Tics

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Synonyms

Tics, tic syndrome, tic disorder, Tourette syndrome

definition

Tics are simple or complex, sudden, short-lived, involuntary or semi-arbitrary Movements (motor tic) or noises and vocalizations (vocal tic). With an internally growing tension, they can be suppressed for a short time. Patients take the Tics true like an inner compulsion and often feel abnormal sensations in the corresponding body region, which are then the reason to carry out the movement.

Epidemiology

The numbers for the frequency of one Tic or Tics in the general population vary greatly. A study of 7 year olds in the UK found a frequency of tics of 4% with equal gender distribution. In a study in Paris schools, however, it was only 0,87%. This difference is due to the different methods of data collection. In one study, for example, patients with less severe symptoms are included in the figures, but not in another.

In general, however, it can be said that these are temporary Tics in child-youthful age (see also: Paediatrics) with a frequency of about 4,8% worldwide occur in the population, with boys being more often and more severely affected than girls. The gender ratio is something 3:1.

In Germany, the frequency is around 6.6% of the total population.

history

In connection with the Tourette syndrome, whose symptoms are both vocal and motor tics, tics were first discovered in 1825 by Jean Itard, a French doctor and educator (1774-1838), mentioned in the medical literature. He described the conspicuous behavior of the Marquise de Dampierre, who had been making complex vowels since she was 7 years old Tics would have.

Sixty years later, the French neurologist published George Gilles de la Tourette made a study of that marquise de Dampierre and eight other patients who participated in similar Tics suffered. The study was titled: "Étude sur une affection nerveuse caracterisée par l'incoordination motrice accompagnée d'écholalie et de coprolalie de la Neurologie, paris 9, 1885, 19-42 et 158-200 " Dr. Tourette referred to the disease that we now know as Tourette's syndrome as the "Maledie des Tics."

classification

There are different ways of classification: A distinction is made between motor and vocal tics:

• Motor tics are movements of the body.
• Vocal tics are noises, sounds, or speech utterances.

Chronic and temporary (transitory) Differentiated tics:

• Transient tics are very common during childhood. These are single or multiple tics that usually involve blinking, grimacing, or shaking the head. The tics begin before the age of 18 and last up to twelve months.
• Chronic tic-Disorders can be motor or vocal in nature, but only one of the two. It can be one or more motor or vocal tics. The duration is longer than a year.
• If motor and vocal tics combined occur, it is Tourette's syndrome.

A distinction is made between simple and complex tics:

• Simple motor tics: movements limited to a muscle region Simple vocal tics: only sounds, no words
• Complex motor tics: coordinated movements of several muscle regions
• Complex vocal tics: Words or phrases

causes

The cause of the Tics is not clear. However, malfunctions in the systems of the Brain to whom the messenger substance (Transmitter) Dopamine have, for example, in the Basal ganglia the case is. Transmitters are substances that transmit signals in the brain and are overly active when tics occur. The thesis is supported by the fact that antagonists of dopamine (Dopamine antagonists) reduce tics, whereas substances that mimic the effects of dopamine (Dopamimetics) and thus increase the dopamine effect, as well as substances such as Amphetamines, Trigger tics. In addition, the number of docking points (Receptors) for dopamine (D2 receptor) the severity of the disease.

Faults in the systems in which Serotonin is present as a messenger substance. The tics are also believed to be hereditary (hereditary) Illness. Tics can be found in family members in 60% of patientsSo there is a so-called "positive family history". The inheritance process is presumably dominant or semi-dominant, i.e. only one parent needs to have the diseased gene for their child to develop tics as well. However, the disease does not have to be inherited in the same degree of severity, but can also only include mild tics. In general, it can be said that women are affected less often and less severely than men.

Tics were also developed when people stopped taking so-called nerve depressants (Neuroleptics) and drugs against epilepsy (Anti-epileptic drugs) observed.

