Tics and Tourette Syndrome
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Tic is a sudden, repetitive, non rhythmic, stereotyped motor movement or vocalisation involving discrete muscle groups.
Tourette syndrome (TS) is a neurologic disorder manifested by motor and vocal or phonic tics usually starting during childhood and often accompanied by obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), poor impulse control, and other co morbid behavioral problems. It is the clinical hallmark of Tics syndrome. Usually inherited and starts between ages of 6 to 10 years old become most severe during puberty and then stabilizes in adulthood.
The cause of primary tic disorders has not been conclusively determined. It is widely assumed to be the
result of an interaction of genetic. Heritability has been estimated to be around 50%.
The cause of secondary tic disorders, it is widely assumed to be the result of infections, drugs, toxins,
developmental, chromosomal disorders, psychological diseases, traumas.
The other causes of tics syndrome are stereotypes/habits, compulsions, self injurious behaviour.
result of an interaction of genetic. Heritability has been estimated to be around 50%.
The cause of secondary tic disorders, it is widely assumed to be the result of infections, drugs, toxins,
developmental, chromosomal disorders, psychological diseases, traumas.
The other causes of tics syndrome are stereotypes/habits, compulsions, self injurious behaviour.
Motor tics range from simple, sudden movements such as eye blinking or grimacing, to complex
behavioural patterns, for example crouching down or hopping.
In extreme cases, complex motor tics may present themselves as obscene gesture or even have an element of self-harm (e.g., hitting oneself in the head).
In some cases the afflicted person is compelled to repeat or imitate a movement observed in another person.
Vocal or phonic tics are involuntary utterances of sounds, noises, sentences or words. A simple vocal tic
may be a slight coughing, clearing of throat, wheezing, squeaking or loud shouting.
More complex vocal tics involve syllables, words or sentences. Utterance of obscene or aggressive words or sentences.
In other cases sufferers feel compelled to repeat their own previously spoken words.
behavioural patterns, for example crouching down or hopping.
In extreme cases, complex motor tics may present themselves as obscene gesture or even have an element of self-harm (e.g., hitting oneself in the head).
In some cases the afflicted person is compelled to repeat or imitate a movement observed in another person.
Vocal or phonic tics are involuntary utterances of sounds, noises, sentences or words. A simple vocal tic
may be a slight coughing, clearing of throat, wheezing, squeaking or loud shouting.
More complex vocal tics involve syllables, words or sentences. Utterance of obscene or aggressive words or sentences.
In other cases sufferers feel compelled to repeat their own previously spoken words.
A familial predisposition is as a risk factor. Heritability has been estimated to be around 50%.
Various prenatal and postnatal factors are considered possible factors that increase the risk. They include
premature birth, prenatal hypoxia, low birth weight as well as excessive nicotine and caffeine
consumption by mother during pregnancy. On rare occasions may develop as secondary symptom of
tumours, poisoning, infection, head trauma or vascular disease.
The disorder is also manifested by the some behavioural patterns; attention deficit hyperactivity disorder
onset is generally by age of 3.5 years and progress to remission by 16-20 years.
Motor tics onset is generally by age of 5.5years and possible remission by 16-20years.
Vocal tics and obsessive compulsive disorder onset by age of 6years and remission by 16-20years
Various prenatal and postnatal factors are considered possible factors that increase the risk. They include
premature birth, prenatal hypoxia, low birth weight as well as excessive nicotine and caffeine
consumption by mother during pregnancy. On rare occasions may develop as secondary symptom of
tumours, poisoning, infection, head trauma or vascular disease.
The disorder is also manifested by the some behavioural patterns; attention deficit hyperactivity disorder
onset is generally by age of 3.5 years and progress to remission by 16-20 years.
Motor tics onset is generally by age of 5.5years and possible remission by 16-20years.
Vocal tics and obsessive compulsive disorder onset by age of 6years and remission by 16-20years
A detailed medical history should be obtained from birth onwards. Additionally, standardised
questionnaires may be used. The Child Behaviour Checklist can be employed to obtain information
concerning possible co-morbid disorders. A thorough physical and neurological examination should be
conducted, including an EEG. The main purpose for this is to exclude other possible illnesses that could
cause the symptoms. Usually no further tests, such as an MRI, are necessary unless there are
pathological findings. ECG, thyroid function tests or other procedures (e.g., metabolic tests) are not
necessary in the absence of abnormal findings. Tests of cognitive ability are not necessary either unless
there is indication of learning problems. Completing questionnaires provides a good opportunity to
observe the patient in a challenging situation, even though patients are often able to suppress tics for a
certain period so that the true extent of the symptoms may not be observed.
questionnaires may be used. The Child Behaviour Checklist can be employed to obtain information
concerning possible co-morbid disorders. A thorough physical and neurological examination should be
conducted, including an EEG. The main purpose for this is to exclude other possible illnesses that could
cause the symptoms. Usually no further tests, such as an MRI, are necessary unless there are
pathological findings. ECG, thyroid function tests or other procedures (e.g., metabolic tests) are not
necessary in the absence of abnormal findings. Tests of cognitive ability are not necessary either unless
there is indication of learning problems. Completing questionnaires provides a good opportunity to
observe the patient in a challenging situation, even though patients are often able to suppress tics for a
certain period so that the true extent of the symptoms may not be observed.
Medications to help control tics or reduce symptoms of related conditions include, Medications that
block or lessen dopamine, Botulinum (Botox) injections. ADHD medications. Central adrenergic
inhibitors. Antidepressants. Anti seizure medications.
Psycho education, involving the patient as well as relevant caregivers, should be provided at the
beginning of treatment. Further, individual causal factors and options for treatment should be
discussed. Referral to self-help groups is also useful. In cases of mild severity – taking into account the
high rate of spontaneous remission – psycho education is all that is required.
Substantial anecdotal evidence exists concerning the benefits of physical activity (rhythmic sports, such
as swimming) and recreational activities in general. Patients should be informed and encouraged
accordingly. There is no evidence that diet, vitamins or mineral supplements as well as hypnosis are of
benefit and should not be recommended.
block or lessen dopamine, Botulinum (Botox) injections. ADHD medications. Central adrenergic
inhibitors. Antidepressants. Anti seizure medications.
Psycho education, involving the patient as well as relevant caregivers, should be provided at the
beginning of treatment. Further, individual causal factors and options for treatment should be
discussed. Referral to self-help groups is also useful. In cases of mild severity – taking into account the
high rate of spontaneous remission – psycho education is all that is required.
Substantial anecdotal evidence exists concerning the benefits of physical activity (rhythmic sports, such
as swimming) and recreational activities in general. Patients should be informed and encouraged
accordingly. There is no evidence that diet, vitamins or mineral supplements as well as hypnosis are of
benefit and should not be recommended.
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