• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제23권2호
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• pp.63-68
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• 2012

Objectives : The purpose of this study was to examine the association of exposures to heavy metals with positive diagnosis for attention-deficit hyperactivity disorder (ADHD) and Tourette's syndrome (TS). Methods : Study participants included 27 children diagnosed with ADHD ($9.9{\pm}2.9$ years of age), 21 diagnosed with Tourette's disorder ($10.7{\pm}2.2$ years of age), and 45 normal control children ($9.6{\pm}0.5$ years of age). A Perkin-Elmer mass spectrometer was used to measure the concentrations of 5 heavy metals (Pb, Cd, U, Be, Hg) in hair samples obtained from each participant. Each heavy metal concentration was compared among the groups by use of a Kruskal-Wallis test. Results : The levels of lead (p=.006) and cadmium (p=.037) observed in the hair of children diagnosed with ADHD were significantly higher than those found in the control subjects. There were no significant differences observed for heavy metal levels when comparing TS and control subjects. Conclusion : We confirmed that lead exposure is a risk factor for ADHD. We also identified that cadmium may be a new candidate risk factor for manifestation of ADHD. We did not find an association between heavy metals and manifestation of TS.

• 턱관절균형의학회지
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• 제10권1호
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• pp.12-20
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• 2020

Objectives: Tourette syndrome (TS) is a disease that occurs evenly in many social classes. Despite the long experience of drug treatment, the preference is low due to various side effects. The aim of this study was to discover herbal medicine resources through network pharmacology analysis predicted to be useful for Tourette syndrome. Methods: We used Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) to identify herbal medicines that can be used for TS by using network pharmacology research methods and to predict the mechanism of action. After evaluating compounds of each identified herb, molecular target proteins and mechanisms of action were analyzed, focusing on compounds that are likely to exhibit clinical activity in consideration of the pharmacokinetic parameters of these individual compounds. Results: Fifty nine ingredients such as atropine, veraguensin, and nuciferin among the compounds contained in 48 types of medicinal herbs such as Daturae Flos (洋金花), Salviae Radix (丹参), and Nelumbinis Plumula (蓮子心) act on the D(2) dopamine receptor, which is a protein involved in the development of TS. It has been found that atropine, veraguensin, and nuciferin are highly likely to exhibit activity by acting on the G protein-coupled receptor signaling pathway. Conclusions: It can be used in conjunction with non-invasive treatment means such as FCST Yinyang Balancing Appliance with herbal therapy to bring about a significant therapeutic effect, and it will be possible to develop a treatment that can replace drug therapy used in Western medicine.

• 한국콘텐츠학회논문지
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• 제22권10호
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• pp.861-869
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• 2022

투렛증후군 환자에게서 뮤파(Mu wave) 동기화가 깨졌을 때 틱이 발생하고, 그 반대로 뮤파 동기화를 이루면 틱이 발생하지 않는다. 연구시험 결과는 전운동피질(Frontal Cortical 3 사이트)에서 뮤파 동기화를 틱 환자가 인위적으로 하지 않고 뉴로피드백 훈련처럼 자율적으로 뇌파 조절이 이뤄진다면 마찬가지 결과로 틱이 발생하지 않는다는 사실을 시사한다. 피시험자에게 틱을 억제시켰을 때 인지 제어 반응 프로세스가 변경된다. 변경된 인지 제어를 뇌파 주파수 파워를 조절하는 뉴로피드백으로 훈련하면 환자가 인위적으로 틱을 억제하지 않아도 자율적으로 치료가 된다. 연구시험 결과는 뇌 운동영역의 뮤파 통제를 통해 틱이 발생하지 않는 생체신호 지표가 뉴로피드백 훈련의 치료프로토콜이 될 수 있는 단초를 마련하였다. 기존 뉴로피드백 치료 프로토콜인 SMR강화, 세타파-베타파 불균형 수정, 알파파 강화 등에 뮤파 강화를 추가할 수 있게 되었다. 본 연구가 투렛증후군 환자 치료법인 뉴로피드백 치료 프로토콜을 보다 과학적으로 검증하는 후속 연구와 임상시험에 활용될 것이다.

