A Tourette Syndrome Case

A boy age 13, first seen 21.3.07

Presenting symptom tourette. It began in February 2003 7.2.2003 with tonsillitis. Fever: 40.40 C and penicillin. Two weeks after that the tics started. He has been on Risperdal for 6 months. Initially the tics abated but they have come back much worse the last few months and the dose has been increased the past fortnight from 1 mg – 1.5 mg.

Nodding his head. Breathes in then stops breathing and nods his head a certain number of times, then he can breathe out again. Makes noises. Respiratory noises or cowling noises. A month ago it was so bad that he fell off the sofa as it was pulling his whole body while he kept his breath and nodded.

Tics are worse from stress worse and every February and March. Migraine in his right eye. Inside. Started before the tics. They come on gradually in the afternoon and subside suddenly. The migraine is better from falling asleep. Started to get Maxalt for it.

Cramps during fever from when he was 2 years old. Started right after a vaccination. stopped in 97. Very bad reaction to penicillin in 95. Rash on legs extending to the rest of the body.

Desires:

salt

smoked food

chili con carne

averse to sweets

Since the Risperdal he has had a strong desire for coca cola which is very unusual, and for dark chocolate. He has put on a lot of weight. Since coming on drugs there have been several conflicts at school as well and he has not wanted to go to school. (That is a usual side effect of the drug!) Now he goes straight home from school every day. Before the drugs he used to stay out and play with the other children.

The other kids think he is weird because his tics have become so strong. He cannot be alone. He used to not mind some years ago. If something frightens him it stays in his system. Very fearful. (It has always been like that) When younger sometimes if there were an area he did not want to go to, one could not get him to go there. For instance, an area of the playground.

Fear of dogs

Fear of the metro

Fear of the dark

Fear of elevators

His self confidence has gone since the tics medicine.

He is a very introverted boy

Wetting the bed at night; Mum is not sure about the time, but probably last part of the night. Has taken Minirin for years.

Periods of peeing his pants at 16 – 16.30.

Maternal Granddad has Tourette (which has never been diagnosed; only recently mum has noticed the tics and he has very unusual habits, weird personality.

Paternal grandmother – migraines

Maternal grandmother 80 and healthy

Mother hypertension

Dad ?

Objective symptoms: Obese. Hides behind his jumper when talking about personal details and turns away.

Repertorization:

Head motions of, nodding

Head, motions of, involuntary

Mind, gestures hands, involuntary of

Mind gestures, makes tics nervous

Bladder urination involuntary night

Mind noise inclination to make

Generals food and drinks salt desire

Generals food and drinks smoked food desire

Generals food and drinks sweets aversion to

Mind fear dogs of

Generals, seasons, winter aggr.

Eye pain daytime only

Eye pain infra orbital neuralgic

Eye pain pressure amel.

Eye pain sleep amel.

Repertorized the eye pain as well separately:

Eye pain daytime only

Eye pain neuralgic infraorbital

Eye pain pressure amel.

Eye pain sleep amel.

Generals pains appear gradually – disappear, and -suddenly

Comment:

The overall picture resembled that of Causticum. Belladonna came up close on repertorization, but Belladonna mainly fitted the mental picture and did not have the food cravings and aversions. The eye symptoms were not covered by Belladonna, and at the time one would have expected a bit more violence if Belladonna were to be given. Considering the history of fevers and cramps one had to bearBelladonna in mind in case it would at some point be necessary to administer it, i.e. in an acute situation. Despite his aversion to sweets it is peculiar (in connection to Causticum) that he had a craving for coke and chocolate which did not quite seem to fit the Causticum picture (although according to Kent there is a thirst for cold drinks with aversion to water), but as the desires had appeared after the onset of taking Risperdal, and they did not seem to be a part of the initial symptom picture, I decided to disregard those two symptoms for the time being as everything else fitted so well. Clarke describes in Causticum a disposition to be frightened and Kent discusses a fearful personality with the tendency to develop some form of convulsive condition.” A localized chorea with jerking of single parts. (Kent, 1988, p 399)” and further (ibid. p. 400) ”Timorous anxiety, overwhelmed with fearful fancies.” The boy was extremely timid, certainly not comfortable with the situation talking about himself. This is very typical for a Baryta-carbonica, who will tend to hide behind a coat or jumper when eliciting his symptoms. However, Baryta-carbonica did not fit the overall picture of the case.

As the boy was on medication and the tics were so severe I wanted to procede slowly and with caution so decided on the 30^th potency. The mother was very concerned with the Rrisperdal and the fact that it seemed not to work so well anymore. She wanted her son to come off the medicine. We agreed to see how the remedy worked and she would talk to the psychiatric unit about it when the boy next had an appointment.

Causticum 30C given 26.3.07

Follow up 7.5. 2007

Up and down.

Has been off the medicine (Risperdal) for a week (In collaboration with the pediatric psychiatric unit) Marked mood swings right after the Causticum. Very angry suddenly or suddenly very sad. It comes out of the blue. He cannot say why it just happens. It happened in the past but not as much as this. We cannot console him when it happens. Tics are the same since coming off the medicine. Happier about going to school. This has happened gradually, but much better the past week since coming off the medicine. Suddenly started cycling to school on his own. He did not eat much before he took the medicine, while he was on it he ate loads, now it is like it used to be. Mostly hungry in the afternoon, like it used to be, while on the medicine hungry all the time and he could cry with hunger. Still wants coke.

