Tics

Tics: Excerpt from Handbook of Signs & Symptoms (Third Edition)

A tic is an involuntary, repetitive movement of a specific group of muscles — usually those of the face, neck, shoulders, trunk, and hands. This sign typically occurs suddenly and intermittently. It may involve a single isolated movement, such as lip smacking, grimacing, blinking, sniffing, tongue thrusting, throat clearing, hitching up one shoulder, or protruding the chin. Or, it may involve a complex set of movements. Mild tics, such as twitching of an eyelid, are especially common. Tics differ from minor seizures in that tics aren’t associated with transient loss of consciousness or amnesia.

Tics are usually psychogenic and may be aggravated by stress or anxiety. Psychogenic tics often begin between ages 5 and 10 as voluntary, coordinated, and purposeful actions that the child feels compelled to perform to decrease anxiety. Unless the tics are severe, the child may be unaware of them. The tics may subside as the child matures, or they may persist into adulthood. However, tics are also associated with one rare affliction — Tourette syndrome, which typically begins during childhood.

History and physical examination

Begin by asking the parents how long the child has had the tic. How often does the child have the tic? Can they identify any precipitating or exacerbating factors? Can the patient control the tics with conscious effort? Ask about stress in the child’s life such as difficult school work. Next, carefully observe the tic. Is it a purposeful or involuntary movement? Note whether it’s localized or generalized, and describe it in detail.

Medical causes

Tourette syndrome

Tourette syndrome, which is thought to be largely a genetic disorder, typically begins between ages 2 and 15 with a tic that involves the face or neck. Indications include both motor and vocal tics that may involve the muscles of the shoulders, arms, trunk, and legs. The tics may be associated with violent movements and outbursts of obscenities (coprolalia). The patient snorts, barks, and grunts and may emit explosive sounds, such as hissing, when he speaks. He may involuntarily repeat another person’s words (echolalia) or movements (echopraxia). At times, this syndrome subsides spontaneously or undergoes a prolonged remission, but it may persist throughout life.

Special considerations

Psychotherapy and administration of a tranquilizer may be helpful in providing relief. Many patients with Tourette syndrome receive haloperidol, pimozide, or another antipsychotic to control tics. Help the patient identify and eliminate any avoidable stress and learn positive ways to deal with anxiety. Offer emotional support to the patient and family.

Book Source Details

• Book Title: Handbook of Signs & Symptoms (Third Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.

More About Tourette Syndrome

• Back to disease: Tourette Syndrome: Introduction
• Next Book Extract About Tourette Syndrome: Seizures, generalized tonic-clonic (Handbook of Signs & Symptoms (Third Edition))
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Handbook of Signs & Symptoms (Third Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-402-1

 » Next page: Seizures, generalized tonic-clonic (Handbook of Signs & Symptoms (Third Edition))

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