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. Tic disorders may be primary (idiopathic or inherited) or secondary to certain conditions (e.g., head trauma, encephalitis).
History and exam
Tanya K. Murphy, MD, MS
JHMACH & USF Maurice A. and Thelma P. Rothman Chair of Developmental Pediatrics
Director, Rothman Center for Neuropsychiatry
Vice-Chair, University of South Florida Pediatrics
Professor, Departments of Pediatrics and Psychiatry
University of South Florida
Johns Hopkins All Children’s Hospital
TKM has received research grants from Auspex Pharmaceuticals, the National Institute of Mental Health, Shire Pharmaceuticals, Pfizer Inc., F. Hoffman-La Roche Ltd., AstraZeneca Pharmaceuticals, Centers for Disease Control and Prevention, Massachusetts General Hospital, Sunovion Pharmaceuticals, Neurocrine Bioscience, Psyadon Pharmaceuticals, and PANDAS Network. She is on the advisory board for the International Obsessive Compulsive Foundation. She is also an author of several references cited in this topic.
Fatima Masumova, DO
Forensic Psychiatry Fellowship, PGY-6
Rutgers Robert Wood Johnson Medical School
FM declares that she has no competing interests.
Cathy L. Budman, MD
National Tourette Centre of Excellence at Northwell Health
Movement Disorders Program in Psychiatry
Hofstra Northwell School of Medicine
CLB has received research funding from Otsuka, Psyadon, Auspex, Teva, Neurocrine, and Synchroneuron Pharmaceuticals. She is a consultant for Bracket and a paid speaker for the Centers for Disease Control and Prevention (CDC) - National Tourette Syndrome Association Partnership. She is an author of several references cited in this topic.
Dr Tanya K. Murphy, Dr Fatima Masumova, and Dr Cathy L. Budman would like to gratefully acknowledge Dr Amber Stocco, Dr Migvis Monduy, and Dr Bobbi Hopkins, previous contributors to this topic. AS, MM, and BH declare that they have no competing interests.
Francis Filloux, MD
Division of Pediatric Neurology
University of Utah School of Medicine
Salt Lake City
FF declares that he has no competing interests.
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