Symptoms

Simple motor tics can be:

Winking, eye rolling, face grimaces, wrinkling noses, pursing lips, pulling up shoulders, shaking the head, slinging arms, pulling in stomach, protruding stomach, finger movements, opening mouth, chattering teeth, body tension, rapid flinging movements of various parts of the body, raising eyebrows, frowning

Complex motor tics can include:

Hopping, clapping, touching objects / people or yourself, smoothing out folds of fabric, running through your hair, throwing movements, biting your tongue or lips or your arm, beating your head, swinging movements, pinching or scratching yourself, pushing movements, writing movements, twisting convulsions, sticking out tongue, kissing, writing the same letter or word over and over again, pulling the pen back while writing, tearing paper or books, repeating coordinated movements just seen (Echopraxia), indecent movements such as masturbation movements (copropraxia).

Simple vocal tics can be:

Groaning, moaning, blowing the nose, whistling, coughing, sniffing, smacking, barking, grunting, gargling, clearing throat, burping, screeching, clicking, etc. u, eee, ou, oh and other sounds

Complex vocal tics can include:

repeated uttering of obscene and aggressive expressions (Coprolalia), repeating sounds or words that have just been heard (Echolalia), repeating syllables (Palilalie), Speech disorders, unusual speech rhythms, rituals such as repeating a sentence until it is "just right".

The coprolalia can be further divided into:

• Sexual and physical curses: "Scheixxe, Fixxxn, Basxxxd, Arsxxxxxh"
• Theological Curses: "Goddamn Heaven"
• Racist and ethnic abuse: "cripples"
• Complex and aggressive sexual descriptions: "You fat bastard of a Hxxe."
• Complex contradicting statements: "I like her, I hate her."

The tics can be suppressed for some time. The occurrence of the tics is like in some patients with a discomfort itch, tingle or Burn connected. These abnormal sensations are known as sensory tics. The execution of the tic should lead to the reduction of the discomfort, for example by blink or Clear throat. All tics often worsen with stress and weaken with concentration. They stop during sleep, but falling asleep and sleep itself are often disturbed (see sleep disorders). Relaxing before going to sleep often triggers the tics.

Aggressive tics that are directed against yourself or others can rarely develop. For example, patients may injure their eyes with a writing implement or put cigarettes on their skin. However, hurting another person is extremely rare.

Clear throat as a symptom

The Clear throat belongs to the simple vocal tics. It's one of the tics that came with Children most often occurs. Sometimes the throat tic occurs after an infection and persists for a while, even after the infection has healed.
A kind of "memory clearing" can result from lowering the clearing threshold. This means that the person concerned involuntarily clears his throat, from memory, so to speak. This hawking tic can be very disruptive to the environment. These reactions then put the person affected in a stressful situation, which then even intensifies the tic. As a rule, if there are no other symptoms, the hawking tic is harmless and disappears again spontaneously.

Twitching of the face

Tics, in the form of twitching of the face, can have several causes. These jerks can only be controlled arbitrarily to a limited extent. A distinction is made between the jerks that arise without external stimulus from the jerks that arise as a result of a stimulus in the form of a reflex.

The twitches, without external stimulus, can result from tiredness or stress. If there are no other symptoms, these twitches are harmless and often go away as spontaneously as they came.

You might also be interested in: What can be causing eye twitching?

The twitching of the face caused by a knock on the cheek results from an increased excitability of the muscles and nerves. As a result, the entire facial muscles usually twitch. This is also called tetany. If there is only a slight twitching at the corner of the mouth, this suggests a vegetative cause rather than tetany. Regardless of the severity, this reflex cannot usually be triggered in healthy people and provides indications of a possible disease.

