Tics and Tourette's syndrome

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VOL 108 / NO 5 / OCTOBER 2000 / POSTGRADUATE MEDICINE

Tics are repetitive movements that are sometimes called nervous habits or habit spasms. They are very common, especially in young children, and usually don't cause serious problems. However, sometimes tics last for long periods of time and become very disruptive. They might then be classified as a true disorder. One of the most severe tic disorders is called Tourette's syndrome.

What causes the problem?
The causes of tics vary from simple habits to complex inherited disorders. The most serious tics seem to be related to an abnormal transmission of messages from the brain. They have been compared to an itch that cries out for a scratch or a sneeze that can be held in but feels so much better when it is let out.

When tics affect the muscles, they are referred to as motor tics. Examples of these are eye blinking, hair tossing, and lip smacking. More complex motor tics include actions like jumping up and spinning around in the air. A tic is considered chronic if it lasts more than 6 months. Sometimes several tics occur together, and this is called multifocal tic disorder.

Vocal tics are also common and include such noises as sniffing, grunting, throat clearing, coughing, and squealing. These are called simple vocal tics. More complex vocal tics include repeating what is heard (echolalia), repeating your own words over and over (palilalia), and intrusion of offensive or profane words into normal speech (coprolalia).

What is Tourette's syndrome?
This is a chronic disorder that has both motor and vocal tics. It is actually quite rare, is usually inherited, and most often starts between the ages of 6 and 10 years.

Tourette's syndrome tends to progress and become most severe during puberty and then to stabilize in adulthood. It can be difficult to diagnose and is easily confused with behavior disorders. This has led to serious problems because of inappropriate management of--and sometimes punishment for--behaviors a child truly cannot control. In many cases, children can control the "urges" to respond to nervous impulses for some time, but when these urges become too intense, the tics burst out in what appears to be totally inappropriate behavior. This explains why some children behave quite normally in school but seem to be totally out of control at home.

Tourette's syndrome usually is first suspected when tics begin to occur several times each day, almost every day, for more than 1 year. However, the type, severity, and frequency of the tics often change over time. Diagnosis depends on evidence that several motor tics plus one or more vocal tics are present and cannot be explained by other medical conditions. Also, the tics must be directly observed by a reliable examiner or recorded on videotape because children might be able to control them during an office visit. At present, there are no specific tests for Tourette's syndrome.

Is help available?
A number of treatments can be used to help youngsters with tics and Tourette's syndrome, and many of these children can function very well. In quite a few cases, however, Tourette's is associated with other problems, such as attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and depression. Therefore, it is very important that a physician supervise the management of Tourette's, since some drugs that alleviate the tics can increase hyperactive behavior or cause other problems. Quite a bit of research has been done on this condition in the last decade, and new drugs are on the horizon. Your doctor often can help you, or he or she might refer you to another specialist, depending on the specific situation.

When should you be concerned about tics?

Simple tics often require no treatment and disappear as a child gets older. However, it's a good idea to ask your doctor about tics if you notice the following, especially in someone less than 21 years of age:

• Several motor tics and one or more vocal tics that can't be explained by other medical conditions, such as seizures or very low blood sugar in a child with diabetes
• Abnormal movements and sounds that occur several times a day, almost every day, and have lasted for more than 1 year
• Changes in the type, severity, complexity, frequency, and anatomic location of the tics
• Patterns of behavior that could lead to injury

The vocabulary of tic disorders and Tourette's syndrome

WORDS USED TO DESCRIBE MOTOR TICS

Simple motor tics: Movements that involve just one body part, such as eye blinks, shoulder shrugs, or cheek twitches

Complex motor tics: Movements that involve more than one muscle group, such as jumping, spinning, hopping, or walking on toes

Chronic motor tic disorder: A tic that lasts more than 6 months

Multifocal motor tic disorder: Several simple or complex tics that occur over the same period of time

Echopraxia: Movements that mimic those of others

WORDS USED TO DESCRIBE VOCAL TICS

Simple vocal tics: Brief noises, such as grunting, sniffing, throat clearing, or coughing

Complex vocal tics: Complex noises in the form of words or phrases that intrude on normal speech

Echolalia: A speech pattern that involves repeating what someone else just said

Palilalia: A habit of repeating your own words over and over

Coprolalia: A very rare disorder that causes someone to say obscene or other socially unacceptable words or phrases

This information is not a substitute for medical treatment.

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