Brief overview
- What is a tic? A sudden movement or sound that serves no purpose and cannot be controlled by the person affected.
- What tics are there? There are motor tics (twitching, blinking, grimacing, stamping, etc.) and vocal tics (clearing the throat, grunting, snapping, repeating words, etc.) in various combinations. The most complex variant is Tourette’s syndrome.
- Causes: In primary tics, the cause remains unknown (suspected: disturbance of messenger metabolism in the brain, genetic predisposition, infections). Secondary tics occur in connection with other illnesses (e.g. brain inflammation) or with medication or drugs.
- Treatment: In the case of secondary tics, treatment of the underlying disease. In the case of primary tics, for example, methods of behavioral therapy (HRT, ERPT), relaxation techniques, possibly medication. Those affected should also reduce or avoid stress (it can intensify tics).
Tic: Definition
As a rule, a tic repeats itself at different intervals.
Tics can occur in different forms. One example is Tourette’s syndrome. Those affected repeatedly start twitching their arms, blinking, grunting or shouting swear words for no apparent reason (medical coprolalia).
A tic is irritating for the environment and very stressful for the person affected. A genuine tic cannot usually be cured. However, the right therapy can often alleviate the symptoms.
Tic: Occurrence and course and
Tics are usually temporary and disappear again after a few weeks or months. Even if the tic disorder lasts longer than a year, it does not necessarily have to become chronic. After a symptom-free interval, however, the tics can recur.
Tics usually occur for the first time in childhood or adolescence. In fact, tics are not uncommon in children. According to experts, around every second child of primary school age develops a temporary tic, usually of a motor nature. Boys are more frequently affected than girls. The cause of this is still unclear.
Combination with other illnesses
Tics can occur in combination with mental or psychiatric illnesses. These do not necessarily have to be directly related to the tic disorder, but doctors have observed that they are more common in such cases (comorbidity).
For example, tics are more common in children with hyperkinetic disorders (ADHD), emotional disorders and Asperger’s syndrome (autism). Depression and developmental disorders are also occasionally associated with tics.
What tics are there?
Tics can vary greatly from person to person. This applies to both the intensity and frequency as well as the content. Doctors differentiate between motor tics and vocal tics, which can occur in simple or complex forms.
Motor tic
In most cases, simple motor tics manifest themselves in the face. Examples of this are
- Blinking, frowning and/or raising the eyebrows
- eye rolling
- Grimacing, head tossing/nodding
- Mouth opening
Simple motor tics can be seen downwards from the head, for example in the form of shoulder twitching or flinging movements of the arms. The trunk and leg muscles are rarely affected, but tics can also occur in these areas.
In the case of complex motor tics, those affected sometimes perform entire movement sequences, for example:
- jumping, hopping
- clapping
- stamping
- tapping
- throwing movements
- hitting or even biting yourself
Some sufferers manage surprisingly well to integrate their motor tic into their everyday movements in order to attract as little attention as possible. This is much more difficult with a vocal tic.
Vocal tic
With a vocal tic, the person affected makes an involuntary and unintentional noise or sound. With a simple vocal tic, this can be, for example:
- clearing the throat, barking or sniffing
- Hissing, coughing, whistling
- Grunting or snapping
- Repeating other people’s or own words/phrases (echolalia, palilalia)
- Pronouncing words that do not make sense; sometimes they are also obscene words (coprolalia)
Above all, if those affected pronounce swear words and insulting content as part of their tic, both those affected and their environment usually suffer greatly.
Further classification of tics
The International Statistical Classification of Diseases (ICD) distinguishes between different groups of tic disorders. The most important are
- Temporary tic disorders: They do not last longer than twelve months and often take the form of blinking, grimacing or head shaking.
- Chronic motor or vocal tic disorder: This lasts longer than a year and consists of either motor or vocal tics (but never both at the same time). Some sufferers only show a single (motor or vocal) tic. However, there are often several tics at the same time, all of which are either motor or vocal in nature.
Tic: causes & diseases
Often no cause for a tic disorder can be identified. This is referred to as a primary or idiopathic tic. In other cases, tics occur secondarily as part of other illnesses or disorders (secondary tic).
