Definitions:
A "Tic" is a stereotypic,
repetitive movement, often in the past refereed to as a "habit spasm".
Tics occur in a variety of conditions, most of which fall in a spectrum between a simple tic disorder, and Tourette's Syndrome.
In adults and some children, a clear
history of a urge preceding the movement, and relief after the movement can be obtained. Also the movements can be suppressed (at the expense of inner stress or increasing discomfort) for variable
lengths of time. It is not unusual for children to inhibit or suppress the movements at school and then once home the tics "come out" in dramatic frequency. Although the movements can be
suppressed they can't be stopped. It typically worsens the comfort of an individual if they are asked or forced into trying to stop them.
Simple Tic
Only a single body part is involved. These include eye blinks, shoulder shrugs, cheek twitches.
Complex Tics
These consist of tics involving a
complex movement or series of movements often involving more than one muscle group. One example would be jumping in the air and spinning around in the air.
Chronic Tic Disorder
By definition these last more than 6 months.
Multifocal Tic Disorder
Multiple simple and/or complex tics
Simple Vocal Tics
Brief noises including sniffing, grunting, throat clearing, coughing etc.
Complex Vocal Tics
These include more complex noises in the form of words (profanities), or phrases intruding into normal speech.
Echolalia
The repetition of what is heard
Palilalia
The tendency to repeat phrases
Tourette's Syndrome
This by definition is a chronic multi-focal tic disorder, with vocalizations lasting 12 months or more.
This most commonly starts at around
age 6-10, progresses to often be most severe during puberty, and then stabilizes into adulthood. Exceptions to this typical pattern do occur and some cases begin in adulthood.
Tourette's syndrome is frequently
associated with obsessive-compulsive traits. At times this feature can be more problematic than the movements. Obsessive behavior can include a variety of habits, rituals, or patterns of
behavior. Some examples include repeatedly checking if a locked door is locked, having to have things arranged in a specific order or pattern, having to spend an excess of time at a task to
ensure it is perfect, as anything less can create stress or anxiety.
Cause
This is a genetic (inherited) illness.
It is autosomal dominant (1/2 of children of an affected parent will inherit the tendency) with variable penetrence (not all who get the gene get Tourette's).
Treatment
There is no cure. Treatment is not
always needed if the movements are mild, and not socially distressing. If treatment is required the following medications are most often used. Surgical treatment in the form of Deep Brain Stimulator
implantation remains an investigational treatment and should only be done in very experienced centers.
To Control Movements
Clonidine, Tetrabenazine, Clonazepam,
Olanzepine, Risperidone, Valproic acid, and rarely and only if severe Pimozide and a variety of neuroleptics, and haloperidol
To control Obsessive traits
Chlormipramine, fluoxetine, and other Selective Serotonin Reuptake Inhibitors (SSRIs).
