2013-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/645801摘要：面部習慣性痙攣相關疾病可以分成等無合併型、暫時型、慢性運動或發生型、妥瑞氏症等幾種型式，在大型的社區流行病學調查顯示在學齡兒童的盛行率高達 10-19%。妥瑞氏症患者常有抽筋.合併注意力集中缺陷症候群（ADHD）等相關症狀，影響到病患生活品質甚至失去正常生活的能力。這些症狀是如何與妥瑞氏症的關連性尚未釐清：究竟他們是妥瑞氏症的一部份，還是只是湊巧一起發生？ 然而開立一般注意力集中缺陷症候群患者使用的興奮劑給妥瑞氏症患者，可能會增加妥瑞氏症患者抽筋的頻率以及嚴重性，因此臨床處理有其困難存在。 雖然面部習慣性痙攣相關疾病是常見疾病，其相關的靜態功能性與磁振擴散頻譜磁振造影檢查並不多見，僅限於少數成人患者的研究，然而注意力集中缺陷症候群患者的靜態功能性與磁振擴散頻譜磁振造影檢查已經有相當數量的報告。因此，本研究將對於 10-12歲罹患妥瑞氏症並在台大門診追蹤的約 40例患者，依據 DSM IV區分為無合併型、暫時型、慢性運動或發生型、妥瑞氏症等幾種型式，同時就否合併注意力集中缺陷症候群依據 SNAP-IV_Chinese_version問卷結果加以分類，在家長或主要照顧人與病患的知情同意之下，對於 10-12歲罹患妥瑞氏症並在台大門診追蹤的約 40例患者與年齡相當的對照組 40例，使用3T Simens Trio scanner磁振造影掃描儀施行非侵襲性的靜態功能性與磁振擴散頻譜磁振造影檢查，並且採用 FSL軟體加以分析，靜態功能性磁振造影檢查以MELODIC ICA軟體分析，磁振擴散頻譜磁振造影檢查以 TBSS軟體分析，同時也以 DSI studio軟體分析重組磁振擴散頻譜，目的在研究靜態功能性與磁振擴散頻譜磁振造影檢查與面部習慣性痙攣相關疾病分類或是否合併注意力集中缺陷症候群的關聯性，以作為將來臨床處理與追蹤的參考。<br> Abstract: Clinical classification of habitual facial spasm-related disorders correlated to the findings of resting-state functional MRI and diffusion spectrum imaging Habitual spasms or tics of the facial structures are also referred to as facial tics. According to DSM IV, tics can be classified as follows: tics disorder not otherwise specified transient tic disorder, chronic motor or vocal tic disorder, and Tourette's disorder. Patients with Tourette syndrome often experienced involuntary vocalization and aggressive impulses in addition to facial spasms. It is well documented that some patients with habitual facial spasm-related disorders also suffer from attention deficit hyperactivity disorder (ADHD). The ADHD and other tics-related symptoms affect patients' quality of life and even impair the ability to live a normal life. The relationship between habitual facial tics or Tourette syndrome and ADHD remains unknown: whether ADHD is part of the Tourette syndrome, or just happened to occur together? However, if we prescribe stimulants used in ADHD patients to Tourette's patients, the frequency and severity of Tourette patients’ facial cramps will be accentuated. Clinical management of habitual facial spasm-related disorders is sometimes difficult and controversial because the underlying mechanism remains undefined. Resting-state functional magnetic resonance imaging (rFMRI) and diffusion spectrum imaging (DSI) of patients with Tourette syndrome are rarely found in literature or limited to a small group number of adult patients. However, considerable number of reports discussing rFMRI and DSI of ADHD are available. This study will include 40 controls or 40 patients who are aged 10-12yeas and suffer from Tourette syndrome and followed up regularly in our outpatient clinics. After obtaining informed consents of patients’ parents or primary caregivers, rFMRI and DSI of 41 directions will be performed on the Siemens 3T Trio scanner. The results will be compared with previous rFMRI and DSI reports and become the image reference for future clinical management and follow-up. The study focuses on the imaging findings of rFMRI and DSI of various types of habitual facial spasm-related disorders and whether the patients of habitual facial spasm-related disorders can be classified in two groups of patients, i.e. related or unrelated to ADHD, based on the clinical findings and rFMRI or DSI findings.