Tic Disorder

DEFINATION: Gilles de la tourette syndrome or tics dissorder is a pervasive disorder affecting neurologic and behavioral function.

EXPLANATION: Tics are the name given to sudden, rapid, recurrent, nonrhythmic, stereotyped and involuntary behaviors that people may display.

Gilles de la tourett described the following features in this syndrome-

  1. Earlier called Gilles de la tourett’s disorder has now been designated as touretts disorder and more specifically chronic motor and phonic disorder.

First case was seen in india in 1970, before which many cases went undiagnosed. According to the DSM

  • Children who are diagnosed with a Tic Disorder have tics (not caused by substance abuse or a medical condition) that occur multiple times each day. These tics are severe enough that they cause distress and/or impairment in daily functioning. Also, the DSM criteria state that Tic Disorder must begin before age 18 in order for the the diagnosis to apply
  • Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently
  • The tics occur many times a day (usually in bouts) nearly every day or intermittently throughout a period of more than 1 year, and during this period there was never a tic-free period of more than 3 consecutive months.
  • The disturbance causes marked distress or significant impairment in social, occupational, or other important areas of functioning.
  • The onset is before age 18 years.
  • The disturbance is not due to the direct physiological effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington’s disease or postviral encephalitis).

 

 PREVALANCE:

SEX BIAS: ratio of 3:1 is seen with males more affected than females.

 AGE OF ONSET: this disorder is more common in children than in adults. Frequency of onset is more before six years of age.

SIGNS AND SYMPTOMS:

Tics alternately increase and decrease in severity, and periodically change in number, frequency, type, and location. Symptoms may subside for weeks or months at a time, but later can recur. People with TS can sometimes suppress their tics for a short time, but the effort is similar to that of holding back a sneeze. Eventually tension mounts to the point where the tic escapes. Tics worsen in stressful situations; however they improve when the person is relaxed or absorbed in an activity

Not all people with TS have disorders other than tics. However, many people experience additional problems such as obsessive compulsive behavior, attention deficit-hyperactivity disorder, learning disabilities, or sleep disorders, which include frequent awakenings or talking in one’s sleep

Most characteristic of TS are Tics which come in two flavors involuntary vocal and motor tics

Vocal Tics are simple motor tic and complex motor tic include:

simple motor tic

  • Compulsive barking or other animal-like sounds
  • Grunting
  • Throat clearing
  • Sniffling
  • Coughing

complex motor tic

  • Echolalia (repeating words that are heard)
  • Coprolalia (repeating or shouting obscene words)

Motor Tics are again simple motor tic and complex motor tic include:

simple motor tic

  • Eye blinking
  • Grimacing
  • Shrugging of shoulder
  • Tongue protrusion

complex motor tic

  • Jerking the head
  • Different facial expressions
  • Body twisting and bending
  • Foot stamping
  • Self-harming behaviors (lip and cheek biting, head banging)
  • Copropraxia