What are Tourette Syndrome tics?
Tics are rapid movements or sounds that are repeated over and over for no reason. (Tic List Below) Tics are brief, intermittent, repetitive, nonrhythmic, unpredictable, purposeless, stereotyped movements (motor tics) or sounds (phonic or vocal tics). Although Tourette Syndorme tics are often described as "rapid" or "sudden," not all are; some tics are "held" or "tonic" movements involving freezing in a position for a few seconds. A person with a tic can't control the movement or sounds.
Tourette Syndrome tics are associated with an urge, and efforts to suppress the tics results in psychic tension and anxiety. Subsequent "release" of the movements or sounds results in relief. Although tics are involuntary, the urge sometimes can be suppressed for short periods with voluntary effort. A burst of tics often follows attempts of suppression, to relieve a buildup of the inner sensation.
Tourette tics are also often worse when a person feels stressed, tired or anxious. Other various factors that can increase tics are some medicines, heat, and food & environmental allergies.
Simple tics are usually the first manifestation of Tourette syndrome. Unlike the common childhood tics that usually vanish within a year, the tics of Tourette Syndrome last and last.
The reason for having Tourette Syndorme tics for at least 12 months is specified in a diagnosis is because transient tics a brief period or one-off episode of tics are really common in children (occurring in around ten per cent of children) and these cases clear up and get better in relatively short time.
Tourette tics usually begin between the ages of 5 to 7, and peak around age 10. During the course of adolescence and by age 18 they might begin to diminish. Some patients, however, will have their tics for life and in other cases (<10%), the Tourette Syndrome tic symptoms can become even more severe in adulthood.
The Tourette tics are involuntary. A variety of sensory and mental states, including urges and a build up of tension, precede the tics and subside after the tics occur. A child (or adult) might be able to suppress them for a short while, but they may come back with a vengeance.
It is not unusual for patients to "lose" their tics as they enter a doctor's office. Parents may plead with a child to "show the doctor what you do at home," only to be told that the youngster "just doesn't feel like doing them" or "can't do them" on command. Adults will say "I only wish you could see me outside the office," and family members will heartily agree. This phenomenon of a doctor's office scaring off the tics can be very frustrating and really intensify the stress of getting a diagnosis and treatment for a Tourette patient.
Suppressing Tourette tics on the other hand is an effort similar to that of holding back a sneeze. Eventually tension mounts to the point where the tic escapes. Tics can also worsen in stressful situations; however they improve when the person is relaxed or absorbed in an activity. In most cases tics decrease markedly during sleep, however there are cases where the tics cause signigicant sleeping problems which can further exacerbate the Tourette symptoms.
--------------------------------------------------------------------------------
Why can't you stop the tic?
Try not to blink...
this wil help you understand how hard it is to stop a Tourette tic.
--------------------------------------------------------------------------------
Two categories of Tourette Syndrome Tics: Simple and Complex.
Simple tics are sudden, brief movements that involve a limited number of muscle groups. They occur in a single or isolated fashion and are often repetitive.
Simple vocal tics are elementary, meaningless noises and sounds i.e. grunting, sniffing, clearing the throat, squeaking.
Simple motor tics are focal movements involving one group of muscles, i.e. eye blinking, tongue protrusion, facial grimacing, shoulder shrug, or head turning.
Complex tics are distinct, coordinated patterns of successive movements involving several muscle groups.
Complex vocal tics include meaningful syllables, words, or phrases i.e. coprolalia, echolalia, palilalia.
Complex motor tics are coordinated or sequential patterns of movement that resemble normal motor tasks or gestures i.e. jumping, smelling objects, touching the nose, touching other people, or self-harming behaviors.
The vocal tic symptoms may interfere with the smooth flow of speech and resemble a stammer, stutter or other speech irregularity. Often, but not always, vocal symptoms occur at points of linguistic transition, such as at the beginning of a sentence where there may be speech blocking at the initiation of speech or at phrase transitions. Patients suddenly may alter speech volume, slur a phrase, emphasize a word or assume an accent.
The motor tic symptoms can occur in sync with, or independent of vocal tics. If the motor tics are mild to moderate, sometimes they can be disguised as other normal motor functions of the body by the Touretter. i.e. they may take a tic that causes them to move their hand in front of their face and blend it with adjusting their glasses, earring, fixing hair or scratching an itch.
Sensory tics refer to uncomfortable sensations, such as pressure, tickle, cold, warmth, or paresthesias that are localized to certain body parts and that are relieved by the performance of an intentional act in the affected area. Rarely, motor tics may be provoked by a mental projection of sensory impressions to other persons or objects and are relieved by touching or scratching that person or object. These are known as phantom tics.
Obsessive-compulsive symptoms and tics can share certain features and possible brain locations. It's not always possible to distinguish a complex tic from a compulsion. A compulsion, by definition, requires the involvement of thoughts (which you may not be able to elicit from a child), whereas tics don't. You can have both.
Therefore, at some point in the continuum of complex motor tics, the term "compulsion" seems appropriate for capturing the organized, ritualistic character of the actions. The need to do and then redo or undo the same action a certain number of times (e.g., to stretch out an arm ten times before writing, to "even up," or to stand up and push a chair into "just the right position") is compulsive in quality and accompanied by considerable internal discomfort. Complex motor tics may greatly impair school work, e.g., when a child must stab at a workbook with a pencil or must go over the same letter so many times that the paper is worn thin. The distinction between complex tics and compulsions may be a difficult one for the physician to make and some "complex tics" may be alleviated by medications used for obsessive-compulsive disorder.
Impulsive symtoms and tics in Tourette Syndrome have resulted in a reference to Tourette's being described as an "impulsive disorder". i.e. Echolalia (the urge to repeat other's words), Echopraxia (the urge to mimic other's actions), Pallilalia (the urge to repeat your own words or thoughts)
Many Touretters describe a strong urging-impulse to perform an action or sound prior to many of their tics. They fell as if they are constantly being overcome by various strange impulses, while at the same time feeling an inability to suppress the impulse. The more time and effort spent trying to control the impulse the stronger the urge becomes. Finally when overwhelmed by the impulse the action is accomplished in the Touretter with out their approved consent of the action.
--------------------------------------------------------------------------------
Treating the Tourette Syndrome Tics
Tourette Syndrome Tics only require treatment when they interfere with the functioning of the patient. Mild tics do not usually require medication for treatment. Intervention in mild tics if needed may only require some basic understanding. Moderate and Severe tics are more likely to be treated with medication if needed and also be supported by better education of patients, school personnel and parents, and initiation of supportive counseling and/or behavior therapy.