Started playing a bit more with the other kids. I have a feeling that I would not mind being on my own. Talking about wanting a dog. No headache at all. More confident again. Has not peed in his nappy so much in the night lately.

Comment:

Causticum initiated a process which continued in the right direction after the discontinuation of the Risperdal. There is a return of an old symptom; the mood swings and at the same time the boy is returning more to old patterns i.e his eating pattern is increasingly back to normal (save the coke) more confident again and happier going to school. Watch and wait.

no rx

Phone call end of May

Relapse so Causticum 200c

Follow up 27.6.07

Just after Causticum 200 C started nodding his head for a short period of time. Then it disappeared. Losing weight very marked. Mum has to take in his trousers. Still shy.

Cold with a fever – no problems. No mood swings. A little sad after taking the remedy. Happier now. Developing so fast. Wanted to wash his hair himself yesterday, never wanted to before. Doing much more on his own. Suddenly growing up so quickly. Before his development seemed to have stopped. The craving for coke has gone. Becoming himself more and more, even better than before the medicine.

Can become frightened at night if there are too many noises, but not as much as before.

No headaches. More confidence, more independent, more active and more social. Having visitors again now. Still wetting the bed a bit. We discussed the possibility of stopping the Minirin, but he was going on a camp in July where he did not want to wet the bed at night.

no rx

Follow up 24.8.07

All summer no tics, no migraine. Migraine just before starting school after the summer holidays. Tried a Causticum 30 for a migraine instead of the Maxalt. Fell asleep and the migraine had gone when he woke up. Not as bad as it used to be.

Nodding his head a little, very little, came at the same time as the migraine just before going back to school. No new symptoms. Still more in balance and his own self. Not wetting the bed despite the fact that they had stopped the Minirin after he had returned from camp.

Causticum 200C repeated because of the relapse around the school start.

Follow up 10.10.07

More daring. Home alone now. Mum does not have to be at home when he gets back from school now. Lots of friends visiting now. Not sad anymore.

Happy. A bit naughty with the other boys. Desires to smash things. Now that mum thinks about it, he has always done that. She has always given him cardboard boxes to smash up even from he was a baby. It has become more prevalent now though.

He feels frustrated if he cannot smash up something if he feels like it. It is triggered if he hears something smash. Loves to watch films in which things are smashed.

Desires salt and fish. Still more confidence.

Comment:

The symptoms are still changing and the Causticum is still working. Some frustration is coming up more marked with a desire to smash things. Considering Tuberculinum, but since the mum said it had been an issue always and the remedy has been working so well, decided to see how far the Causticum takes this symptom, but keep Tuberculinum in mind in case the Causticum suddenly does not work anymore – or symptom picture changes dramatically. Still bearing in mind the Belladonna as well.

no rx

30.11.07

Has not wet the bed, but migraine in November as mum was taken to hospital seriously ill. Although migraine, no need to take anything. Not as severe. Did not fall asleep. No tics at school anymore. Hardly any tics at all. Very very tired since mum has been ill.

Causticum 200C repeated

Follow up 6.2.08

Has been very well, no tics, no bed wetting. Not wanting to smash things anymore.

Recently things are going a little downhill, last week or two. A migraine 28.1.07

Causticum 1M

Follow up 12.3.08

Much better. Feels a change in himself. He felt better about coming here. More outgoing. Easier to talk to him. Says his thoughts have changed for the better, but won’t explain how. Has not thought about smashing things. But generally easier to talk to and does not hide behind his jumper. Doing well

No rx

Follow up 26.6.08

In May, suddenly a very high temperature. After that a rash came out. The rash was similar to a rash he had when he was 2 months old.

No tics at school anymore.

Things are going well socially at school. He is still quite tired. Not when he is with his mates after school, but when they have gone he is exhausted. Eating more fruit and vegetables and loves vegetable juice now.

Objective: Growing tall and slim.

No rx

Letter from boy’s mother in Autumn 08, in which she writes, that the boy is doing well and they’ll be in touch if there were to be a relapse.

Comment:

It has taken a bit more than a year for this boy to go through and deal with his symptoms and the return of old symptoms all the way back, according to Hering’s law of cure, to the rash he had all over the body as a reaction to penicillin when he was 2 months old. In fact it is interesting to notice that both the rash and the tics seemed to be triggered by the use of penicillin. During this time he has come off all his conventional drugs as well; Risperdal,Mmaxalt and Minirin. In the process he has become happier in himself, more confident and outgoing. On top of this his diet has become healthier and he has lost weight without him giving it much thought.

It certainly raises the question as to the effect of the increasing use of drugs in children. In this case it is clearly becoming a vicious circle; the Risperdal leading to a different food pattern causing obesity, the boy becoming more introverted getting more tics, needing increasing doses of Risperdal so on and so forth. It is worrying what the use of Ritalin,Rrisperdal,Cconcerta,Sstrattera (dependant on diagnosis) and the like does to the mental state, the general health and well being of the children.

References:

Clarke, J. H. (1988) Dictionary of practical material medica (volume 1, reprint), New Delhi, B.Jain publishers

Kent, J. T. (1988) Lectures on Homoeopathic materia medica (reprint), New Delhi, B.Jain Publishers