Psychosocial stress and the use of medication during pregnancy can be linked to the occurrence of a tic disorder in the child, as studies have shown. The same applies to smoking, alcohol consumption and the use of other drugs during pregnancy.
Primary tic
How a primary tic (idiopathic tic) develops is still unclear. However, it is certain that a genetic predisposition plays a role, as tic disorders often run in families.
There is also increasing evidence that a disorder in the messenger metabolism in the brain is involved in the development of tic disorders. An excess of the messenger substance (neurotransmitter) dopamine is the focus of research here.
The abbreviation PANDAS refers to neuropsychiatric disorders (probably autoimmune diseases) that occur after infection with certain streptococci in childhood. These can include tic disorders.
Secondary tic
A secondary tic develops in connection with other diseases such as
- Inflammation of the brain (encephalitis)
- Wilson’s disease (copper storage disease)
- Huntington’s disease (Huntington’s disease)
Very rarely, drugs (such as cocaine) or certain medications can also trigger tics. These medications include anticonvulsants such as carbamazepine or phenytoin, which are used to treat epilepsy.
Tic: When should you see a doctor?
A tic disorder rarely poses an acute health risk. Nevertheless, those affected should consult a doctor as soon as the tics appear for the first time. The doctor can identify possible illnesses as the cause and initiate treatment at an early stage. It may then be possible to prevent the symptoms from worsening and the tic from becoming chronic.
Tic: What does the doctor do?
First of all, the doctor must determine whether there is a genuine tic disorder and, if so, whether there is a recognizable cause for it. The doctor will then suggest a suitable therapy accordingly.
Tic: examinations and diagnosis
In addition to the physical examination, the medical history (anamnesis) is an important diagnostic criterion. The doctor asks the patient (or parents in the case of children), for example, when a tic first occurred, how often it is noticeable and what could have triggered it. He also asks about any previous illnesses.
There are also questionnaires that relatives or parents fill out over a period of several weeks. This information is then used by the doctor to assess how severe the tic disorder is. Internationally, for example, the “Yale Global Tic Severity Scale” (YGTSS) is used for this purpose. Once the correct diagnosis has been made, treatment can begin.
Tic: Treatment
In the case of a secondary tic, the causative disease must be treated.
If a primary tic is present, comprehensive counseling of the affected person and their relatives is very important. The patient and their caregivers should understand the condition and be aware of possible exacerbating factors. For example, it is important for parents to understand that their child cannot control the tics. Requests to stop repeated blinking, grunting or stamping only cause additional stress for the child – the tics can even become more severe as a result.
In the case of affected children or adolescents, it can also be useful to inform teachers and trainers about the disorder in order to ensure a broad understanding. Of course, this should only be done with the consent of those affected.
Possible therapy concepts include
- Relaxation techniques and self-management, in which patients learn to consciously relax and thus reduce the tic symptoms in a targeted manner (e.g. progressive muscle relaxation).
- Habit Reversal Training (HRT) describes a therapy model that, among other things, trains the conscious perception of tics and helps to develop a motor counter-response (e.g. stretching out arms against shoulder twitching).
- Exposure and Response Prevention Training (ERPT), on the other hand, aims to interrupt the thought or automatism that a tic attack must always follow a premonition.
Medication for tics?
There are also drug therapies, although they are not always used for tic disorders. Doctors weigh up the expected benefits of a medication against its potential risks and side effects for each patient.
The greatest treatment effects can be achieved with psychotropic drugs that block the docking sites for dopamine (dopamine receptors) in the brain. These include, for example, tiapride, pimozide and haloperidol. The doctor may also use other medications in the case of concomitant disorders.
A persistent tic disorder cannot be permanently cured. However, the tic can at least be alleviated with the right therapeutic approaches.
Tic: What you can do yourself
If the stress comes from within (e.g. due to pronounced perfectionism), the unfavorable inner attitude can be checked and changed with the help of psychotherapeutic procedures (cognitive behavioural therapy) if necessary.
It can also be helpful to learn a relaxation technique such as autogenic training or meditation and practise it regularly.
