Richmond Practice - Tics

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What are tics?
Tics are sudden, repetitive, non-rhythmic movements or sounds involving discrete muscle groups. Tics can be invisible to the observer, such as abdominal tensing or toe crunching. Common motor and phonic tics are, respectively, eye blinking and throat clearing. A unique aspect of tics, relative to other movement disorders, is that they are suppressible yet irresistible.

Tics may increase as a result of stress, fatigue, boredom or high emotional states. Strong emotions can be negative, such as anxiety, or positive, 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. Immediately preceding tic onset, most people become aware of an urge that is similar to the need to yawn, sneeze, blink, or scratch an itch. Children may be less aware of the urge associated with tics than adults, but their awareness tends to increase with maturity.

Tics usually start in childhood (before the age of 18) and affect about one in 100 children. Tics are not due to the effects of medication or another medical condition. We distinguish:
  • Transient tic disorders are the very most frequent consists of multiple motor and/or phonic tics with duration of at least 4 weeks, but less than 12 months.
  • Chronic tic disorder is either single or multiple motor or phonic tics, but not both, which are present for more than a year.
  • Tourette’s disorder (Tourette syndrome) is diagnosed when both motor and phonic tics are present for more than a year.

Many children have mild symptoms and aren't diagnosed. Some people with Tourette's disorder take medicines to relieve the symptoms, but many people don't need to.
Knowledge, education and understanding are first line in the management plans of tic disorders like Tourette’s disorder, or Tourette syndrome.The management of the symptoms may include pharmacological, behavioural and psychological therapies. Pharmacological intervention is reserved for more severe symptoms. Other treatments (such as supportive psychotherapy) may help to avoid or lift depression and social isolation and to improve family support. Educating a patient, family, and surrounding community (such as friends, school, and church) is a key treatment strategy, and may be all that is required in mild cases of Tourette’s disorder, or Tourette syndrome.

Relaxation techniques, such as exercise, yoga or meditation, may be useful in relieving the stress that may aggravate tics. Medication is available to help when symptoms interfere with daily life or if there is a risk of self harm. Trials with Botox injections suggest there may be some effect in facial and even some phonic tics.

Consult your doctor if:
  • You are concerned about any symptoms
  • You believe the symptoms may need medical management.

At Elsbeth's Doctors our consultant paediatrian and GPs can help with diagnosis and management of these symptoms.




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