• 정신신체의학
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• 제18권1호
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• pp.3-10
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• 2010

뚜렛 증후군은 주로 아동기에 발생하는 만성적인 운동 및 음성 틱을 주소로 하는 질환이다. 기저핵-시상-피질 회로에서의 이상이 비자발성 틱의 병태생리에 중요한 역할을 하는 것으로 생각된다. 뚜렛 증후군은 흔히 주의력 결핍 과잉행동장애나 강박장애와 병존한다. 경두개 자기자극술은 연구용으로 많이 사용되는 신경생리학적 기법이다. 이 기법이 피질의 활성을 변화시킬 수 있다는 증거들이 많아서, 반복적 경두개 자기자극술은 피질의 활성도를 바꾸어서 결과적으로 내재한 서로 연결된 피질-피질하 회로에 영향을 주기 위하여 치료적 목적으로도 사용된다. 우리는 본 논문에서 경두개자극술의 여러 신경생리학적 변인들과 임상적 응용에 관하여 기존의 연구보고들을 고찰하여 보고자 한다.

• 대한불안의학회지
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• 제6권1호
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• pp.24-30
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• 2010

Objectives : Tic disorder is known to be a chronic neuro-behavioral disease, cognitive behavioral treatment (CBT) strategies, like habit reversal training (HRT), are introducing recently. We report the effectiveness of HRT in Tourette disorder, which are very common in clinical settings. Methods : The DSM-IV clinical diagnosis applied by child psychiatrist. YGTSS, Kovac's children's depression inventory, Spielberger State-Trait Anxiety Inventory, Abbreviated Conners' Rating Scales, Dupaul ADHD Rating Scales are used. Ultimately, totally 10 children were evaluated. Subject group are consist of 6 boys and 4 girls, and the mean age was $10.90{\pm}1.73$ years old. This study is treatment-refractory 10 patients (from 9-14 years old) though 1 years drug treatment and psychiatric consultation were taken. We administered 5 times of HRT for 4 weeks. Results and Conclusion : There were improvement of scores in Yale Global Tic Severity Scale, Clinical Global Improvement. Our observations indicate that HRT might be effective in the treatment of Tourette disorder.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제33권4호
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• pp.91-98
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• 2022

Objectives: Comprehensive behavioral intervention for tics (CBIT) is effective in children with chronic tic disorders. This study aimed to assess the effect of group-based CBIT (group-CBIT) on tic severity and comorbid symptoms. We compared the efficacy of group CBIT with that of a control. Methods: Thirty children with chronic tic disorder or Tourette's disorder were enrolled in this study. Eighteen were assigned to the group-CBIT for eight sessions, and 12 were assigned to the control group. Tics and comorbid symptoms were assessed pre- and post-intervention using the Yale Global Tic Severity Scale (YGTSS), Premonitory Urge for Tics Scale, attention-deficit hyperactivity disorder Rating Scale-IV, Children's Yale-Brown Obsessive-Compulsive Scale, and the Korean-Children Behavioral Checklist. We compared the pre- and post-intervention results of each group and determined the difference in the pre- and post-intervention results between intervention and the control group. Results: The YGTSS motor and vocal tic interference, global impairment, and global severity scores decreased in the intervention group only. Group CBIT was superior in reducing the motor tic interference, impairment score, and global severity score to the control group. Conclusion: The group-CBIT showed an improvement in tic symptoms, especially in reducing the level of interference and impairment of tics.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제34권4호
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• pp.236-241
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• 2023

Objectives: According to the 10th revision of the International Classification of Diseases, the main categories of tic disorders (F95.0, F95.1, and F95.2) follow a diagnostic hierarchy based on the duration and diversity of tic symptoms. The present study investigated the use of this diagnostic hierarchy in real-world clinical practice. Methods: Based on the National Health Insurance Service-National Health Information Database, the diagnosis of transient tic disorder (F95.0) made after a diagnosis of chronic motor or vocal tic disorder (F95.1) or Tourette's syndrome (F95.2) and diagnosis of chronic motor or vocal tic disorder (F95.1) made after a diagnosis of Tourette's syndrome (F95.2) were referred to as type A errors. The diagnosis of transient tic disorder (F95.0) repeated after a period of >12 months was referred to as type B error. Demographic and clinical differences according to the diagnostic error types were analyzed using analysis of variance, Student's t-tests, and chi-squared tests. Results: Most participants (96.5%) were without errors in the diagnosis of tic disorders. Higher proportions of males (p=0.005) and antipsychotic prescriptions (p<0.001) were observed in patients with type A or B diagnostic errors. A higher proportion of health insurance holders was observed among those with type A errors (p=0.027). Conclusion: Errors were absent in majority of the tic diagnoses in real-world clinical practice in terms of the diagnostic hierarchy.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제17권1호
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• pp.27-31
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• 2006

