Tic Disorders and
Tourette's syndrome (TS)
Tic disorders
• A tic is a sudden, repetitive, non rhythmic motor
movement or vocalization involving discrete muscle
groups.
• Common motor and phonic tics are, respectively, eye
blinking and throat clearing.
• Tics must be distinguished from movements of other
movement disorders such as chorea, dystonia,
myoclonus; movements exhibited in stereotypic
movement disorder or some autistic people, and the
compulsions of OCD and seizure activity.
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• Classification of Tics
– Motor or phonic
• Motor tics are movement-based tics
affecting discrete muscle groups.
• Phonic tics are involuntary sounds
produced by moving air through the nose,
mouth, or throat. They may be alternately
referred to as verbal tics or vocal tics,
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– Simple or complex
• Simple motor tics are: sudden, brief,
meaningless movements involve only one
group of muscles, such as eye blinking,
head jerking, or shoulder shrugging.
• A simple phonic tic can be almost any
sound or noise, with common vocal tics
being throat clearing, sniffing, or
grunting.
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• Complex motor tics: more purposeful
appearing and of a longer nature & involve
a cluster of movements and appear
coordinated.
Examples: pulling at clothes, touching people,
touching objects, echopraxia and copropraxia
(involuntarily performing obscene or
forbidden gestures).
• Complex phonic tics include echolalia, and
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coprolalia.
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• Characteristics
– Tics may increase as a result of stress, fatigue,
boredom, or high-energy emotions, which can
include negative emotions, such as anxiety, but
positive emotions as well, such as excitement or
anticipation.
– Relaxation may result in a tic increase (for
instance, watching television or using a
computer), while concentration on an absorbing
activity often leads to a decrease in tics.
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• Classification (DSM-IV-TR)
– Transient tic disorder: multiple motor and/or
phonic tics ( >= 4 weeks, but < 12 months).
– Chronic tic disorder: (either single or multiple
motor or phonic tics, but not both) > 1.
– Tourette syndrome: (both motor and phonic tics >
1 year).
– Tic Disorder NOS: was diagnosed when tics were
present, but did not meet the criteria for any
specific tic disorder.
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• Epidemiology
– Tic disorders: are more common among
males
– over 19% of school-age children have tic
disorders;[
– About 1 in 100 people may experience some
form of tic disorder, usually before the onset
of puberty.
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Tourette's syndrome (TS)
• TS is an inherited neuropsychiatric disorder
• onset in childhood,
• characterized by multiple physical (motor) tics and at
least one vocal tic (10% of TS patients exhibit
coprolalia).
• The characteristic of the tics in TS:
– wax and wane,
– can be suppressed temporarily, and are preceded by
a premonitory urge.
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• Most TS cases are mild and the severity of tics
decreases as the patient pass through
adolescence.
• Prevalence: 0.4% - 3.8% (5 to 18 y) may have TS
•
• Prevalence of other tic disorders in school-age
children is higher (eye blinking, coughing, throat
clearing, sniffing, and facial movements).
• TS does not adversely affect intelligence or life
expectancy.
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• Cause: unknown, genetic and environmental
factors play a role in the etiology of TS
• Comorbid conditions: ADHD, OCD (that often
cause more functional impairment)
• Therapy:
– There is no effective treatment , medication is
unnecessary.
– Education is an important part of any treatment
plan, and explanation and reassurance alone are
often sufficient treatment.
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QA?
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