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Definition:–
Tics are purposeless, rapid and repeated contractions of a group of muscles that result in movement (a motor tic) or the production of a sound (a vocal tic). Sometimes, a tic involves more complex behaviour.
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Motor tics often involve the muscles of the face, head and neck, with movements such as blinking, lip smacking, facial twitching, grimacing and shrugging of the shoulders. Common vocal tics include coughing, grunting or clearing the throat.
The intensity of a tic can vary. Occasionally, tics are forceful, which can be frightening and uncomfortable.
Tics aren’t voluntary movements – in other words, they can’t be consciously controlled – although some people say they feel a strong urge to move, linked to stress. Some people are able to suppress their tics briefly, but this is said to be like holding back a sneeze and tension rises until the tic finally escapes.
Tics are usually divided into several categories, as described below.:-
Transient tic disorders:-
As many as one in ten children will develop a transient or simple tic at some point during their school years. Such tics usually occur in just one muscle group and don’t last more than a few months, although a child may have a series of different transient tics over a period of years.
Transient motor tics may include blinking, squinting, snapping the fingers, jerking the head or wrinkling the nose. Occasionally, transient vocal tics such as gurgling or humming occur. The tic may even involve more bizarre behaviour, such as touching objects or licking.
Transient tics may become more prominent when a child is tired or excited, but they don’t lead to harm and don’t need treatment. They decrease or disappear when the child sleeps.
Chronic tic disorders:-
Not only do chronic tics persist, sometimes for years, but they change little in their character. While they don’t usually need treatment, they can be disruptive, especially if a child realises others think them strange. Occasionally, a person has several tics and is said to have chronic multiple tics.
Tourette syndrome:
Chronic tics are also a feature of Tourette syndrome. This neurological disorder causes multiple motor and vocal tics, which can be quite dramatic and frequently change in nature. Tourette syndrome usually begins in early childhood, varies in intensity and lasts more than a year.
Tourette can be particularly debilitating because the vocal tics can include the uncontrollable use of obscene language (known as coprolalia) and repetition of phrases the person hears others use (called echolalia).
Those with Tourette syndrome often have a variety of psychological problems too, such as attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD) and self-harm behaviour, although the link isn’t clear.
Like other tics, the exact cause of Tourette syndrome isn’t known, although genetics appear to play a part. It’s likely that a particular gene makes a person more vulnerable than others to environmental factors that also contribute to the condition.
Simple tics:-
Simple motor tics are typically sudden, brief, meaningless movements that usually involve only one group of muscles, such as eye blinking, head jerking or
shoulder shrugging. Motor tics can be of an endless variety and may include such movements as hand clapping, neck stretching, mouth movements, head, arm or leg jerks, and facial grimacing.
A simple phonic tic can be almost any sound or noise, with common vocal tics being throat clearing, sniffing, or grunting.
Complex tics:-
Complex motor tics are typically more purposeful-appearing and of a longer nature. They may involve a cluster of movements and appear coordinated.Examples of complex motor tics are pulling at clothes, touching people, touching objects, echopraxia and copropraxia.
Complex phonic tics may fall into various series (categories), including echolalia (repeating words just spoken by someone else), palilalia (repeating one’s own previously spoken words), lexilalia (repeating words after reading them) and coprolalia (the spontaneous utterance of socially objectionable or taboo words or phrases). Coprolalia is a highly publicized symptom of Tourette syndrome; however, only about 10% of TS patients exhibit coprolalia.Complex tics are rarely seen in the absence of simple tics. Tics “may be challenging to differentiate from compulsions”, as in the case of klazomania (compulsive shouting).
•Simple motor tics involve a single muscle group.
•Complex motor tics usually involve more than one muscle group.
•Complex vocal tics involve more meaningful speech (such as words) than simple vocal tics.
•Complex motor tics aren’t as rapid as simple motor tics and can even look like the person is performing the tic on purpose.
Shoulder shrugging is one of the most common simple motor tics; others include:
•nose wrinkling
•head twitching
•eye blinking
•lip biting
•facial grimacing
•repetitive or obsessive touching
•kicking
•jumping
Common vocal tics include:–
•coughing
•throat clearing
•grunting
•sniffing
•barkingTransient vs. Chronic Tics
Transient vs. Chronic Tics:-
It’s perfectly normal to worry that a tic may never go away. Fortunately, that’s not usually the case. Most tics are temporary and are known as transient tics. They tend to not last more than 3 months at a time.In rarer instances people have tics that persist for an extended period of time. This is known as chronic tic disorder. These tics last for more than a year. Chronic tics can be either motor or vocal, but not both together.
Dignosis:–
Tics can sometimes be diagnosed at a regular checkup after the doctor asks a bunch of questions. No specific test can diagnose tics, but sometimes doctors will run tests to rule out other conditions that might have symptoms similar to tics.
