Facial tics: Tourette Syndrome and Other Types

[David Baxter PhD]

Facial tics: Types, disorders, and treatment
By Jon Johnson, MedicalNewsToday.com
June 18, 2018

A facial tic is an involuntary, uncontrolled spasm in the facial muscles. The tic is unwanted and generally occurs regularly enough to be a nuisance to the person who experiences it.A person can hold in a tic temporarily, in a similar way to holding in a sneeze, but doing so often makes the person increasingly uncomfortable.

A few different disorders can cause facial tics, but most of the time facial tics do not indicate a severe medical condition.

According to a report in Pediatric Neurology, facial tics occur more commonly in children than adults, and boys seem to be much more likely to experience facial tics than girls. Most children's facial tics fade after a few months.

What are facial tics?
Facial tics are involuntary muscle movements that can happen anywhere in the face. However, they usually occur in the same place each time and happen frequently enough to bother the person. Severe tics can affect a person's quality of life.

Common types of facial tics include:

• rapid eye blinking or winking
• squinting
• flaring the nostrils
• clicking the tongue
• sucking the teeth
• raising the eyebrows
• opening and closing the mouth
• scrunching the nose
• mouth twitching

As well as these muscular tics, some people may also experience vocal tics, such as clearing the throat or grunting.

A person may suppress a tic temporarily, but it will come out eventually.

Types of tic disorders
Different types of disorders can cause facial tics. The severity of the tic, as well as the presence of other symptoms, can often help a doctor identify the underlying condition.

Transient tic disorder
Transient tics are temporary. Transient tic disorder may cause a regular facial or vocal tic, but the tic typically lasts for under a year.

Transient tic disorder usually only causes tics while a person is awake. People rarely have tics while they are sleeping.

Transient tic disorder is responsible for the majority of causes of tics in children. They usually resolve without any treatment.

Chronic motor tic disorder
Chronic motor tic disorder is a more persistent tic disorder. For a doctor to diagnose a person with chronic motor tic disorder, they must have experienced tics for over a year, for periods of at least 3 months at a time.

Unlike transient tic disorder, chronic motor tic disorder causes tics that can also occur during sleep.

Chronic motor tic disorder can occur in both children and adults. Young children who have chronic motor tic disorder may not need treatment, as symptoms may be more manageable or subside on their own over time.

Adults who have the disorder may need medication or other treatment to control the tics.

Tourette's syndrome
Tourette's syndrome, often shortened to Tourette's, is a chronic condition that causes one or more motor or vocal tics.

Most people who have Tourette's syndrome develop it during childhood, but the disorder can continue into adulthood. Tics usually become less severe as the person ages.

People with Tourette's syndrome have both motor and verbal tics. They may make sounds or say words involuntarily.

Some people with Tourette's syndrome have only small motor tics, such as rapid blinking or throat clearing. However, they may also have more involved motor tics, such as:

• shrugging one or both shoulders
• shaking the head uncontrollably
• flapping the arms
• saying inappropriate words
• making inappropriate gestures
• yelling out

People can often manage symptoms of Tourette's syndrome by having behavioral therapy. However, people who have any additional underlying conditions may need medication.

Treatment
Treatment for facial tics can vary depending on the type and severity of the tic. Many tics, such as those caused by transient tic disorder, may go away without treatment over time.

Tics that interfere with performance in school or at work may require treatment. Long-lasting, chronic tics, such as those caused by Tourette's syndrome, may need more extensive treatment.

Treatment for tics may include:

Medication
Medication for tics include classes of drugs called alpha-adrenergic agonists, neuroleptic drugs, and dopamine blockers.

In cases of persistent facial twitches or tics, doctors may recommend Botox injections. Botox injections can paralyze the facial muscles for a few months, which may be enough to stop a tic from coming back.

Medications can also help treat any underlying conditions causing the tic, such as Tourette's syndrome or ADHD.

Psychotherapy
Doctors may recommend a person has regular sessions with a psychotherapist who can help the person find ways to change or eliminate the tics.

Behavioral modification and habit reversal techniques may help some people get over their tics and improve their quality of life.

The process typically involves teaching the person to identify when the tic is about to happen. Once a person can do this, the therapist will then encourage them to try to replace the tic with a different behavior.

Over time, this may help replace the physical habit with one that is less distracting or does not affect a person's daily functioning.

Surgery
Some surgical methods may help in severe cases of facial tics, such as those caused by Tourette's syndrome.