Tics in children

Children between the ages of 6 and 14 are often affected by tics. Mostly these are temporary motor tics, which often disappear after 12 months at the latest.
Usually these types of tics are harmless. If the tics last longer than 12 months, it may be a chronic course. It can also be that a harmless tic lasts a little longer before it spontaneously disappears.
The actual chronic tics are characterized by the tics slowing down. At the same time, the tics can spread further and affect different muscle groups throughout the body. This means, if previously only an involuntary twitch of the eye was recognizable, that then a twitch of the shoulder (see also: Shrug) or something similar.
In the case of temporary tics, it is often not the tics themselves that are stressful for the child, but the reactions of those around them. Often out of concern, parents and teachers admonish or ask the child to refrain from these tics. But even well-intentioned, loving requests put the children under stress because they are usually unable to control the tics at first. This can make them feel like they are doing something wrong. When attempts to change behavior fail, tension, pressure and stress result. Stress can then contribute to the tics becoming more pronounced. The reason for this is likely to be found in the brain regions, the basal ganglia, which cannot be controlled at will. More precisely, it is about the connection pathways to the various centers in the brain, which are not yet fully developed in the child. It is believed that the temporary tics are an expression of a remodeling process in the brain. Figuratively, this can be compared to converting roads in traffic. A road that is being renewed sometimes worsens smooth driving in the short term. As a result, the car and the driver jerk or shake. After successful completion of the conversion work, driving is then much smoother than before. A child's brain could behave in a similar way. Children often report a kind of "anticipation" before the tics occur.
Some compare this anticipation with the feeling one has just before sneezing. This can be used to a limited extent to perceive the impending tics and consciously suppress them. If you remind yourself of how you involuntarily blow out a "sneeze", you can also imagine that control is not easy and unconditional.

Tics in young children

Tics can also occur in the Toddler age occur. They express themselves similarly to tics in childhood. It has been observed that tics in small children often manifested themselves when there was a change in the daily routine of the small child.
Triggers can e.g. entering kindergarten, moving house, divorce or other. It is assumed that evolutionarily determined humans and small children especially have the need for rituals, which then offer them security. Tensions and insecurities can be great, especially in situations where what feels like major upheavals. Accordingly, the desire for relaxation and security can grow. A kind of ritual in the form of developing tics or “quirks” can arise as a result. This can be particularly pronounced in young children.
Of the Difference between compulsive acts and the involuntary tics is sometimes difficult to see. Both can arise for the reasons described above - but do not have to be. Likewise, the development of a tic or a “quirk” of a toddler does not necessarily have to have a psychological cause, but appears to develop for no reason.
It will Relationship with the development of the brain into consideration, which can also play a role in the development of tics in babies or children. Most of the time, these tics and "quirks" are harmless and often disappear as suddenly as they arose. For the tics in small children, the same principles apply to the parents and the environment as for the tics in children of primary school age. In early childhood it is usually not possible to get a limited control of the tics through the type of perception training that is supportive in adults and older children.This is because, among other things, at this age the brain is not yet completely and differently developed.
In any case, it is helpful to convey to the child that they can cope with any situation and that they can express their feelings and fears in their own way. Education and integration of the kindergarten teachers and other people who have to do with the toddler is very beneficial.

Tics in the baby

Some parents report "tics" in their babies, such as a twitch with the Shoulders or a shake of the body. Just like the tics in other age groups, these tics are mostly harmless and disappear as spontaneously as they came.
The cause of tics in babies is likely to be the growth phase in the child's brain. The different brain structures and different nerve tracts still have to grow and develop a lot after birth. So-called pattern generators, which are used for vital functions, such as Breathing, for example, is “delivered” at birth. These pattern generators can also trigger rhythmic muscle twitching and must first finely regulated become.
The motor tics can throw the baby off balance for a short time. A "small tic" could then, for example, lead to a fall from the changing table. Otherwise these tics are usually harmless without any additional abnormalities. When the growth and maturation of the brain and nerve tracts are complete, the tics usually go away on their own.

Tics in adults

In adults are tics less often without previous illnesses. You can feel similar to other age groups, in terms of to wink, Twitching of the face, clear throat and the like show.
If the tics occur in adulthood without a previous illness, the same applies as in other age groups. They are mostly temporary, harmless and can be aggravated by stress.
Adults can be targeted through Perception training learn to control the tics as much as possible. The extent to which this is successful is very individual and depends on various factors. The perception training can take place in various ways Relaxation techniques and Body awareness exercises be embedded. Individual, professional support is helpful in some cases.
It has also been observed in some adults that, for example, when singing, the tics can disappear for a short time. This could be related to linking certain areas of the right brain. But this has not yet been scientifically proven and is controversial. For some people affected and their relatives, attending a self-help group helps.

