Tic
A
tic is a sudden, repetitive,
stereotyped, nonrhythmic, involuntary movement (motor tic) or sound (phonic tic) that involves discrete groups of muscles. Tics can be invisible to the observer (e.g.; abdominal tensing or toe crunching). Movements of other
movement disorders (e.g.;
chorea,
dystonia,
myoclonus) must be distinguished from tics. Other conditions (e.g.;
autism,
stereotypic movement disorder) also include movements which may be confused with tics. Tics must also be distinguished from compulsions of
OCD and
seizure activity.
Tics are classified as motor vs. phonic, and simple vs. complex.
Motor tics are movement-based tics affecting discrete muscle groups.
Phonic tics are involuntary sounds produced by moving air through the nose, mouth, or throat. They may be alternately referred to as verbal tics, vocal tics, or phonic tics, but some diagnosticians prefer the term phonic tics, to reflect the notion that the
vocal cords are not involved in all tics that produce sound.
[Robertson MM. Tourette syndrome, associated conditions and the complexities of treatment. Brain. 2000 Mar;123 Pt 3:425-62. PMID 10686169]Simple tics
Simple motor tics are typically sudden, brief, meaningless movements, such as eye blinking or shoulder shrugging. Motor tics can be of an endless variety and may include such movements as hand-clapping, neck stretching, mouth movements, head, arm or leg jerks, and facial grimacing.
A
simple phonic tic can be almost any possible sound or noise, with common vocal tics being throat clearing, coughing, sniffing, or grunting.
Complex tics
Complex motor tics are typically more purposeful-appearing and of a longer nature. Examples of complex motor tics are pulling at clothes, touching people, touching objects,
echopraxia and
copropraxia.
Complex phonic tics may fall into various categories, including
echolalia (repeating words just spoken by someone else),
palilalia (repeating one's own previously spoken words), lexilalia (repeating words after reading them) and, most controversially,
coprolalia (the spontaneous utterance of socially-objectionable or taboo words or phrases). Coprolalia is a highly-publicized symptom of
Tourette syndrome; however, according to the
Tourette Syndrome Association, Inc. (TSA), fewer than 15% of TS patients exhibit coprolalia.
[Tourette Syndrome Association. Tourette Syndrome: Frequently Asked Questions Accessed 8 May 2006.][Zinner SH. Tourette disorder. Pediatr Rev. 2000 Nov;21(11):372-83. PMID 11077021]Complex tics are rarely seen in the absence of simple tics.
Typically, tics increase as a result of
stress or high energy emotions, which can include negative emotions, such as anxiety, but positive emotions as well, such as excitement or anticipation. Relaxation may result in a tic decrease or a tic increase (for instance, tics may increase when one relaxes watching television), while concentration in an absorbing activity often leads to a decrease in tics.
[National Institutes of Health (NIH). Tourette Syndrome Fact Sheet Accessed 23 Mar 2005.][Packer, L. Tourette Syndrome "Plus". Accessed 12 Feb 2006.] Neurologist and writer
Oliver Sacks describes a physician with severe TS, (Canadian Mort Doran, M.D., a
pilot and
surgeon in real life, although a
pseudonym was used in the book), whose tics remit almost completely while he is performing surgery.
[Doran, Morton L. The Tourette Syndrome Association, Inc., Connecticut Chapter 1998 Educators' Conference; 1998 Nov 6; Danbury, CT.] [Sacks O. An Anthropologist on Mars. Knopf, New York, 1995.]Tic disorders occur along a spectrum, ranging from mild to more severe, and are classified according to duration and severity (transient tics, chronic tics, or Tourette syndrome). Tourette syndrome is the more severe expression of a spectrum of tic disorders, which are thought to be due to the same genetic vulnerability. Nevertheless, most cases of Tourette syndrome are not severe.
[ The treatment for the spectrum of tic disorders is similar to the treatment of Tourette syndrome.There is some confusion in film and literature about tics. In comedies, a person with muscle tics may haplessly raise their hand at an obviously inappropriate time and suffer the consequences. This is very implausible: tics are semi-voluntary actions taken by the sufferer to alleviate the feeling of an unwanted, premonitory urge. One would not thrust his arm in the air as if he were possessed.]
Tics must be distinguished from fasciculations. Small twitches of the upper or lower eyelid, for example, are not tics because they don't involve a whole muscle. They are twitches of a few muscle fibre bundles, which you can feel but barely see. [Freeman, R. Tourette syndrome: minimizing confusion. Accessed 18 February 2006.]TIC can also refer to a home-based computer security system; a motion sensitive camera or inappropriately named files to attract attention or catch an intruder. These are passive security defences - they do not catch the intruder, but instead catch him or her out.* Black, Kevin J. Tourette Syndrome and Other Tic Disorders.
*Evidente, GH. "Is it a tic or Tourette's? Clues for differentiating simple from more complex tic disorders." PostGraduate Medicine Online. October 2000 108:5.
* Swerdlow, NR. Tourette Syndrome: Current Controversies and the Battlefield Landscape. Curr Neurol Neurosci Rep. 2005, 5:329-331. PMID 16131414
* Tourette Syndrome Association. What is Tourette syndrome?
