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Tic

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For other uses, see tic (disambiguation).

A tic is a sudden, repetitive, nonrhythmic, stereotyped motor movement or vocalization involving discrete muscle groups.[1][2] Tics can be invisible to the observer, such as abdominal tensing or toe crunching. Common motor and vocal tics are, respectively, eye blinking and throat clearing.[3] Movements of other movement disorders (for example, chorea, dystonia, myoclonus) must be distinguished from tics. Other conditions like autism and stereotypic movement disorder also include movements which may be confused with tics. Tics must also be distinguished from compulsions of OCD and seizure activity.

Description and classification

Template:Clips of tics Tics are classified as motor vs. phonic and simple vs. complex.

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, but most diagnosticians prefer the term phonic tics to reflect the notion that the vocal cords are not involved in all tics that produce sound.[4]

Tics may increase as a result of stress, tiredness, 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 in an absorbing activity often leads to a decrease in tics.[5][6] Neurologist and writer Oliver Sacks describes a physician with severe Tourette syndrome, (Canadian Mort Doran, M.D., a pilot and surgeon in real life, although a pseudonym was used in the book), whose tics remit almost completely while he is performing surgery.[7][8]

Immediately preceding tic onset, most individuals are aware of an urge[9] that is similar to the need to yawn, sneeze, blink, or scratch an itch. Individuals describe the need to tic as a buildup of tension[10] which they consciously choose to release, as if they "had to do it".[11] Examples of this premonitory urge are the feeling of having something in one's throat, or a localized discomfort in the shoulders, leading to the need to clear one's throat or shrug the shoulders. The actual tic may be felt as relieving this tension or sensation, similar to scratching an itch. Another example is blinking to relieve an uncomfortable sensation in the eye.

Tics are described as semi-voluntary or "unvoluntary",[12] because they are not strictly involuntary—they may be experienced as a voluntary response to the unwanted, premonitory urge. A unique aspect of tics, relative to other movement disorders, is that they are suppressible yet irresistible;[13] they are experienced as an irresistible urge that must eventually be expressed.[12] Some people with tics may not be aware of the premonitory urge. Children may be less aware of the premonitory urge associated with tics than are adults, but their awareness tends to increase with maturity.[12]

Simple tics

Simple motor tics are typically sudden, brief, meaningless movements, such as eye blinking 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 possible sound or noise, with common vocal tics being throat clearing, coughing, sniffing, or grunting.

Complex tics

Complex motor tics are typically more purposeful-appearing and of a longer nature. 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, according to the Tourette Syndrome Association, Inc. (TSA), fewer than 15% of TS patients exhibit coprolalia.[14][15]

Complex tics are rarely seen in the absence of simple tics. Tics "may be challenging to differentiate from compulsions",[16] as in the case of klazomania (compulsive shouting).

Tic disorders

Main article: Tic disorder

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.[15] 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, 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.[17] 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 don't involve a whole muscle. They are twitches of a few muscle fibre bundles, which you can feel but barely see.[18]

Society and culture

There is some confusion in media portrayals of tics.

Notes

  1. ^ Leckman JF, Bloch MH, King RA, Scahill L. "Phenomenology of tics and natural history of tic disorders". Adv Neurol. 2006;99:1–16. PMID 16536348
  2. ^ American Psychiatric Association (2000). "Diagnostic criteria for 307.23 Tourette's Disorder". Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision (DSM-IV-TR), ISBN 0890420254. Retrieved on July 22, 2008.
  3. ^ Malone DA Jr, Pandya MM. "Behavioral neurosurgery". Adv Neurol. 2006;99:241–47. PMID 16536372
  4. ^ Robertson MM. Tourette syndrome, associated conditions and the complexities of treatment. Brain. 2000 Mar;123 Pt 3:425-62. PMID 10686169
  5. ^ National Institutes of Health (NIH). Tourette Syndrome Fact Sheet Accessed 23 Mar 2005.
  6. ^ Packer, L. Tourette Syndrome "Plus". Accessed 12 Feb 2006.
  7. ^ Doran, Morton L. The Tourette Syndrome Association, Inc., Connecticut Chapter 1998 Educators' Conference; 1998 Nov 6; Danbury, CT.
  8. ^ Sacks O. An Anthropologist on Mars. Knopf, New York, 1995.
  9. ^ Cohen AJ, Leckman JF. Sensory phenomena associated with Gilles de la Tourette's syndrome. J Clin Psychiatry. 1992 Sep;53(9):319–23. PMID 1517194
  10. ^ Bliss J. Sensory experiences of Gilles de la Tourette syndrome. Arch Gen Psychiatry. 1980 Dec;37(12):1343–47. PMID 6934713
  11. ^ Kwak C, Dat Vuong K, Jankovic J. Premonitory sensory phenomenon in Tourette's syndrome. Mov Disord. 2003 Dec;18(12):1530–33. PMID 14673893
  12. ^ a b c The Tourette Syndrome Classification Study Group. Definitions and classification of tic disorders. Arch Neurol. 1993 Oct;50(10):1013–16. PMID 8215958 Full text, archived April 26 2006.
  13. ^ Dure LS 4th, DeWolfe J. Treatment of tics. Adv Neurol. 2006;99:191-96. PMID 16536366
  14. ^ Tourette Syndrome Association. Tourette Syndrome: Frequently Asked Questions Accessed online 6 Jan 2006.
  15. ^ a b Zinner SH. Tourette disorder. Pediatr Rev. 2000 Nov;21(11):372-83. PMID 11077021
  16. ^ Scamvougeras, Anton. Challenging Phenomenology in Tourette Syndrome and Obsessive–Compulsive Disorder: The Benefits of Reductionism. Canadian Psychiatric Association (February 2002). Retrieved on 2007-06-05
  17. ^ Adult-onset tic disorder, motor stereotypies, and behavioural disturbance associated with antibasal ganglia antibodies
  18. ^ Freeman, R. Tourette syndrome: minimizing confusion. Accessed 18 February 2006.

Further reading

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