Overview of Tourette Tics

[Retired]

Tics are classified as either simple or complex

Simple motor tics are sudden, brief, repetitive movements that involve a limited number of muscle groups. Some of the more common simple tics include eye blinking and other vision irregularities, facial grimacing, shoulder shrugging, and head or shoulder jerking.

Simple vocalizations might include repetitive throat-clearing, sniffing, or grunting sounds.

Complex tics are distinct, coordinated patterns of movements involving several muscle groups.

Complex motor tics might include facial grimacing combined with a head twist and a shoulder shrug. Other complex motor tics may actually appear purposeful, including sniffing or touching objects, hopping, jumping, bending, or twisting. Simple vocal tics may include throat-clearing, sniffing/snorting, grunting, or barking.

More complex vocal tics include words or phrases. Perhaps the most dramatic and disabling tics include motor movements that result in self-harm such as punching oneself in the face or vocal tics including coprolalia (uttering swear words) or echolalia (repeating the words or phrases of others).

Some tics are preceded by an urge or sensation in the affected muscle group, commonly called a premonitory urge. Some with TS will describe a need to complete a tic in a certain way or a certain number of times in order to relieve the urge or decrease the sensation.

Tics are often worse with excitement or anxiety and better during calm, focused activities.

Certain physical experiences can trigger or worsen tics, for example tight collars may trigger neck tics, or hearing another person sniff or throat-clear may trigger similar sounds.

Tics do not go away during sleep but are often significantly diminished.

What is the course of TS?

Tics come and go over time, varying in type, frequency, location, and severity. The first symptoms usually occur in the head and neck area and may progress to include muscles of the trunk and extremities.

Motor tics generally precede the development of vocal tics and simple tics often precede complex tics. Most patients experience peak tic severity before the mid-teen years with improvement for the majority of patients in the late teen years and early adulthood.

Approximately 10 percent of those affected have a progressive or disabling course that lasts into adulthood.

Can people with TS control their tics?

Although the symptoms of TS are involuntary, some people can sometimes suppress, camouflage, or otherwise manage their tics in an effort to minimize their impact on functioning. However, people with TS often report a substantial buildup in tension when suppressing their tics to the point where they feel that the tic must be expressed. Tics in response to an environmental trigger can appear to be voluntary or purposeful but are not.

Involuntary movements - Actions beyond one's control that sometimes can be suppressed, but only for very limited periods and then must be expressed


What are some types of Tourette tics?
Tics may include repetitive eye blinking, head jerking, neck stretching, foot stamping, or body twisting and bending. In a few cases, such tics can include inappropriate words and phrases.

It is not uncommon for a person with Tourette Syndrome to continuously clear his or her throat, cough, sniff, grunt, yelp, or shout.

A few people with Tourette's engage in self-harming behaviors such as lip and cheek biting and head banging.

Sources: National Institue of Mental Health (NIMH)
National Institute for Neurological Disorders and Stroke (NINDS)
All information quoted from these sources is in the public domain


Tics are defined, rather vaguely, in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) as a recurrent, non-rhythmic series of movements (of a non-voluntary nature) in one or several muscle groups.

Read this article for a thorough examination of the nature of tics, their dynamics and effects

COGNITIVE-BEHAVIORAL MANAGEMENT OF TIC DISORDERS

Attachment this article is available for viewing or download below.

The following Topics are discussed in this article:

• What counts as a tic?
  Comorbidity and covariation
  Relationship of tics with other disruptive behaviours
  Emotional Associations
  Self-management strategies
  Coping strategies--Maintaining the tic cycle

 

[HA]

This is such a great overview, Steve! I found the link to the article that talks about CBT and other comorbid conditions really interesting.

Specifically the difference between OCD and TS symptoms regarding impulsive versus compulsive behaviours. OCD is a compulsion being anxiety provoking while the impulsive tic has an emotional release once completed and this release is not experienced with carrying out a compulsion of OCD.

I also did not realize that there could be touching of objects or other movements with TS. I just assumed it was only physical body tics. I see a man in the grocery store who is overtaken with touching areas around him repeatedly and constant meaningless movements of his limbs which will subside for periods of time then start again. He is very disabled by this and it is heartbreaking to see. A very nice young man who has such difficulty paying for groceries that you begin to appreciate the simple tasks that the rest of us do on a daily basis without a thought. Now I wonder if it was OCD (which I assumed) or if instead, it was a severe case of TS.

I also wondered how psychomotor seizures compared to the symptoms of TS.

Cheers

 

[Retired]

HeartArt,

I'm glad you found the overview informative. Of course we cannot speculate on what might be afflicting the man you saw in the store, but sometimes one can get a clue about the cause being Tourette if the person seems to repeat the pattern of movements.

When we give in service presentations to students or even adults to explain Tourette Syndrome at the request of a co-worker or fellow student, we use a few examples to try to make those without Tourette appreciate the involuntary nature of the tics.

One example is to relate the need to tic to the need to scratch an itch. If you've ever tried not to scratch an itch, you know how difficult that can be.

Another example would be to keep your eyes open for five minutes without blinking. Well we all know that's impossible, but when you experience the physical and mental forces at work at the point just before you absolutely have to blink..that's what it's like to tic.

I also wondered how psychomotor seizures compared to the symptoms of TS.

I am sorry but I don't know the answer to that question. Perhaps someone else with an understanding of psychomotor seizures could elaborate.

 

[HA]

Hi Steve,

According to the information below, it may be possible that the main difference is lack of conciousness for psychomotor seizures:

Complex Partial Seizures
(Psychomotor or Temporal Lobe Seizures)

A complex partial seizure occurs when epileptic activity spreads to both temporal lobes in the brain. A complex partial seizure often occurs after a simple partial seizure of temporal lobe origin. Complex partial seizures are experienced most by children. In some children, they lead to tonic-clonic seizures.

A complex partial seizure does not involve convulsions, but consciousness is impaired. Someone experiencing one will no longer respond to questions after the seizure starts.

A complex partial seizure often begins with a blank look or empty stare. They will appear unaware of their surroundings and may seem dazed. The seizure may progress to include chewing movements, uncoordinated activity, or sometimes performing meaningless bits of behaviour which appear random and clumsy. These automatisms may include actions such as picking at their clothes, trying to remove them, walking about aimlessly, picking up things, or mumbling. Someone experiencing a complex partial seizure may become frightened and try to run and struggle. Following the seizure, there will be no memory of it.

A complex partial seizure usually lasts about 2 to 4 minutes. It may be followed by a state of confusion lasting longer. Once the pattern of seizures is established, it will usually be repeated with each subsequent seizure.

Complex partial seizures sometimes resist anticonvulsant medication.