Tic Disorder

Aka: Tic Disorder, Transient Tic Disorder, Motor Tic, Vocal Tic

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II. Epidemiology

  1. Incidence of tic in children under age 10 years: 20%
  2. Motor Tics more common than verbal tics

III. Definition: Tics

  1. Non-rhythmic, purposeless movements or vocalizations
  2. Sudden and rapid actions

IV. Pathophysiology

  1. Basal Ganglia disorder involving Dopaminergic and serotinergic Neurons

V. Symptoms

  1. Timing
    1. May be repeated compulsively until feels right
  2. Palliative
    1. Suppressible with concentration and distraction
  3. Provocative
    1. Worse with stress or excitement
    2. Dramatic tic outburst may occur after prolonged tic suppression
  4. Tic aura precedes a tic in 80% of cases
    1. Example: Shoulder burning Sensation before a Shoulder shrug tic

VI. Types: Timing

  1. Transient (Duration less than 12 months, accounts for up to 15% of cases)
    1. See Secondary Causes of Tic Disorder
  2. Chronic (Duration longer than 12 consecutive months)
    1. Primary Vocal and Motor: Tourette's Syndrome

VII. Types: Simple Tics

  1. Simple Vocal Tics
    1. Throat clearing
    2. Sniffing
    3. Animal sounds (e.g. barking)
    4. Coughing
    5. Yelling
    6. Hiccuping
    7. Belching
  2. Simple Motor Tics (clonic/brief, dystonic/prolonged or tonic/sustained)
    1. Eye blinking
    2. Nose twitching
    3. Sticking Tongue out
    4. Head turning or neck Stretching
    5. Shoulder jerking
    6. Muscle tensing
    7. Flexing fingers
    8. Kicking

VIII. Types: Complex Tics

  1. Complex Vocal Tics
    1. Parts of words or phrases repeated
    2. Talking to oneself in multiple characters
    3. Assuming different intonations
    4. Coprolalia (Use of Profanity)
    5. Echolalia (repeating another person's words)
    6. Paliphrasia or Palilalia (repeating one's own words)
  2. Complex Motor Tics
    1. Copropraxia (obscene gestures)
    2. Echopraxia (Imitating another person's gestures)
    3. Flapping arms
    4. Facial grimace
    5. Picking at clothing
    6. Complex touching movements
    7. Jumping
    8. Shaking feet
    9. Pinching
    10. Poking
    11. Kissing self or others
    12. Spitting
    13. Hair brushing
    14. Throwing motions

IX. Diagnosis: Transient Tic Disorder (DSM-IV)

  1. Motor or Vocal Tics (single or multiple)
  2. Tics occur multiple times per day on most days for 1-12 months
  3. Onset before age 18 years
  4. Not due to a Tic Secondary Cause

X. Differential Diagnosis

  1. See Secondary Causes of Tic Disorder
  2. Chorea
    1. Abrupt, non-repetitive irregular movements (multifocal and migratory)
    2. Example: Syndeham's Chorea
  3. Dystonia
    1. Stereotypic, slow sustained Muscle Contraction without variation
    2. Results in abnormal Posture
    3. Example: Blepharospasm
  4. Myoclonus
    1. Fast, sudden, involuntary Muscle jerking
    2. Example: Myoclonic Epilepsy

XI. Labs

  1. General
    1. Thyroid Stimulating Hormone (TSH)
  2. Rapid onset varying with Upper Respiratory Infection
    1. Throat Culture
    2. Antistreptolysin O
    3. Anti-DNAse B

XII. Management

  1. See Tic Management

XIII. References

  1. Bagheri (1999) Am Fam Physician 59(8):2263-72 [PubMed]
  2. Kenney (2008) Am Fam Physician 77:651-60 [PubMed]
  3. Rampello (2006) J Neurol 253: 1-15 [PubMed]

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