最近のトゥレット症の情報

『トゥレット症』の概要

 「東京医療講演会2019」より、金生由紀子先生の報告がありましたので、抜粋してお知らせします。

 トゥレット症では、チックが長期間持続することから、ライフステージによってチックをどう受け止めて、どう対応するかが変化してくると考えられるため、その理解の参考になればと企画されたものです。
 トゥレット症に併発症が高率に認められる事を述べるとともに、チックと併発症の典型的な経過を示しました。パーキンソン病も含まれる神経系疾患の中での運動障害への分類を基本としつつも、神経発達症でも、強迫関連症でもあるとされています。つまり親の育て方や本人の性格は、根本的な原因とは言えず、発達障害であると同時に、強迫性も重要な特徴であるという事だと思われます。

 次に、星加明徳先生が「幼児期・学童期のトゥレット症の特徴と治療・支援について」と題して、小児科外来で診療してきたお子さん達のデータを示しながら、お話をされました。

 重症度評価法であるシャピロの重症度尺度で評価したところ、男子より女子で軽症な者が多く、発症年齢が高いほど重症な傾向があったとのことでした。治療の基本的な構成として「家族ガイダンス」「心理教育」「環境調整」「認知行動療法」「薬物療法」をあげてから、薬物療法が必要になるのは「本人が学校や家庭の生活で困った時」である、と明確にしました。

 最近の名称では「注意欠如・多動症及び、自閉スペクトラム症」となる代表的な発達障害の併発にも触れて、主な問題がチックなのか行動なのかを考えることが大切であること。チックが目立つ場合には、ADHDやASDは軽症なことが多いが、不注意優勢のADHDの併発には留意するようにとのことでした。

 最後に新井先生が「思春期以降のトゥレット症の治療・支援、自らの疾患を受け入れ前向きに生きていくこと」と題して、前思春期から思春期に生じる様々な事柄を述べた上で、具体的な例を示しつつお話されました。

 この時期には、チックに加えて強迫症状や怒り発作がしばしば起こるとともに、前駆衝動の自覚が高まります。比較的低年齢では、心理教育や環境調整を保護者に向けて行っていますが、子どもの意思を確認しながら進めることになってきます。加えて子どもの症状の捉え方が変化する時期でもあり、本人への働きかけをしていく中で、子どもによる捉え方の違いがみえてきます。また、成長しても重症チックが続いていると、症状をコントロールできないことに無力感を感じるようになり、それに伴って家族との葛藤が高まることがあります。そのような中で本人の社会参加意欲が高まるのを見守りながら、疾患を受容して症状を抱えつつ前向きに生活しようとするように、治療動機を高めることを大切にしているとのことでした。

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