Tics (Habit Spasms; Tourette's Syndrome)
Tics are rapid, involuntary movements that are usually jerky and repetitive. They commonly involve muscles of the face, shoulders, or arms, producing such motions as eye blinking, mouth twitching, forehead wrinkling, head shaking, and shoulder shrugging. Sometimes tics are accompanied by grunts or other involuntary noises or words.
Simple tics, or habit spasms, frequently begin during childhood or adolescence. Some researchers have theorized that they develop as nervous mannerisms to relieve tension. These habitual patterns usually disappear spontaneously, but in some people, they become ingrained behavior. Once a tic has been established, the person may be able to control it for a short period, but it soon returns and often is even more noticeable than before.
Simple tics are three times more common in males than females. Sometimes they are associated with an obsessive-compulsive behavior disorder, such as a need to wash every few minutes. A tendency to develop tics seems to run in some families. In a few instances, tics may be caused by an underlying neurological disorder.
With time, some people become totally unaware of their tics and lose any ability to control them. The mannerisms tend to intensify when these persons feel stressed, anxious, or self-conscious and lessen or even disappear during sleep or an absorbing activity, such as reading or watching television.
The most severe type of tic is called Gilles de la Tourette's syndrome, named for the French physician who first described it in 1885. This movement disorder, believed to be caused by a chemical imbalance in the brain, is characterized by a variety of facial and body tics and noises such as sniffing, throat clearing, grunting, or barking. Some people constantly repeat what is said to them, and others stutter or repeat their own words. An especially disturbing vocal aspect is coprolalia, the involuntary use of obscenities.
Tourette's syndrome usually begins between the ages of 2 and 15 and often lasts for a lifetime, although in some people it disappears by adulthood. In severe cases, the person is unable to hold a job or engage in social activities.
Diagnostic Studies and Procedures
Diagnosis begins with a doctor asking questions about the nature of the tics, such as when they began, how often they occur, and whether stress or specific activities bring them on. This questioning is followed by an examination that includes simple neurological tests. In some cases, a CT scan or MRI may be ordered, as well as EEG (electroencephalography), a study of the brain's electrical activity.
A decision as to the necessity of medical treatment is based on the type and severity of the tic, its underlying cause, and the degree to which it interferes with normal activities. Minor nervous tics in children are usually temporary and are best ignored.
Patients with simple anxiety-induced tics may be treated with a short course of a benzodiazepine tranquilizer, such as diazepam (Valium). While these drugs do not have a direct effect on a tic itself, they may alleviate anxiety while the patient undergoes psychotherapy to resolve the problem.
Haloperidol (Haldol), a drug that is normally used to treat psychotic disorders, helps up to 80 percent of patients who have Tourette's syndrome, with a 70- to 90-percent decrease in the symptoms. Unfortunately, symptoms are likely to return if the drug is stopped. Even so, only 20 to 30 percent of patients continue long-term use of Haldol because of its side effects, which include drowsiness, a dulling of mental function, and problems in muscle control that resemble Parkinson's disease. A safer drug is clonidine (Catapres), an antihypertensive drug that blocks certain nerve impulses. Some studies suggest that it helps 40 to 70 percent of Tourette's patients.
Patients who are not helped by Haldol or Catapres may be given pimozide (Orap), a new drug created specifically for Tourette's syndrome. It works by inhibiting the brain's receptors for dopamine, a chemical that transmits nerve messages. Its side effects are similar to those of Haldol, but unlike Haldol, Orap has not yet been studied for use in children under the age of 12.
Biofeedback Training. Some patients are able to overcome simple tics by learning to control the responsible nerve and muscle responses.
Meditation. Deep breathing and other relaxation techniques associated with meditation can help alleviate stress and may reduce the frequency and severity of simple tics. Related techniques like self-hypnosis may also help.
Trying to control tics by voluntarily suppressing them does not work and may even worsen the problem. A better approach is to identify the stressors that seem to exacerbate a tic, and then avoid them or work on improving stress-coping techniques.
Tourette's syndrome can be difficult to live with, especially because many people have little or no understanding of the disease and assume that the afflicted person is mentally unbalanced. Joining a self-help group can help, as can psychological counseling for the patient and family members. Although Tourette's syndrome does not affect intelligence, it can disrupt the thought processes and learning.
Other Causes of Abnormal Movements
Tics and related abnormal movements may also be caused by Huntington's disease, dystonia, Parkinson's disease, and other neuromuscular disorders.