What Is It?
A tic is a sudden, rapid, repetitive movement (motor tic) or vocalization (vocal tic).
There are two main types of tics:
Simple tics involve one muscle group
Simple motor tics include head shaking, eye blinking, sniffing, neck jerking, shoulder shrugging and grimacing. These are more common.
Simple vocal tics include coughing, throat clearing and barking.
Complex tics involve more than one muscle group
Complex motor tics include self-hitting or self-biting, jumping and hopping, and twirling while walking.
Complex vocal tics include repeating words out of context, echoing what someone else said and speaking obscenities.
Tics sometimes change over time from one simple type of tic to another or from a simple to a complex tic. Some tics are slow and sustained rather than brief and rapid. Some involve the lower body.
Tics are thought to be inherited neurological disorders that affect the body's motor system. They also can be caused by head injury or certain drugs, such as stimulants.
People with tic disorders describe an urge building up inside them before the tic appears. This buildup feeling is called a premonition. People with tics often feel relief after the tic is over.
Although tics are involuntary, tics cease during sleep and the urge sometimes can be suppressed for short periods with effort. After making an effort to suppress a tic, the person usually has a burst of tics to relieve a buildup of the inner sensation. To get some idea of what this is like, try not blinking for as long as you can. You'll feel a buildup sensation the longer you don't blink, and you'll feel great relief when you finally do blink.
When both motor and vocal tics are present and last for more than one year, the disorder is named Tourette's syndrome. A number of other disorders often occur along with tic symptoms. For example, more than 50% of people with Tourette's syndrome also have attention-deficit hyperactivity disorder, and approximately 30% to 40% also have obsessive-compulsive disorder.
Typical symptoms of motor tics include involuntary (uncontrolled) muscular movements of the mouth or eyes, head twitching, and shoulder shrugging. Examples of less common, complex tic symptoms are bending over to touch the floor, smoothing clothing and jumping.
Vocal tics are involuntary expressions, such as noises, words (sometimes obscenities) or repetitive phrases (in some cases with increasing rapidity).
Symptoms vary greatly among people with tic disorders, ranging from barely observable tics to severe and incapacitating symptoms. Fatigue, anxiety and other stressful events often make symptoms worse in people with tic disorders.
Temporary tic disorders usually involve motor tics rather than vocal tics and are more frequent in boys than girls. The most common age at which tic disorders are diagnosed is seven years. Tic symptoms usually change over time, sometimes increasing around the beginning of puberty, then gradually decreasing. Many people with tic symptoms are tic-free by young adulthood, although sometimes tics last into adulthood.
As many as 25% of all children experience temporary tics at some time. Boys are affected more commonly than girls. Temporary tics usually last for less than one year and usually do not require treatment. When tics last for more than one year, the problem is called chronic motor tic disorder.
There is no way to prevent motor or vocal tics unless the tic was brought on by the use of stimulant drugs, in which case stopping the drug may get rid of the tic.
Your physician will look for and treat any potential cause of a tic disorder.
Mild tics do not require treatment unless they are socially embarrassing or interfere with your life. Emotional support may be important for children who feel that they are different, and psychological counseling may be helpful. Behavior training can be effective. For example, people suffering with tics may be taught to recognize that a tic is beginning and perform another movement that is incompatible with the tic.
Severe tics can be treated with medications, such as fluphenazine, pimozide, or tetrabenazine. These medications affect certain chemical messengers in the nervous system. A number of other medications, including injections of botulinum toxin (Botox and others), also may be effective. Associated conditions such as attention-deficit hyperactivity disorder or obsessive-compulsive disorder may require additional, specific treatments.
When To Call a Professional
Call a professional if a tic disorder worsens or if the tics keep you from doing daily activities. Professional assistance also may be necessary if emotional or behavioral problems develop.
In most cases, the long-term outcome is excellent.
American Academy of Neurology (AAN)
1080 Montreal Ave.
St. Paul, MN 55116
Tourette Syndrome Association
42-40 Bell Blvd.
Bayside, NY 11361