TIC DISORDER

DrFahim"Ahmadi"MD 1
DEFINITION OF TIC
• Repeated

• Sudden

• Rapid

• Non rhythmic

• Stereotyped motor movement including

sounds or vocalization

DrFahim"Ahmadi"MD 2
EPIDEMIOLOGY OF TIC
• A large, community-based study suggested that over 19% of school-
age children have tic disorders

• Tics begin before age 18 years.(typically between ages 4 and 6 Yr).

• Increase in severity to a peak at about age 10 to 12 yr.

• Male to Female 3:1

• Decrease during adolescence

• Most tics disappears spontaneously.

• In about 1% of children ,tics persist into adulthood.

DrFahim"Ahmadi"MD 3
CAUSES OF TICS
• Tour rete's syndrome
Primary Genetics
• Huntington’s disease

Infections • Encephalitis
• Stimulants
• Levodopa
• Carbamazepine
Drugs
• Phenytoin
• Phenobarbital
• antipsychotics
Secondary
Toxins • Carbon monoxide
Chromosomal abnormalities and other causes of MR
• Head trauma
• Stroke
Others
• Degenerative disease
• Schizophrenia

DrFahim"Ahmadi"MD 4
CLASSIFICATION DSM - 5
Tourette Syndrome : Both
 motor and vocal tics have been present for
> 1 year.

Persistent Tic disorder:

Singe or Multiple motor or vocal tics
 (but not both motor and vocal ) have
been present for > 1 years.

Provisional Tic disorder:

 Single or Multiple motor and /or vocal
tics have been present > 1 year.

DrFahim"Ahmadi"MD 5
TYPES OF TICS
Classification Motor Vocal

Blinking Grunting or Barking

Grimacing Sniffing or snorting

Simple
Head jerking

Combination of simple tics Coprolalia: Uttering socially

( head turning plus shoulder inappropriate words( eg,
shrugging) obscenities, ethnic slurs)

Copropraxia : using sexual or Echolalia: Repeating one’s own or

Complex
obscene gesture another’s sounds or word

Echopraxia: Imitating
someone’s movements
DrFahim"Ahmadi"MD 6
COMORBIDITIES

ADHD

OCD SAD

LD

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COMORBIDITIES
Comorbidities are common
Adolescents( and Adult) with tics may have one or more of the following:

1
3 Depression

2 Bipolar Disorder

3 Substance abuse

DrFahim"Ahmadi"MD 8
SYMPTOMS AND SIGNS
Tic can be:

• Motor or vocal

• Simple or complex

Simple tics: are a very brief movement or

vocalization ,typically without social meaning(can not be
recognizable gesture or word)
Complex tics: Last longer and may involve a combination
of simple tic.
Complex tics may appear to have social meaning.
DrFahim"Ahmadi"MD 9
DEFERENTIAL DIAGNOSIS
 Chorea in adults
 Complex partial seizure
 Frontal lobe syndrome
 Hemi facial spasm
 Huntington disease
 Neurogenic effects of cocaine
 Periodic limb movement disorder
 Wilson’s disease
 Intellectual disability

DrFahim"Ahmadi"MD 10
 Tics worse with:
• Stress
• Fatigue
• Most prominent when the body is relaxed.

 Tics may lessen when:

• Tasks ( school and work activities)
• Mental Concentration
• Rarely interfere with motor coordination.
 Tics disappears:
 During sleep

Note: Mild tics often cause few problems but Severe tics particular coprolalia are physically
and/or socially disabling

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TREATMENT

1) Cognitive – behavioral therapy

2) Sometimes Clonidine or antipsychotics

3) Treatment of comorbidities

DrFahim"Ahmadi"MD 12
TREATMENT
Drugs:
• Clonidine :0.05 to 0.5 mg po once/day to 4
times/day is effective in some patients.
• Risperidone 0.25 to 1.5 mg po bid
• Haloperidol 0.5 to 2 mg po bid or tid
• Olanzapine 2.5 to 5 mg po once /day.
• Fluophenazine is also effective in suppressing tics.
• SSRIS (OCD)
• STIMULANTS ( ADHD)
DrFahim"Ahmadi"MD 13
REFERENCES:

• CLINICAL NEUROLOGY AMINOFF 8TH EDITION 2012

• INTERNET(www.merckmanuals.com/Medscape)

• NEUROLOGICAL DISEASE (Step by Step treatment)

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