One surgical therapy is called deep brain stimulation. Some scientists believe that by implanting electrodes in the brain, electrical currents can reach specific sections of the brain, which may help regulate brain waves and reduce tics.

A recent study found that deep brain stimulation may help relieve symptoms of Tourette's syndrome, but more research is still required to pinpoint the best areas of the brain to stimulate.

Natural remedies
Doctors may also recommend natural treatments for facial tics. Stress is believed to play a role in the development and persistence of tics, so natural remedies will involve reducing stress in the person's life.

Stress-relieving activities include:

• light exercises
• imaginative play
• yoga
• meditation

Getting a full night's rest is also crucial for people looking to reduce stress and find relief. Sometimes, a doctor may recommend counseling.

When to see a doctor
Often, facial tics are transient and will go away on their own. A person should see a doctor if they experience any tic that lasts longer than a year.

Anyone who experiences tics that are severe, persistent, or affect many different muscle groups should contact their doctor for a proper diagnosis.

It is not always possible to prevent facial tics, but many do not require treatment and subside on their own.

Treatments that can help people manage the tic are available for persistent tics. Learning stress relief techniques and seeing a therapist may also help some people.

 

[GaryQ]

Thanks for posting the article David.

There are few inaccuracies regarding Tourette Syndrome in the article that I would like to point out.
The following clarifications all come from the official Tourette Canada website: Tourette.ca

Tourette's syndrome
Tourette's syndrome, often shortened to Tourette's, is a chronic condition that causes one or more motor or vocal tics.

1- Not a major issue but the official name is Tourette Syndrome not Tourette's Syndrome (although many people call it Tourette's)

2 - There must be at least 2 motor tics and one vocal tic in order for TS to be diagnosed

What is the Diagnostic Criteria for Tourette Syndrome (TS)?

In order to be diagnosed with TS, a person must meet a set of conditions or diagnostic criteria. These criteria, found in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) are:​

• At least two motor tics and at least one vocal tic (not necessarily at the same time);
• Tics persist for more than a year (tics can wax and wane during this period);
• Tics begin before age 18; and
• Tics are not caused by a substance or other condition (e.g., Huntington Disease, infection, head injury).

Most people who have Tourette's syndrome develop it during childhood, but the disorder can continue into adulthood. Tics usually become less severe as the person ages.

3 - In order for TS to be diagnosed as stated above, 2 motor tics and one vocal tic must have begun before age 18

Some people with Tourette's syndrome have only small motor tics, such as rapid blinking or throat clearing.

[/QUOTE]

4 - Throat Clearing is a vocal tic not a motor tic

(A vocal tic is pretty much anything that makes sounds from the head not only actual words as we would assume by the term "vocal tic".)
​

What is a tic?

Tourette Syndrome (TS) tics are sudden, intermittent, repetitive, unpredictable, purposeless, nonrhythmic, involuntary movements or sounds. Tics that produce movement are called “motor tics,” while tics that produce sound are called “vocal tics” or “phonic tics.” Tics can be either simple or complex.Simple motor tics involve one muscle group and include eye blinking, lip-licking, shoulder shrugging, and head jerking. Complex motor tics involve a coordinated movement produced by a number of muscle groups. For example, touching objects, jumping, or spinning around. Complex motor tics may also include imitating someone else’s actions (echopraxia) or exhibiting inappropriate or taboo gestures of behaviours (copropraxia.)Simple vocal tics include sniffing, grunting, throat clearing, uttering single syllables (e.g. uh-uh-uh) and humming. Complex vocal tics include uttering linguistically meaningful utterances (words and phrases), or changing the pitch and volume of voice. Complex vocal tics may also involve repeating a phrase he/she has heard over and over (echolalia), repeating one’s own words (palilalia) or uttering obscenities or socially taboo phrases (coprolalia).The most important thing to understand about the tics associated with Tourette Syndrome is they are the result of a neuropsychiatric condition. The sounds and behaviours are involuntary and are not being done by choice.​

 

[David Baxter PhD]

Thanks for those corrections, @GaryQ.

I was mainly posting it because it points out that not all tics are necessarily Tourette and that some can be quite common in young children, especially boys, and some do “grow out of them”.

 

[GaryQ]

With Steve our resident TS expert retired and knowing he would have pointed these facts out I figured I'd make my old friend and mentor proud by filling a tiny little portion of the big shoes he left to fill