Tourette
Syndrome Tics
What
are Tourette Syndrome tics?
Tics
are rapid movements or sounds that are repeated
over and over for no reason. (Tic
List Below) Tics are brief,
intermittent, repetitive, nonrhythmic, unpredictable, purposeless,
stereotyped movements (motor tics) or sounds (phonic or vocal
tics). Although Tourette Syndorme tics are often described
as "rapid" or "sudden," not all are; some
tics are "held" or "tonic" movements involving
freezing in a position for a few seconds. A person with a tic
can't control the movement or sounds.
Tourette
Syndrome tics are associated with an urge, and efforts to suppress
the tics results in psychic tension and anxiety. Subsequent "release"
of the movements or sounds results in relief. Although tics
are involuntary, the urge sometimes can be suppressed for short
periods with voluntary effort. A burst of tics often follows attempts
of suppression, to relieve a buildup of the inner sensation.
Tourette
tics are also often worse when a person feels stressed, tired
or anxious. Other various factors that can increase tics are some
medicines, heat, and food & environmental allergies.
Simple
tics are usually the first manifestation of Tourette syndrome.
Unlike the common childhood tics that usually vanish within a
year, the tics of Tourette Syndrome last and last.
The
reason for having Tourette Syndorme tics for at least 12 months
is specified in a diagnosis is because transient tics –
a brief period or one-off episode of tics – are really common
in children (occurring in around ten per cent of children) and
these cases clear up and get better in relatively short time.
Tourette
tics usually begin between the ages of 5 to 7, and peak
around age 10. During the course of adolescence and by age 18
they might begin to diminish. Some patients, however, will have
their tics for life and in other cases (<10%), the Tourette
Syndrome tic symptoms can become even more severe in adulthood.
The
Tourette tics are involuntary. A variety of sensory and
mental states, including urges and a build up of tension, precede
the tics and subside after the tics occur. A child (or adult)
might be able to suppress them for a short while, but they may
come back with a vengeance.
It
is not unusual for patients to "lose" their tics as
they enter a doctor's office. Parents may plead with a child to
"show the doctor what you do at home," only to be told
that the youngster "just doesn't feel like doing them"
or "can't do them" on command. Adults will say "I
only wish you could see me outside the office," and family
members will heartily agree. This phenomenon of a doctor's office
“scaring” off the tics can be very frustrating and
really intensify the stress of getting a diagnosis and treatment
for a Tourette patient.
Suppressing
Tourette tics on the other hand is an effort similar
to that of holding back a sneeze. Eventually tension mounts to
the point where the tic escapes. Tics can also worsen in stressful
situations; however they improve when the person is relaxed or
absorbed in an activity. In most cases tics decrease markedly
during sleep, however there are cases where the tics cause signigicant
sleeping problems which can further exacerbate the Tourette symptoms.
Why
can't you stop the tic?
Try
not to blink...
this
wil help you understand how hard it is to stop a Tourette tic.
Two
categories of Tourette Syndrome Tics: Simple and Complex.
Simple
tics are sudden, brief movements that involve a limited
number of muscle groups. They occur in a single or isolated fashion
and are often repetitive.
Simple
vocal tics are elementary, meaningless noises and sounds
i.e. grunting, sniffing, clearing the throat, squeaking.
Simple
motor tics are focal movements involving one group of
muscles, i.e. eye blinking, tongue protrusion, facial grimacing,
shoulder shrug, or head turning.
Complex
tics are distinct, coordinated patterns of successive
movements involving several muscle groups.
Complex
vocal tics include meaningful syllables, words, or phrases
i.e. coprolalia, echolalia, palilalia.
Complex
motor tics are coordinated or sequential patterns of
movement that resemble normal motor tasks or gestures i.e. jumping,
smelling objects, touching the nose, touching other people, or
self-harming behaviors.
The
vocal tic symptoms may interfere with the smooth flow
of speech and resemble a stammer, stutter or other speech irregularity.
Often, but not always, vocal symptoms occur at points of linguistic
transition, such as at the beginning of a sentence where there
may be speech blocking at the initiation of speech or at phrase
transitions. Patients suddenly may alter speech volume, slur a
phrase, emphasize a word or assume an accent.
The
motor tic symptoms can occur in sync with, or independent
of vocal tics. If the motor tics are mild to moderate, sometimes
they can be disguised as other normal motor functions of the body
by the Touretter. i.e. they may take a tic that causes them to
move their hand in front of their face and blend it with adjusting
their glasses, earring, fixing hair or scratching an itch.
Sensory
tics
refer to uncomfortable sensations, such as pressure, tickle, cold,
warmth, or paresthesias that are localized to certain body parts
and that are relieved by the performance of an intentional act
in the affected area. Rarely, motor tics may be provoked by a
mental projection of sensory impressions to other persons or objects
and are relieved by touching or scratching that person or object.
These are known as phantom tics.
Obsessive-compulsive
symptoms and tics can share certain features and possible
brain locations. It's not always possible to distinguish
a complex tic from a compulsion. A compulsion, by definition,
requires the involvement of thoughts (which you may not be able
to elicit from a child), whereas tics don't. You can have both.
Therefore,
at some point in the continuum of complex motor tics, the term
"compulsion" seems appropriate for capturing the organized,
ritualistic character of the actions. The need to do and then
redo or undo the same action a certain number of times (e.g.,
to stretch out an arm ten times before writing, to "even
up," or to stand up and push a chair into "just the
right position") is compulsive in quality and accompanied
by considerable internal discomfort. Complex motor tics may greatly
impair school work, e.g., when a child must stab at a workbook
with a pencil or must go over the same letter so many times that
the paper is worn thin. The distinction between complex tics and
compulsions may be a difficult one for the physician to make and
some "complex tics" may be alleviated by medications
used for obsessive-compulsive disorder.
Impulsive
symtoms and tics in Tourette Syndrome have resulted in
a reference to Tourette's being described as an "impulsive
disorder". i.e.
Echolalia (the urge to repeat other's words), Echopraxia (the
urge to mimic other's actions), Pallilalia (the urge to repeat
your own words or thoughts)
Many
Touretter’s describe a strong urging-impulse to perform
an action or sound prior to many of their tics. They fell as if
they are constantly being overcome by various strange impulses,
while at the same time feeling an inability to suppress the impulse.
The more time and effort spent trying to control the impulse the
stronger the urge becomes. Finally when overwhelmed by the impulse
the action is accomplished in the Touretter with out their approved
consent of the action.
Treating
the Tourette Syndrome Tics
Tourette
Syndrome Tics only require treatment
when they interfere with the functioning of the patient. Mild
tics do not usually require medication for treatment. Intervention
in mild tics if needed may only require some basic understanding.
Moderate and Severe tics are more likely to be treated with medication
if needed and also be supported by better education of patients,
school personnel and parents, and initiation of supportive counseling
and/or behavior therapy.
