Tic disorders

Brief, sudden, repetitive movements and/or sounds that increase with stress, anxiety, or excitement.

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 anxiety, obsessive-compulsive disorder, and ADHD are common.

Tics are often intermittent and mild in children and may not require treatment. Treatment is indicated only for those patients whose tics are interfering with activities of daily living or social interactions, or who experience significant tic-related physical pain.

Tics are brief, sudden, repetitive movements and/or sounds. They are divided into motor tics (e.g., blinking, shrugging shoulders, grimacing, or jerking) or phonic 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, and excitement, and decrease with distraction.[1]Jankovic J, Lang AE. Movement disorders: diagnosis and assessment. In: Bradley WG, Daroff RB, Fenichel GM, et al. Neurology in clinical practice: principles of diagnosis and management. 4th ed. Philadelphia, PA: Elsevier; 2004:313-5.[2]Singer HS. Tourette syndrome and its associated neurobehavioral problems. In: Swaiman KF, Ashwal S, Ferriero DM. Pediatric neurology: principles and practice. 4th ed. Philadelphia, PA: Elsevier; 2006:887-98.[3]Fahn S, Jankovic J. Principles and practice of movement disorders. Philadelphia, PA: Elsevier; 2007:409-33. Tic disorders may be primary (idiopathic or inherited) or secondary to certain conditions (e.g., head trauma, encephalitis).