Tics are sudden, stereotyped and repetitive movements or vocalizations that are involuntary and often appear similar to normal movements. They can be brief simple movements such as eye blinking or facial grimacing or more complex behaviors such as jumping or repetitive touching. Common vocal tics or vocalizations are humming, throat clearing and coughing. Tics can be a temporary or a passing phase (transient tic disorder) or more chronic. The diagnosis of Tourette’s syndrome is defined as a history of multiple motor tics and at least one vocal tic occurring for longer than 12 months.
Tourette’s syndrome typically begins in the first decade of life (6 to 7 years of age). There is an increased risk of attention deficit/hyperactivity disorder in patients with Tourette syndrome and this often manifests before the onset of tics. There is also an increased risk for obcessive compulsive behaviors in someone with Tourette’s. It’s not clear how common Tourette’s Syndrome is but a reported history of tics in school age children is relatively common with between 10-20% of the population reporting some type of tic history. It is generally thought to be more common in boys than girls.
Though the exact cause of Tourette’s Syndrome is not entirely clear in many cases it clearly runs in families and therefore indicates an underlying genetic cause.
Evaluation and treatment is focused on ensuring the correct diagnosis, excluding neurologic causes such as epilepsy or other type of movement disorders and assessing for associated diagnosis (ADHD, OCD and anxiety/depression). Education of the child and family as to the nature of the condition, including exacerbating factors and how to manage these behaviors at home and in the school, are critical to the management of this disorder. Treatment itself is based on the disability the patient experiences related to the tics, either physical or social/emotional. Treatments included daily medications and/or evidence-based behavioral therapy.
Though often a chronic condition, tics wax and wane in most individuals over time and can often remit or dramatically improve approaching adulthood. Nonetheless, until that time, children with tics should be evaluated, educated and managed in a way as to ensure the highest quality of life and maximize developmental and emotional potential.
