What are the types of tics?
Tics are divided into motor and vocal, simple and complex. Simple - short movements of one muscle group, such as blinking. Complex ones - a sequence of movements, jumping, touching, repeating someone else's words. Based on duration, a distinction is made between transient tics, which last less than a year, chronic motor or vocal tics, and Tourette's syndrome. Shouting obscene words, with which the syndrome is often associated, occurs only in a small proportion of patients.
- Simple motor movements - blinking, grimacing, shoulder twitching
- Complex motor skills - jumping, touching, gestures
- Simple vocals - coughing, grunting, sniffling
- Complex vocal words and phrases
- Transient - up to a year
- Tourette's syndrome - motor and vocal tics for longer than a year
Causes and risk factors
Tics are associated with the functioning of the basal ganglia - brain structures that regulate movement and the dopamine system. Heredity is of great importance: relatives often have tics or obsessions. Stress, anxiety, fatigue, and spending a long time in front of a screen do not cause tics, but they intensify them. Often tics are combined with attention deficit hyperactivity disorder, obsessive-compulsive disorder, anxiety, and these conditions are sometimes more disturbing than the tics themselves.
- Tics or obsessions in relatives
- Male gender
- Attention Deficit Hyperactivity Disorder
- Obsessive-compulsive disorder
- Anxiety, emotional stress
- Lack of sleep and overwork
Symptoms and course
Typically, tics begin at 4–7 years of age with blinking or grimacing, then they can change: some disappear, others appear. The severity comes in waves, often peaking between 10 and 12 years of age, and by adolescence and adulthood, many tics noticeably weaken. The tics usually disappear during sleep, and decrease with intense activity. A characteristic symptom is a premonition of a tic—an itch or tension that can only be relieved by movement.
- Frequent blinking, squinting
- Twitching of head, shoulders
- Grimaces, licking lips
- Coughing, grunting, sniffling
- Premonition before the tick
- Increased by anxiety and fatigue
Diagnostics
The diagnosis is made by a neurologist based on the description and observation of tics; It is useful to show the doctor the video recording, since the tics often subside during the appointment. There are no special tests to confirm tics. An EEG is prescribed if there is doubt and it is necessary to exclude epileptic seizures, an MRI of the brain is prescribed in case of an atypical course or neurological disorders. The doctor also evaluates attention, mood and obsessions, and if necessary, refers to a psychiatrist. Blinking is sometimes associated with eye problems, so you may need to see an ophthalmologist.
- Examination by a neurologist
- Video recording of tics at home
- EEG for suspected epileptic seizures
- MRI of the brain with an atypical picture
- Consultation with a psychiatrist for ADHD, anxiety, obsessions
- Examination by an ophthalmologist for frequent blinking
Treatment and assistance for the child
Mild tics that do not interfere with life are often not treated with medications. The main thing is to explain to family and teachers the nature of tics, not to make comments, punish or ask to “stop”, because this increases tension and tics. The most effective method for persistent tics is complex behavioral therapy for tics: the patient learns to notice the anticipation and perform a competing movement. For severe tics, the doctor prescribes drugs from the groups of alpha-2 agonists or antipsychotics; for local tics, botulinum therapy is sometimes used. At the same time, ADHD, anxiety and obsessions are treated.
- Don't focus on tics
- Calm daily routine and good sleep
- Comprehensive behavioral therapy for tics
- Medicines prescribed by a neurologist or psychiatrist
- Treatment of comorbid ADHD and anxiety
- School support