In good times or bad, having a child with a tic disorder is certainly concerning for any parent, Many people experience spasm-like movements of particular muscles at some point, but not all qualify as a tic disorder. Most are harmless and temporary, and even invisible: Tensing of abdominal muscles or toe movements, for example. In some cases, however, tics can be quite noticeable, as with the outbursts seen with Tourette’s syndrome, and greatly affect a person’s quality of life.
WHAT IS A TIC?
A tic is a brief, sudden movement or vocalization, which may seem like a normal gesture. but occurring repetitively and without warning. While people of all ages can experience tics, they are most often seen in children, affecting around 20% of all kids at one time or another. Tics are more common in boys than girls.
TYPES OF TICS
There are two types: motor tics and vocal tics. Either can be simple or complex in nature.
Motor tics: Simple motor tics may include movements such as blinking or head-jerking. Complex motor tics consist of a series of movements performed in the same order. For instance, a child might reach out and touch a specific toy or person repeatedly.
Vocal tics: Simple vocal tics might be clearing your throat, sniffing, or grunting. Examples of complex vocal tics might be repeating what another person just said or sudden inappropriate language.
INVOLUNTARY OR UN-VOLUNTARY?
Interestingly, tics are thought not to be involuntary movements. They are involuntary movements. There’s a difference. With an involuntary movement, a person is able to temporarily suppress the action. This suppression, though, results in discomfort that worsens until it is finally relieved by performing the tic. The sensation is almost like needing to scratch an itchy spot. Children are not as aware as adults are of this urge.
WHY DO TICS OCCUR?
No one knows exactly why tics occur. Stress and sleep deprivation seem to play a role in some cases. Tics may actually increase in frequency as a result of boredom or, conversely, high-energy emotions. These can be negative emotions like anxiety or positive emotions like excitement or anticipation. Relaxation may result in more tic activity while concentration on a task often leads to a decrease. There’s a report of a surgeon who had severe tic disorder but was able to suppress it while performing surgery.
TICS VS. TWITCHES
While many people use the terms tic and twitch interchangeably, there are differences between these two types of movements. Unlike tics, the majority of muscle twitches are isolated occurrences, not repeated actions. Twitches are entirely involuntary and cannot be controlled or suppressed.
An example of a muscle twitch is an eyelid spasm. This often occurs repeatedly over a sustained period of time and occurs most often in adults rather than children. It’s thought to be due to the misfiring of certain cells in an area of the brain.
LEVELS OF SEVERITY OF TIC DISORDERS
Doctors use four characteristics to identify and diagnose tic disorders:
- the age when tics began
- duration of the tics
- severity of the tics
- whether tics are motor or vocal or both
There are three levels of severity:
Transient tic disorder. This is most often seen in childhood and affects up to 20% of school-age children. In transient tic disorder, the tic is present for at least a month but less than a year. The majority of tics seen in this disorder are motor tics.
Chronic motor/vocal tic disorder: Chronic tic disorder occurs in less than 5 percent of kids. While transient tics disappear within a year, chronic tics can last for much longer. They may be either motor or vocal, but not really seen to be both. For a diagnosis of chronic tic disorder, symptoms must begin before age 18.
Tourette’s syndrome: This syndrome is the most severe tic disorder. It is characterized by the presence of both motor tics and vocal tics. Symptoms typically begin when children are between ages 5 and 18 years. Severity commonly changes over time, with periods of reduced activity followed by sometimes striking frequency. Tourette’s syndrome may improve as the patient matures.
DIAGNOSIS OF TIC DISORDERS
The evaluation of Tics must rule out a multitude of other movement disorders like Huntington’s chorea, dystonia, and myoclonus. The movements seen in conditions like obsessive-compulsive disorder or even autism must also be excluded. A full evaluation by a specialist, if available, is warranted.
Besides actual genetic or innate medical conditions that cause similar disorders, tics can be induced by certain recreational drugs, head trauma, stroke, and carbon monoxide poisoning. Tests ordered to evaluate tic disorders include blood tests and neurologic studies like EEGs to evaluate brain waves and MRIs of the brain.
TREATMENT OF TIC DISORDERS
Unfortunately, no clear guidelines exist for tic disorders. Every provider has their preferred course of therapy based upon their experience. Most begin with a “wait and see” approach. Many patients with tics resolve their condition on their own after a few cycles.
When necessary, medications may help, but these are often very strong drugs like Haldol or risperidone, both antipsychotics or meds used to treat ADHD like Strattera and guanfacine. Some report improvement with antidepressant drugs. All these medications can have serious side effects that can be worse than the tics; they should always be started at the lowest possible dose.
The current therapy of choice for tic disorders is called habit-reversal therapy, or HRT. With this method, the individual learns to recognize the “trigger” that induces the tic. Once recognized, the patient learns to respond by engaging in some alternative behavior that reduces the tension. HRT can be highly effective, in both children and adults, with up to 50 percent improvement after 6 weeks of therapy.
Nutritional changes have been recommended as an alternative option. Omega-3 fatty acids, magnesium, vitamin B6, and avoidance of caffeine, sugar, and soda are supposed to help. Exercise can also help relieve stress that worsens tic behavior by replacing it with other motor activity.
Suspect a loved one has a tic disorder? Answer the questions in the link below:
Joe Alton MD
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