent-environment rating scale, the patients with RAP had more conflicts with their parents about control issues. Family members of the patients with RAP were socially less competent and less abjustable. The parents of the patients with RAP were more affectionate and spent more time with their children but they were unfair and vague on instruction and discipline.