Tics are brief, involuntary, repetitive movements or vocalisations. Tics are also suppressible, meaning that people can voluntarily hold them for a short period of time (usually seconds) before releasing them again. They are usually associated with an urge before the movement, which is often described as an uncomfortable feeling.
Tics are common, with around 1 in 6 people experiencing them at some point in their life. Most of the time, tics are not associated with an underlying neurological disease. The majority of people who experience tics in childhood or adolescence have significant improvement as they get older without any treatment.
Motor (movement) tics include excessive blinking or sniffing; movements of the face such as raising eyebrows, pouting, grimacing, nose wrinkling; and shoulder, neck, or trunk movements. Vocal tics include grunting, clearing the throat, sniffing, humming and whistling.
People with tic disorders (especially Tourette’s syndrome) may have a tendency towards obsessive and compulsive behaviours. For example, not stepping on cracks, or checking locks multiple times. Some people are diagnosed with obsessive compulsive disorder (OCD) if these types of behaviours become intrusive and negatively affect a person’s day-to-day life. Mental Health services are usually involved to help these people.
Anxiety and depression are also more common in people with tic disorders. Tics can be exacerbated by untreated anxiety or depression. Treating an underlying mood disorder often improves the tic symptoms as well.
It is very uncommon for tics to be caused by an underlying neurological disease. Brain imaging is not usually required for patients with the above tic disorders. However, if there are other neurological problems in addition to the tics, it may be necessary to perform additional investigations. A neurologist is the best specialist to make these decisions.
What about Tourette’s syndrome?
Tourette’s syndrome (TS) is a more severe and persistent tic disorder. Compared to simple motor or verbal tics, TS is uncommon. It is estimated to affect less than 1 in 100 people. It almost always starts before the age of 18 and is rare in adults. Males are more commonly affected than females.
TS patients have multiple motor and vocal tics. Tics tend to occur many times per day. The verbal tics may be more complex in TS, and inappropriate comments or repeating words or phrases are reasonably common. Saying swear words (coprolalia) can occur, but is not nearly as common as what is portrayed in the media.
Managing tic disorders
For the majority of patients, confirming the diagnosis of tics and providing reassurance and non-pharmacological advice is all that is required. Knowing that tics usually improve in adulthood and are not usually associated with a serious underlying cause is reassuring.
Cognitive behavioural therapy (CBT) can be useful in improving tic frequency and severity of symptoms in patients with both simple tic disorders and TS. Access to this therapy is quite limited in New Zealand, especially through the public health system. TicHelper is an online self-guided CBT program that some people have found helpful.
Some medications may suppress tics but are not a cure and most patients with tics do not need them. All medications for tics have potential side-effects and do not work for everyone. A neurologist would advise if these are indicated.