Tics in gifted people

On the one hand, tics can develop gifted children and adults for the same external reasons as with normally gifted children and adults.
On the other hand, it can be due to the stronger stimulus perception and sensitivity to stimuli from gifted children and adults develop tics. These can arise in the course of brain development. Similar to normally gifted children, it can occur in the course of Remodeling the brain into temporary tics come.
As with the tics of the normally gifted, the behavior of the environment is often more stressful than the tic itself.
A characteristic feature of gifted people is a so-called elevated one psychomotor sensitivitythat are in Urge to move, Enthusiasm and a Excess of energy expresses. Many gifted people of all ages can only learn content by heart while moving. Gifted people also show their body movements, especially when they concentrate. In the case of children, e.g. a constant wiggling of the foot or the whole leg or a tap on the table with the pen.
With some gifted adults For example, you can watch them move their mouth or hands steadily while concentrating. These movements serve to reduce tension and are important for gifted children as well as for gifted adults. In order not to disturb other children at school, the gifted children can be offered a kneading ball or a similar object. Gifted adults can reduce their tension e.g. chew or scribble with chewing gum, knit or even with a kneading ball. If, in addition to the harmless tics or "quirks", other and permanent behaviors appear that restrict the everyday life of the person concerned from his / her point of view, the person should seek out a competent person who is familiar with giftedness.
In contrast to the tics described above, gifted children and adults report with this type of tics, Rare of a "Anticipation" in the form of discomfort or similar. However, as with other children and adults, the unconditional "acceptance" of the person is beneficial.

diagnosis

The diagnosis takes place through questioning (anamnese) of the patient and observation of the symptoms over a longer period of time so that the severity of the disease can be assessed. This is done with the help of questionnaires and estimation scales. It is also important to assess the medical history of the patient himself and his family. However, there is no specific examination, neither laboratory nor imaging. However, a measurement of brain waves (electroencephalogram, EEG) and a process for the production of virtual sectional images (S.ingle-Photon-E.missionscomputertomography, SPECT) of the brain to delimit the Tic syndrome from other diseases.

Test for tics

There is no standardized test for tics. So far, various examinations have been combined if necessary, which suggest a tic or its cause and uncover possible previous illnesses. One thing is important detailed questioning of the person concerned or the parents of the affected child. In the "Diagnostic System for Mental Disorders According to ICD 10 and DSM IV for Children and Adolescents - II" there is one Diagnostic checklist, such as Third-party and self-assessment questionnairesthat can be helpful in making a diagnosis.
An indication of tics can be the previously felt "pre-feelings" in the form of abnormal sensations or feelings of tension. in the EEG there may be a lack of willingness potential for simple tics, which is visible in the EEG in voluntary movements.
In addition, in special examinations Changes in dopamine transport, a neurotransmitter in the brain. If a tic disorder is suspected, liver, kidney, and thyroid values ​​are routinely checked.

Differential diagnosis

It is difficult to get motor tics from Obsessive-compulsive disorder to distinguish.

Obsessive-compulsive disorder are associated with obsessive-compulsive apprehensions such that an anxious discomfort arises when the action is suppressed. As with Tics a certain number of repetitions of the action is necessary in order to avert compulsive fears. The fears are not understandable to the patient or even nonsensical, whereas patients with a tic disorder experience the previous discomfort as tangible. The compulsions themselves are carried out voluntarily, more specifically and more slowly than the movements in motor tics. In addition, tics are visible to others from the start, but compulsions can often be hidden for a long time. The prognosis for both diseases is also different: Compared to tics, there is a complete decrease (Remission) obsessive-compulsive disorder is rare.

The motor tics must be accompanied by rapid involuntary muscle twitches (Myoclonia) and movement disorders (Dystonia) can be distinguished. Tics can be suppressed for a certain period of time, but myoclonia cannot be suppressed and dystonia can only be suppressed to a certain extent. In addition, tics are accompanied by a previous discomfort that triggers the actual movement. This sensory component is the main difference to other movement disorders.

therapy

Many of the patients learn from their own over time Tics deal and neither need a psychotherapeutic (see also: physical therapy) another drug treatment. However, if therapy is required, this can only be done symptomatically, i.e. the Symptoms, i.e. the tics themselves, are treated, but the cause is mostly unexplained and cannot be treated.

