What are Tics?
Tics are repetitive and involuntary muscular movements that can occur in any part of the body. These movements are uncontrollable and unknown to the individual, happening due to nervous system disorders. Symptoms for tic start showing early in life at the age of 2-5 years. Unwanted and continuous blinking of an eye is one of the most common examples of a tic disorder.
Associated Anatomy
Brain and nerves
Causes of Tics
The exact cause of tic disease is still unknown, but from the studies to date, tics can occur because of:
- Genetic factors: Although the exact mechanism is not known, genetic factors play a significant role in causing tics. Genes inherited over generations can express themselves abnormally, leading to changes in neurotransmitters like serotonin and dopamine, resulting in sudden and rapid movements.
- Environmental factors: Infections, toxins, or certain drugs can alter the region in the brain responsible for controlling movements in the body.
Signs or Symptoms of Tics
Symptoms of the disease vary across individuals and can change and get more complex with time. An uncontrolled, repetitive, and irregular movement including sound or muscular involvement is a common sign of tics. Other symptoms varying from simple to complex tics include:
- Blinking of eye
- Head jerk
- Shrugging of shoulders
- Tapping of foot
- Twitching and scratching
- Imitating other people’s movements
- Pinching oneself or others
- Sniffing
- Clearing the throat or coughing
- Grunting
- Clicking of tongue
- Whistling
- Squeaking
- Making obscene comments or gestures unknowingly
- Repeating phrases or sounds
Stages of Tics
Tics can be simple or complex, depending on the severity of symptoms.
- Simple tics are mild and include simpler movements like blinking and jerking with vocals such as coughing or throat clearing.
- Complex tics are more severe and the motor movements are intensive. Vocals include echoing and repeating words or phrases. Complex motor tics include jumping, sniffing, twisting, or shrugging.
Possible Tics Treatments
As the causes of tics are not well known, no specific Tics treatment is available to date. But if the symptoms are severe, and it interferes with the daily routine and hinders the normal lifestyle of the patient, it is suggested that:
- Medications: Medicines like ADHD stimulants, antidepressants and dopamine blockers help to provide relief to the symptoms and not cure the disease. There are various side effects and varied effects of medications on different patients, thereby limiting their use.
- Therapy: Individuals suffering from tics undergo behaviour therapy or psychotherapy. Individuals are taught habit reversal or behaviour intervention; so that they can interrupt the tics and the patient consciously does new movements when a tic occurs.
- Botox injections: Injections containing botulinum are injected into the muscles restricting their movement.
Risk factors of Tic disorders
The factors that increase the risk of tic disorders are:
- Men are more inclined to tics when compared to women, they are three times more likely to have the disease
- Tics can be a cumulative effect of certain genes, so genetic bias is more likely to happen
- Studies reveal that tics are inherited as a dominant gene, so the chances of inheritance of genes are 50%, from parents to child
- Environmental factors like smoking during pregnancy, lower weight of child during birth and other complications during pregnancy might increase the risk
- Having a family history of tics, increase the chances of having the disorder
- Severe viral or bacterial infections, brain injury or trauma can also alter the brain functionality and lead to the sudden onset of tics
Possible complications
Medicines used in the treatment of tics can result in common side effects like anger, anxiety, depression, difficulty in sleeping and concentrating and other learning complications. A person suffering from tics may also suffer from low self-esteem and is very conscious. Complications like behavioural changes, OCD (obsessive-compulsive disorder), ADHD (attention-deficit hyperactivity disorder) and social changes can be seen in individuals.
Prevention
Primary Prevention
- Prevention from tic is almost impossible as the cause is still unknown
- By avoiding stress, the severity of tics can be reduced as stress worsens the symptoms
- Tics can be caused if a person is suffering from Lyme disease (a bacterial infection), so prevention from infections can prevent tics
Secondary Prevention
Tics cannot be prevented, but can be managed easily by,
- Relaxation exercises like yoga
- Good sleep
- Focusing on other things than tics
- Maintaining a healthy lifestyle
- Accepting that the individual is suffering from tics
Alternate Name
Tourette’s syndrome
Typical Test
No laboratory tests or screening methods can identify tics. Diagnosing tics solely depends on the observations. Neurologists may run some scans like MRI or CT scans to rule out other possible disorders with similar symptoms. First symptoms are visible in the teenage years and are repeatedly occurring for a span of one year. The immediate caregiver plays the most important role in describing symptoms to help with an accurate diagnosis.
Epidemiology
- Tics disorder is more prevalent in boys than girls
- More number of tic disorder cases are seen in children of the white race when compared to the population worldwide
- 1 out of every 162 children suffers from tic syndrome
- Half of the children who are suffering from tics are left undiagnosed. The average age of dominance of tic syndrome is 6-12 years
Expected prognosis
Individuals suffering from tics can lead a normal life with an average life expectancy. With time, people manage to live with the symptoms and learn how to overcome them. Anxiety, OCD (obsessive-compulsive disorder), low self-esteem and self-harming behaviours are common known side effects of tics. Many clinical studies are ongoing to determine the exact cause and gain a better understanding of the genetic relation.
Natural progression
Tics are not a progressive disorder. Though it is a life-long disease, it does not worsen with time. In fact, symptoms associated with tics gradually decrease from adolescent years to later stages in life. Tics have no known effect on the intelligence of an individual.
Pathophysiology
Recent advancements in studies show that tics occur when there are certain changes in the region of the brain responsible for controlling movements in the body. Also, modifications in neurotransmitters like dopamine can induce tics.
Our Medical Tics Experts
If you are facing any similar signs or symptoms please contact the Nanavati Max team to schedule an appointment at : +91 22 6836 0000
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