Tic disorders • A tic is a sudden, repetitive, non rhythmic motor movement or vocalization involving discrete muscle groups. • Common motor and phonic tics are, respectively, eye blinking and throat clearing. • Tics must be distinguished from movements of other movement disorders such as chorea, dystonia, myoclonus; movements exhibited in stereotypic movement disorder or some autistic people, and the compulsions of OCD and seizure activity.
10/03/2020 Tic disorders and Tourette Syndrome 2
• Classification of Tics – Motor or phonic • Motor tics are movement-based tics affecting discrete muscle groups. • Phonic tics are involuntary sounds produced by moving air through the nose, mouth, or throat. They may be alternately referred to as verbal tics or vocal tics,
10/03/2020 Tic disorders and Tourette Syndrome 3
– Simple or complex • Simple motor tics are: sudden, brief, meaningless movements involve only one group of muscles, such as eye blinking, head jerking, or shoulder shrugging. • A simple phonic tic can be almost any sound or noise, with common vocal tics being throat clearing, sniffing, or grunting. 10/03/2020 Tic disorders and Tourette Syndrome 4 • Complex motor tics: more purposeful appearing and of a longer nature & involve a cluster of movements and appear coordinated. Examples: pulling at clothes, touching people, touching objects, echopraxia and copropraxia (involuntarily performing obscene or forbidden gestures). • Complex phonic tics include echolalia, and 10/03/2020 coprolalia. Tic disorders and Tourette Syndrome 5 • Characteristics – Tics may increase as a result of stress, fatigue, boredom, or high-energy emotions, which can include negative emotions, such as anxiety, but positive emotions as well, such as excitement or anticipation. – Relaxation may result in a tic increase (for instance, watching television or using a computer), while concentration on an absorbing activity often leads to a decrease in tics. 10/03/2020 Tic disorders and Tourette Syndrome 6 • Classification (DSM-IV-TR) – Transient tic disorder: multiple motor and/or phonic tics ( >= 4 weeks, but < 12 months). – Chronic tic disorder: (either single or multiple motor or phonic tics, but not both) > 1. – Tourette syndrome: (both motor and phonic tics > 1 year). – Tic Disorder NOS: was diagnosed when tics were present, but did not meet the criteria for any specific tic disorder. 10/03/2020 Tic disorders and Tourette Syndrome 7 • Epidemiology – Tic disorders: are more common among males – over 19% of school-age children have tic disorders;[ – About 1 in 100 people may experience some form of tic disorder, usually before the onset of puberty.
10/03/2020 Tic disorders and Tourette Syndrome 8
Tourette's syndrome (TS) • TS is an inherited neuropsychiatric disorder • onset in childhood, • characterized by multiple physical (motor) tics and at least one vocal tic (10% of TS patients exhibit coprolalia). • The characteristic of the tics in TS: – wax and wane, – can be suppressed temporarily, and are preceded by a premonitory urge.
10/03/2020 Tic disorders and Tourette Syndrome 9
• Most TS cases are mild and the severity of tics decreases as the patient pass through adolescence. • Prevalence: 0.4% - 3.8% (5 to 18 y) may have TS •
• Prevalence of other tic disorders in school-age
children is higher (eye blinking, coughing, throat clearing, sniffing, and facial movements). • TS does not adversely affect intelligence or life expectancy. 10/03/2020 Tic disorders and Tourette Syndrome 10 • Cause: unknown, genetic and environmental factors play a role in the etiology of TS • Comorbid conditions: ADHD, OCD (that often cause more functional impairment) • Therapy: – There is no effective treatment , medication is unnecessary. – Education is an important part of any treatment plan, and explanation and reassurance alone are often sufficient treatment. 10/03/2020 Tic disorders and Tourette Syndrome 11 QA?