23. November 
 
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Definition and causes of Tics

Tics are uniform, repetitive, involuntary movements of a muscle or a small muscle group. It is usually the muscles of the face, neck or shoulders that are involved. These involuntary movements called motoric tics and is by far the most common form of tics. Tics might also be sudden sounds or words, if the speech muscles are involved. These are called vocal tics. Tics are exacerbated by stress and nervousness. Boys and men have tics more so than girls and women. Tics usually develop in childhood and youth, and it is estimated that up to 10% of all children at some point have tics.

Usually there is no reason for tics, and they rarely require treatment. However, tics can be debilitating, especially in the form called Tourette's syndrome where both involuntary body movements and sounds such as snorting, cough, whisper or grunting. Tourette syndrome is a hereditary condition, so there will often be others in the family with similar symptoms. Many patients with Tourette's syndrome also develop behavioral problems and about half have Attention Deficit and Hyperactivity Disorder (ADHD). More than half of patients with Tourette's syndrome also have Obsessive Compulsive Disorder also known as OCD which is a psychiatric condition.

Symptoms of Tics

Tics can be simple or complex. The simple motoric tics involve very small muscle groups and are simple movements such as blinking, flinching, grimace, wrinkle of the nose, lip protrusion, jerking shoulders and the head throwing the arms around involuntarily. There are also simple vocal tics, which consists of snorting, cough, whistle, hum, grunt, scream, yell or gasp.

The complex motoric tics are combined movements, which mean that more muscle groups must work together. This might be jumping, clapping, touching objects or others, tongue or lip biting, scratching, sticking out the tongue or compulsive awkward body positions. Complex vocal tics are more or less meaningful words, phrases or sentences that interrupt the flow of speech. This can lead to the impression of stutter.

In rare cases, the involuntary movements replicate sexual situations or might be provocative gestures. Similarly, the person may unwillingly speak profanely or use strong sexual expression. There might also be involuntary imitation of someone else's movements or speech. Tics vary much in terms of severity, incidence, duration and nature. There can be both good and bad periods.

Particularly in children there are cases where the child may withhold tics for several hours only then to get repeated violent tic attacks. Some experience a tingling sensation in the area where the tics occur before the onset of an attack. Tics often improve during or after hard physical activity and often disappear completely during sleep. They can be exacerbated when the child is completely relaxed or tired.

If there is one or more vocal tics and while many different motor tics, which vary in number and intensity over a period of more than a year, there are Tourette's syndrome.

At the same time, there are often symptoms of ADHD - Attention deficit hyperactivity disorder or OCD - Obsessive compulsive disorder.
 

Precautions and diagnosis of Tics

If there are only few and simple tics that are not particularly troublesome the best is to bide time as most such tics cases disappear by itself. If to the contrary, social problems arise, the doctor should be consulted, who can refer for further examination.

The diagnosis is made based on medical history, and by the doctor observing the occurrence of tics in the child. The latter may be difficult because tics can be suppressed during the consultation.
 

Treatment of Tics

The vast majority of tics require no treatment. Thorough information about the condition to both patient, family and social circles is usually sufficient. Particularly children may have problems with bullying, and it may therefore be a good idea to inform the day care or the school, so there is understanding of the problem. Particularly children with Tourette's syndrome are often perceived as naughty or badly mannered and they often experience many unjust defeats.
 

In the case of Tourette's syndrome medical treatment with antipsychotic drugs which also applied to many psychiatric illnesses might be used. The biggest problem for many with Tourette's syndrome is that they also have ADHD or OCD why these disorders also have to be addressed simultaneously. This is done partly by special educational initiatives to teach the child normal social rules and behaviour. It is also important with order and predictability in the daily life.

Outlook

Most tics are transient and disappear spontaneously over time. Patients with Tourette's syndrome, sometimes recover spontaneously after puberty, while in others it is a lifelong disorder.

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