Tics are involuntary, repeated, irregular, rapid muscle movements including sounds or vocalization. If a combination of motor and vocal tics occur it is called Tourette's syndrome.

Tics vary widely in severity; they occur in about 20% of children. Tourette syndrome, the most severe type, occurs in 3 to 8/1000 children. Male to female ratio is 3:1. Tics occur before the age of 18 years, typically between ages 4 and 6 years and mostly disappear spontaneously. However, in about 1% of children, tics persist into adulthood.

Tourette's syndrome

Tourette's syndrome is a complex neurological disorder. It is characterized by multiple tics - both motor and vocal. It is the most severe and least common tic disorder. 0.3 % of children aged 6 to 17 in the US have been diagnosed with. For many patients, symptoms improve with age. It is often associated with deficit hyperactivity disorder and obsessive-compulsive disorder.

Symptoms

Motor tics

• Include head and shoulder shrugging, blinking, grimacing, head jerking, banging, clicking fingers, or touching things or other people.

Vocal tics

• Include coughing, throat clearing or grunting, barking, sniffing or repeating words or phrases.

Simple tics

These are sudden briefly tics using few muscle groups. Examples include nose twitching, eye darting, or throat clearing.

Complex tics

These involve several muscle groups. Examples include hopping or stepping in a certain way, gesturing, or repeating words or phrases.

Tics rarely interfere with motor coordination. Mild tics rarely cause problems, but severe tics, particularly coprolalia (which is rare), are physically and/or socially disabling.

Sometimes tics are explosive in onset, appearing and becoming constant within a day.

Facts about tics

• Worsen with emotions as anger, anxiety, fatigue, excitement.
• Worsen with extreme temperatures.
• Occur during sleep.
• Vary over time.
• Vary in type and severity.
• Improve over time.

Causes

The exact cause of tic disorders is unknown.

Research in Tourette's Syndrome identified some specific gene mutations that may have a role as well as brain chemicals glutamate, serotonin and dopamine.

Diagnosis

We at KindCare Medical Center are starting the diagnostic clarification by taking an extensive medical history addressing your symptoms, the trigger factors, the duration and the frequency, work environment, social habits, toxic exposure, risk of infectious diseases and family history of neurological disease. Check of vital signs such as blood pressure and pulse, followed by a proper physical examination with focus on mental health are mandatory. Tic disorders are diagnosed based on signs and symptoms. In addition, laboratory tests and imaging of brain as MRI are offered for ruling out underlying conditions.

Treatment

Tics are treated only if they interfere with a child's activities or self-image. Treatment options at KindCare Medical Center may include Cognitive behavioural therapy, medications. With any drug, the lowest dose required to make tics tolerable is used; doses are tapered as tics wane. Adverse effects of dysphoria, parkinsonism, akathisia, and tardive dyskinesia are rare but may limit use of antipsychotics; using lower daytime doses and higher bedtime doses may decrease adverse effects. Neurofeedback, also called EEG biofeedback, is a not pharmaceutical therapy option which has shown to improve tic disorders. Relaxation techniques can be supportive.

Coping and self-help tips

• Avoid stress and anxiety.
• Get enough sleep.
• Join a support group.
• Reach out to friends and others for help and support.
• Remember that tics tend to improve or disappear with age.
• Parents of children with tics may wish to inform teachers, caregivers.
• Help boost the child's self-esteem by encouraging interests and friendships.
• Ignore times when a tic occurs, and avoid pointing it out to the child.