연구목적 : Streptococcus 감염에 취약한 생물학적 지표라고 알려진 D8/17 항체가 PANDAS로 의심되는 뚜렛장애 환자에서 높은지를 알아보고, 뚜렛장애군 중 D8/17 양성반응 여부에 따라 임상경과에 차이가 있는지를 알아보고자 본 연구를 시행하였다. 방 법 : PANDAS가 의심되는 뚜렛장애 소아환자 9명과 비교 대상으로 틱증상이 없이 일관되게 지속적으로 주의력결핍 과잉 행동장애를 보이는 2명의 소아를 택하여 B 임파구 D8/17 항원 양성반응 비율과 혈청 ASO 농도를 비교분석하였다. 결 과 : PANDAS가 의심되는 9명의 뚜렛장애 소아의 경우 평균 77.9%($50.9{\sim}100%$) D8/17 B임파구 양성 비율을 보여 비교대상인 2명의 ADHD(24.8%, 53.7%) 보다 의미 있게 높았다. 뚜렛장애 중 90% 이상의 높은 양성비율을 보이는 경우가 4예 (44..4%)였다. 특히 모녀 뚜렛장애인 경우 각각 98.4%, 99.0%라는 높은 수치를 보였다. 뚜렛장애의 심한 정도와 D8/17 양성 임파구 비율간에 의미있는 상관관계는 없었다. ASO titer와D8/17양성 임파구 비율간에 통계적으로 의미 있는 상관관계는 없었지만 뚜렛장애 66.7%에서 100IU/ml 이상을 보였다. 결 론 : 상기결과를 종합하여 볼 때 일부 뚜렛장애 환자의 경우 streptocooccus 감염과 연관된 PANDAS일 가능성이 충분히 있다고 판단되었다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제21권3호
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• pp.133-140
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• 2010

Tic disorders, including Tourette syndrome, are known as neurobiologic disorders and as such, much emphasis has been placed on isolating genetic determinants. Although previous reports involving studies of discordance among monozygotic twins have shown the importance of genetic predisposition, they have also supported a role for environmental factors in the development of tic disorders. Therefore, it is important to consider that both genetic and environmental factors contribute to their clinical expression. The goal of this article was to review recent reports regarding the role of environmental factors in development and progression of tics. Specific environmental factors associated either with a more severe course of illness or improved outcomes were discussed. Given that accumulating evidence had suggested the usefulness of behavior therapies in the suppression of tic disorders, particular emphasis was placed on the impact of several contextual factors.

• 턱관절균형의학회지
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• 제11권1호
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• pp.25-36
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• 2021

It was observed that the effectiveness of Yin-yang balancing therapy of the tempromandibular joint (YBT) or functional cerebrospinal therapy (FCS) in three cases: an acute and a chronic motor tic disorder and a Tourrette's disorder (TD). These three cases were mainly managed with cervical balancing appliance for the Yin-yang Balancing on tempromandibular joint (TMJ) and pelvic balance therapy. They were treated concurrently with acupuncture, cupping and herb-medicine. Clinical outcome measurement was based on subjective measures with visual analogue scale (VAS), Yale Global Tic Severity Scale (YGTTS) and clinical observations for 235, 279 and 273 days respectively. The patient showed positive changes after the treatment and this effect maintained over the follow-up period. Although it is not clear whether the effect is sustained afterwards or not, a positive effect on the motor tic disorders and TD was observed. And so, furthermore strict clinical and structural researches for verification on YBT is expected.