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La parakinésie brachiale oscitante
Yawning: its cycle, its role
Warum gähnen wir ?
 
Fetal yawning assessed by 3D and 4D sonography
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mise à jour du
20 août 2014
J Psychosom Res.
2008;65(5):497-500
Air swallowing as a tic

Weil RS, Cavanna AE, Willoughby JM, Robertson MM

Chat-logomini

 
A tic is a brief involuntary movement that can be suppressed by the individual but at the expense of mounting inner tension, often with subsequent rebound. Gilles de la Tourette syndrome (GTS) is a neurodevelopmental disorder characterized by multiple motor tics and one or more vocal tics that usually begin before the age of 18.
 
Estimates of the prevalence of GTS vary. The generally accepted figure was 0.5/1000, but recent research suggests that between 1% and 3% of school children are affected.
 
The nature and phenomenology of tics vary widely, even in documented familial cases. They may take the form of a movement, a vocalization (phonic tic), or a complex phenomenon such as an echophenomenon or coprolalia (the inappropriate uttering of obscenities) which is a rare manifestation of GTS. Tics can be increased in conditions of stress, boredom, or fatigue. Patients often report that tics are preceded by distinct premonitory feelings or sensations, they are temporarily suppressible, and patients experience relief after the tic has occurred. Tics can also fluctuate in severity and change character within the same person.
 
It is increasingly recognized that tics can be unusual in their manifestations and even self-injurious with reports of teeth grinding, vomiting, and retching, and other selfinjurious behaviors [10].
 
Case report
 
A 22-year-old man with mild learning disability was referred to the National Hospital for Neurology and Neurosurgery where he was diagnosed with GTS. The patient was assessed with the National Hospital Interview Schedule, the Yale Global Tic Severity Scale, the MOVES self-rating scale for GTS, and the Tourette Syndrome Diagnostic Confidence Index. The first tic that the patient exhibited took the form of barely audible muttering, a complex tic, at the age of 14. This was followed by a wide variety of tics. He had at least 47 motor tics including frowning, blinking, facial grimacing, and smelling things, as well as some complex movements such as hopping and skipping. He had at least 17 vocalization tics which included yawning, barking, snorting, and saying "yes" very loudly. He also had mental coprolalia, echolalia, palilalia, forced touching, aggression, and some obsessive compulsive behaviors. On the Yale Global Tic Severity Scale he scored 48/55, and on the Diagnostic Confidence Index he scored 69%, suggesting that there was no doubt at all about the diagnosis and that he had GTS of moderate severity. Family history of note included a maternal aunt with facial tics in childhood, lasting into adulthood. He had been prescribed clomipramine 85 mg daily since the age of 16 for depressive symptoms associated with his GTS. Treatment with clonidine had previously been attempted for his tics, but as it had no effect on them it was withdrawn.
 
At the age of 18, the patient presented with longstanding constipation and 5 weeks of bloating, abdominal distension, and repeated regurgitation associated with profuse belching.
 
This was relieved by the passage of flatus. He also had reduced appetite and had lost half a stone (3.2 kg) in weight. His parents had noticed the sounds of air swallowing. We enquired and it appeared that he was probably not able to suppress the air swallowing, but it was unclear if air swallowing increased in times of anxiety: his being learning disabled made the subjective history less clear.
 
On examination, the abdomen was distended and resonant to percussion. Bowel sounds were normal but continuous. Plain abdominal X-ray revealed a grossly distended stomach, air in the intestine but no mechanical obstruction
 
. A small bowel meal, which followed the initial plain abdominal film by 1 week, was within normal limits, excluding a volvulus. Blood tests were normal and the patient was diagnosed with a "windy abdomen" due to air swallowing. The air swallowing and associated symptoms resolved spontaneously, within 7 weeks of onset.
 
The symptoms of abdominal distension and discomfort recurred more mildly 5 months later and resolved within 6 weeks, soon after stopping clomipramine. Although the gastrointestinal symptoms and air swallowing improved, other motor and vocal tics worsened and he was treated with sulpiride and paroxetine. He continued on these medications until he suffered a further relapse of air swallowing 3 years later. This was also milder than the initial episodes and associated with abdominal distension, but far less than on the earlier occasions. Supine abdominal X-ray showed generalized distension of the gastrointestinal tract. The distension resolved with conservative management. The patient has remained well on the same treatment for the past 7 years. He has had no further periods of air swallowing or abdominal distension. His motor and vocal tics are also well controlled and he has been able to work in a supermarket for the past 3 years.