Tics are brief, sudden, repetitive movements and/or sounds that increase with stress, anxiety, transitions, or excitement.
Tics occur most commonly in children and adolescents, with boys more frequently affected than girls.
The exact pathophysiologic mechanisms are unknown, but the disorders are likely to be due to disturbances of the cortico-striatal-thalamo-circuitry.
Comorbid conditions such as obsessive-compulsive disorder, ADHD, and anxiety are common.
Tics are often intermittent and mild in children and may not require treatment. Treatment is indicated only for patients whose tics are interfering with activities of daily living or social interactions, or who experience significant tic-related physical pain.
See also Tourette syndrome.
Tics are brief, sudden, repetitive movements and/or sounds. They are divided into motor tics (e.g., blinking, shrugging shoulders, grimacing, or jerking) and vocal tics (e.g., throat clearing, sniffing, grunting, or more complex utterances). Patients describe an inner urge or a local premonitory sensation, which is then relieved by performing the tic. The tic can be voluntarily suppressed for short periods of time. Tics increase with stress, anxiety, transitions, and excitement, and decrease with distraction. Tic disorders may be primary (idiopathic or inherited) or secondary to certain conditions (e.g., head trauma, encephalitis).
History and exam
Key diagnostic factors
- observed tics
- premonitory sensation
- ability to suppress tics
- symptoms may improve when distracted
- otherwise normal neurologic exam
Other diagnostic factors
- symptoms worse with stress, anxiety, excitement, or transitions
- variable severity over time
- symptoms of comorbid psychiatric disorder
- onset at age <18 years
- male sex
- family history of tics
- family history of obsessive-compulsive disorder (OCD), ADHD, or depression
- prenatal maternal smoking
- history of OCD or ADHD
- history of autism spectrum disorder (ASD)
1st investigations to order
- clinical diagnosis
Investigations to consider
- MRI brain with and without contrast
- cerebrospinal fluid analysis (lumbar puncture)
symptoms not interfering with activities of daily living
symptoms interfering with activities of daily living: nonpregnant
severe tics refractory to behavioral and pharmacologic therapies
symptoms interfering with activities of daily living: pregnant
- Functional tic-like behaviors
- Obsessive-compulsive disorder (OCD)
- Diagnosing tic disorders
- Use of medical marijuana for Tourette syndrome
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