Behavioral therapy, in which one should learn how to do this, is often useful Tics mastered in everyday life. The tics become weaker when concentrating on one thing or an action, but stronger when stressed. Drug therapy is usually only used for chronic tics that last longer than a year or that are so frightening for the environment that the patient is too restricted. Also at aggressive ticsthat are directed against the patient himself or other people, drug treatment makes sense. The most effective tic-reducing drugs are Neuroleptics how Haloperidol, Pimozide and Fluphenazinewhose effect comes about by influencing dopamine receptors. However, it is important to weigh up the benefits of the therapy and the possible side effects of the medication. The taking of Neuroleptics lead to tiredness and decreased motivation, which is particularly problematic for school children. In addition, neuroleptics carry the risk of disrupting movement sequences (Dyskinesia), which is why they should only be prescribed in severe cases. Clonidine, tiapride and sulpiride have fewer side effects, but they are also not as effective.

Danger:

Drugs used to treat hyperactivity or obsessive-compulsive disorder in children can lead to an increase in tics!

Homeopathic Treatment for Tics

A temporary tic is usually harmless at any age and often disappears spontaneously. No treatment is necessary here.
In some cases one also works homeopathic treatment supportive with tics. Here is one detailed anamnesis and in-depth knowledge of the treating person conducive.
Soothing effects have been observed with the following preparations: Agaricus muscarius, China officinalis, Cina / Artermisa cina, Cuprum metallicum, Hypscyamus niger, Ignatia amara, Lycopodium clavatum, Sepia officinalis, Zincum metallicum. The treatment must be individually tailored and depends on the Type and severity of the tic, as well as according to the psychological condition / expression of the person concerned and accompanying symptoms. For example Zincum metallicum at Children used, the tic of which manifests itself in involuntary movements of the eyes, mouth, hands and / or legs.

forecast

At about 60% the patient comes to a spontaneous complete Remission or at least to a significant improvement. If the disease already appeared in childhood, the chances of improvement are even higher; around two thirds become free of it towards the end of the first or the beginning of the second decade of life Tics.

Tics from stress

Stress doesn't cause tics, but it can Trigger and intensify tics. It is therefore important on the one hand that those affected learn how to deal with stress well and, on the other hand, that the environment does not trigger additional stress.
The principles of behavior of a child or an adult or a gifted person of any age with a temporary or chronic tic contain the same basic principles described there. Furthermore, an individual stress management of the person concerned is desirable. This stress management can be among others Relaxation procedure, Body awareness exercises, Movements and creating a balanced everyday life

Tics after a stroke

A stroke, in a specific area in the brain called the basal ganglia, can cause tics.
Often this expresses itself then in a one-sided involuntary Sling of arms and legs, a so-called Hemiballism. The sufferer can make these movements not control. They can be mistakenly interpreted as an expression of aggressiveness by strangers.
Perception training, stress management and, if necessary, homeopathic therapy or drug therapy with neuroleptics are recommended.
In physiotherapy, occupational therapy, and speech therapy, the tics in the context of a stroke can be treated in a targeted manner. Participation and independence in everyday life, as well as increasing the individual quality of life and the integration of relatives, should be in the foreground.

Tics in Tourette's syndrome

At the Tourette syndrome can be different motor and vocal tics observe. The tics of Tourette syndrome often begin in childhood or young adulthood. Often one sees one in addition to the tics Obsessive Compulsive Disorder and an ADHD. Also can conspicuous social behavior but does not have to be. The motor tics can be so pronounced that those affected are not able to use their hands for everyday activities.

Summary

Tics are sudden, rapid, repetitive movements or sounds. They can be temporarily suppressed with increasing tension. You will like one inner compulsion experienced and often have abnormal sensations in the affected body regions, which lead to the execution of the movement. The diagnosis is made through detailed questioning (anamnese) and observation of the patient over a longer period of time. The therapy is symptomatic and often also psychotherapeutic. However, some patients learn to cope with their disease even without therapy. Drug therapy with neuroleptics is only recommended in cases of extreme distress. In many cases, the tics improve or even completely subside.

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