Tic disorders occur along a spectrum, ranging from mild to more severe, and are classified according to duration and severity (transient tics, chronic tics, or Tourette syndrome). Tourette syndrome is the more severe expression of a spectrum of tic disorders, which are thought to be due to the same genetic vulnerability. Nevertheless, most cases of Tourette syndrome are not severe. The treatment for the spectrum of tic disorders is similar to the treatment of Tourette syndrome.
Differential diagnosis:
Tourettism refers to the presence of Tourette-like symptoms in the absence of Tourette syndrome as the result of other diseases or conditions—also known as secondary causes. Although tic disorders are commonly considered to be childhood syndromes, tics occasionally develop during adulthood; adult-onset tics often have a secondary cause. Tics that begin after the age of 18 are generally not considered symptoms of Tourette’s syndrome.
Tics must be distinguished from fasciculations. Small twitches of the upper or lower eyelid, for example, are not tics, because they do not involve a whole muscle. They are twitches of a few muscle fibre bundles, which one can feel but barely see
The Embarrassment Factor
Many times, people don’t see themselves having a tic — they’re not walking around with a huge mirror at all times! So it’s only natural that they may think that their tic is the worst tic ever. Of course it isn’t, but it’s still a concern for many people with tics. And these exaggerated thoughts can cause unnecessary feelings of embarrassment or angst, and actually make the tic worse.
The tic might seem to begin either for no appreciable reason, or perhaps be incited by something like an eye irritation which begins a cycle of blinking that doesn’t stop when the irritation is gone. The simple tic usually goes away in six months or so, seemingly sooner if the child is not being reminded of it all the time by his family.
Sometimes the symptoms become more chronic. If the symptoms are limited to muscular movements, the condition is called multiple chronic motor tic disorder. If the child has both vocal and motor symptoms which last more than a year, the term Gilles de la Tourette syndrome or more commonly Tourette syndrome.
Symptoms (motor and vocal tics) in Tourette syndrome can be pretty bizarre. Most extreme and distressing are involuntary cursing (coprolalia) and obscene gestures (copropraxia). Suffice it to say that any involuntary repetitive activities or vocalizations in children between 2 and 14 or so deserve consideration for Tourette syndrome.
A significant percentage of children with Tourette syndrome show signs of attention deficit disorder as well. Because treatment of ADD with stimulants such as methylphenidate (Ritalin¨) may possibly initiate or worsen tics, and perhaps may bring on full-blown Tourette syndrome, any new or worsening tics in a child on ADD medication must be immediately reported to the childs physician.
Long term studies of the natural history of Tourette syndrome show the average age of onset as about five to six years old. Tic severity peaks around 10 years of age, with a range between 8 and 12 years. About one fifth of patients with Tourette syndrome will have such severe problems that school is interfered with or impossible. Almost all patients get better with time, and by age 18, half of affected children are tic-free, and nine of ten have only mild or no tics.
Nobody wants to make tics worse, but is there any way to make them better? While you can’t cure tics, you can take some easy steps to lessen their impact:
•Don’t focus on it. If you know you have a tic, forget about it. Concentrating on it just makes it worse.
•Avoid stress-filled situations as much as you can — stress only makes tics worse. So get your work done early and avoid the stress that comes with procrastination and last-minute studying.
•A tic? What tic? If a friend of yours has a tic, don’t call attention to it. Chances are your friend knows the tic is there. Pointing it out only makes the person think about it more.
•Get enough sleep. Being tired can makes tics worse. So make sure to get a full night’s rest!
•Let it out! Holding back a tic can just turn it into a ticking bomb, waiting to explode. Have you ever felt a cough coming on and tried to avoid it? Didn’t work out so well, did it? Chances are it was much worse. Tics are very similar.
In certain cases, tics are bad enough to interfere with someone’s daily life and medication may be prescribed.
Don’t let a little tic dictate who you are or how you act. Learning to live with and not pay attention to the tic will make you stronger down the road.
Treatment and recovery :-
Psychological support and counselling can be helpful for those with disruptive tics and cognitive behavioural therapy may help some people control their condition.
Medication is the most effective treatment in reducing the tic itself. However, the powerful drugs used (such as haloperidol, pimozide, fluphenazine and clonidine) tend to have unpleasant side-effects. So, while 70 per cent of those with Tourette have tried drugs, for example, many people prefer to manage without medication if possible.
*Don’t panic if your child develops a tic – most are mild and transient
*Most tics don’t interfere with life or school and don’t require treatment
*People taking stimulant drugs (for ADHD, for example) may develop tics but these should cease when the drug is stopped
*Stress can aggravate symptoms or simply make life harder – relaxation and biofeedback techniques may help.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Resources:
http://www.bbc.co.uk/health/conditions/tics1.shtml
http://kidshealth.org/teen/diseases_conditions/brain_nervous/tics.html
http://www.drhull.com/EncyMaster/T/tics.html
Tics
http://en.wikipedia.org/wiki/Tic
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