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Diagnosis

To diagnose Reye’s syndrome, a doctor will order blood tests to measure the child’s blood sugar levels and the blood levels of ammonia and liver enzymes to evaluate liver function. A child with Reye’s syndrome will have low sugar levels and elevated levels of ammonia and liver enzymes in the blood. The clotting time of the blood also is tested; the blood may take longer than normal to clot. The doctor will feel your child’s abdomen to check for swelling of the liver. He or she may order a liver biopsy (in which samples of cells are taken from the liver and examined under a microscope) to see if the liver is damaged, and an electroencephalogram (EEG; see page 687), an examination of the electrical activity of the brain, to evaluate brain function. The doctor also may order CT scans (see page 112) or MRIs (see page 113) to assess swelling of the brain and liver, and a lumbar puncture (see page 693) to examine the spinal fluid to rule out disorders such as meningitis (see page 692).

Treatment

A child with Reye’s syndrome is hospitalized and given fluids intravenously (through a vein) to replace those lost from vomiting, to restore the balance of electrolytes (essential minerals that help regulate various body processes) in the blood, and to reduce swelling. Brain swelling is also controlled with medication. Pressure monitors may be implanted in the brain to evaluate brain swelling. The child’s electrolyte levels, blood glucose (sugar) levels, and blood clotting also are monitored. If necessary, the child may be given medication to maintain adequate blood pressure. If the child has difficulty breathing, he or she may be placed on a ventilator (an artificial breathing machine).

Recovery depends on the severity of the condition. Children who have a mild episode of Reye’s syndrome may recover fully in about a week, with no lasting effects. Children who survive a severe episode of Reye’s syndrome may have permanent brain damage.

Tourette Syndrome

Tourette syndrome is a nervous system disorder characterized by sudden, repeated, involuntary movements and vocal sounds called tics. Unlike other tic disorders, the tics of Tourette syndrome often occur along with certain behavior disorders including attention deficit hyperactivity disorder (ADHD; see page 730) and obsessive-compulsive disorder (see page 720). Children with Tourette syndrome often have anxiety (see page 718) or depression (see page 709) and may have a tendency to physically injure themselves. Other behavior disorders that commonly accompany Tourette syndrome are poor impulse control, poor anger control, and antisocial behavior. Such behavior problems can interfere with school performance and social interactions even more than the tics.

Tourette syndrome usually begins between 2 and 15 years of age, and the tics become the most extreme at about age 10. The tics usually lessen as the child gets older; by age 18, half of all affected people no longer have tics. In some people, the disorder is lifelong, and 10 percent of affected people have more severe symptoms in adulthood than in childhood. Estimates of the prevalence of Tourette syndrome range from less than 1 percent to 4 percent of the population, affecting three times as many boys as girls. The disorder tends to run in families.

Symptoms

The tics of Tourette syndrome that involve body movement (motor tics) often include blinking, nose twitching, muscle tensing, mouth opening, shoulder rotation, head shaking, or bending of the trunk. Examples of more extreme motor tics are hitting, jumping, kicking, making obscene gestures, or imitating the gestures of others. Typical vocal tics include sniffing, throat clearing, grunting, or blowing. Some affected children repeat their own words or the words of others or shout profanities or other inappropriate words or phrases. Many children with Tourette syndrome say that these body movements or utterances are preceded by feelings of anxiety or uncomfortable sensations so severe that they can be relieved only by