Giả thuyết cho thấy rằng một số trường hợp TS xảy ra trên cơ sở của một quá trình tự miễn sau nhiễm liên cầu như là một phần của một quang phổ của các triệu chứng neurobehavioral gọi là rối loạn tự miễn dịch trẻ em tâm thần kinh liên quan với nhiễm liên cầu (gấu trúc) | 212 Budman and Kurlan hypothesis suggests that some cases of TS occur on the basis of an autoimmune process following streptococcal infection as part of a spectrum of neurobehavioral symptoms termed pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection PANDAS 36 . Secondary tic disorders may also occur in a number of neurological disorders including Huntington s disease Parkinson s disease progressive supranuclear palsy neuroacanthocytosis Meige s syndrome startle disorders and developmental basal ganglia syndrome 31 37 . COURSE AND PROGNOSIS The onset of tics occurs between the ages of 2 and 15 years in most cases with the mean age at onset being 7 years 38 . The initial tics usually occur in the upper body commonly involving the eyes . eye blinking or other parts of the face. Vocal tics represent the initial manifestation of illness for a minority of patients. Over the short term tics characteristically change in type and wax and wane in severity. The longer term lifelong course of the TS tic disorder has been investigated in several studies. Erenberg found that 73 of adult TS subjects reported that over a period of years their tics had either lessened considerably or almost disappeared 39 . Bruun followed 136 TS patients from 5 to 15 years and found that tic severity lessened over time with 59 rated mild-moderate initially and 91 rated so at follow-up 40 . Over time 28 came off medications and 52 reported spontaneous improvement. Shapiro and Shapiro observed that 5-8 of TS patients recover completely and permanently in adolescence tics become less severe in 35 of cases during adolescence and less severe in most patients in adulthood 38 . Thus many patients with TS experience an improvement or resolution of tics after adolescence. TREATMENT OF TICS Most patients with mild tics who have made a good adaptation in their lives can avoid the use of any medications. Educating patients family members peers and school personnel .
