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Tic Disorders

Including Tourette syndrome, chronic motor or vocal tic disorder, and transient tic disorder, tic disorders are similar pathophysiologically but differ in severity and prognosis. All tic disorders, commonly known simply as tics, are involuntary, spasmodic, recurrent, and purposeless motor movements or vocalizations. These disorders are classified as motor or vocal and as simple or complex.

Tics begin before age 18. All tic disorders are three times more common in boys than in girls. Transient tics usually are self-limiting, but Tourette syndrome follows a chronic course with remissions and exacerbations.

Causes

Although their exact cause is unknown, tic disorders occur more frequently in certain families, suggesting a genetic cause. Transient tic disorder is common in children. Five to twenty four percent of all school age children have had tics at some stage during this period. The cause of transient tic disorder or short-lived, temporary tic, is either organic or psychogenic. The child may have facial tics or tics involving movement of the arms, legs, or other areas. Tics appear to get worse with emotional stress and are absent while sleeping.

Signs and symptoms

Assessment findings vary according to the type of tic disorder. Inspection, coupled with the patient's history, may reveal the specific motor or vocal patterns that characterize the tic, as well as the frequency, complexity, and precipitating factors. The patient or his family may report that the tics occur sporadically many times a day.

Note whether certain situations exacerbate the tics. All tic disorders may be exacerbated by stress, and they usually diminish markedly during sleep. The patient also may report that they occur during activities that require concentration, such as reading or sewing.

Determine whether the patient can control the tics. Most patients can, with conscious effort, control them for short periods.

Psychosocial assessment may reveal underlying stressful factors, such as problems with social adjustment, lack of self-esteem, and depression.

Diagnosis

There are no diagnostic laboratory tests to screen for tic disorders. Except for the tics, the results of the patient's physical and neurological examinations are normal. The doctor takes a complete medical history including a detailed account of prenatal events, birth history, head injuries, episodes of encephalitis or meningitis, poisonings, and medication or drug use. The patient's developmental, behavioral, and academic histories are also important. There is an average delay of five to 12 years between the initial symptoms of a tic disorder and the correct diagnosis.

Treatment

Behavior modification and operant conditioning help treat some tic disorders. Psychotherapy can help the patient uncover underlying conflicts and issues as well as deal with the problems caused by the tics. Tourette syndrome is best treated with medications and psychotherapy.

No medications are helpful in treating transient tics. Haloperidol is the drug of choice for Tourette syndrome.

Pimozide (an oral dopamine-blocking drug) and clonidine are alternative choices. Antianxiety agents may be useful in dealing with secondary anxiety but do not reduce the severity or frequency of the tics.

Prevention

There are few preventive strategies for tic disorders. There is some evidence that maternal emotional stress during pregnancy and severe nausea and vomiting during the first trimester may affect tic severity. Attempting to minimize prenatal stress may possibly serve a limited preventive function.

Similarly, because people with tic disorders are sensitive to stress, attempting to maintain a low-stress environment can help minimize the number or severity of tics (reducing the number of social gatherings, which can be anxiety-provoking, for example). This approach cannot prevent tics altogether, and must be undertaken with an awareness that it is neither healthful nor advisable to attempt to eliminate all stressful events in life.