Tics are involuntary movements or vocalizations. The term derives from the French word *tic*, which means “nervous twitch.” Tics involving abrupt movements are called motor tics. Tics involving vocalizations are called vocal tics. The combination of vocal and motor tics is known as Tourette syndrome. Another distinction is made based on the type of tic: simple and complex tics.
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Motor tics cause sudden movements. These movements are meaningless, serve no purpose, and can be very intense.
While simple motor tics affect only one muscle group, complex motor tics can involve multiple muscle groups. They may give the impression that the person is performing a purposeful action.
Complex motor tics can cause people to unexpectedly stomp their feet, hop, or jump out of their chairs. Special forms of complex motor tics include copropraxia and echopraxia.
Copropraxia involves obscene movements. Gestures such as giving the middle finger, sticking out the tongue, or touching one’s own genitals are typical symptoms.
Echopraxia refers to the involuntary imitation of other people’s gestures and movements.
Vocal tics, on the other hand, are involuntary vocalizations such as clearing the throat, smacking the lips, or grunting. Special forms of complex vocal tics include echolalia, coprolalia, and palilalia.
Echolalia is characterized by the constant repetition of what has been heard. Those affected repeatedly mimic words, sentences, or sounds. Echolalia frequently occurs in association with schizophrenia and autism.
Palilalia is similar to echolalia. Those affected repeat spoken words over and over again, increasing their speech rate as they do so. Palilalia is a typical accompanying symptom in people with tic disorders. It also occurs in connection with Parkinson’s disease.
A characteristic of coprolalia is the compulsive use of vulgar terms. It is a common symptom associated with tic disorders. Those affected have no control over their behavior.
Compulsive symptoms or ADHD often occur alongside tics © Creative Cat Studio | AdobeStock
The reasons for primary tics, which occur without any apparent cause, are not yet fully understood. Based on observations of familial clusters, genetic causes are suspected.
Secondary tics are a sign of another underlying condition. They occur, for example, in connection with the following conditions:
Tic disorders usually first appear during childhood. At first, the affected child is not consciously aware of the condition.
Medical experts estimate that nearly one in two children develops a tic by elementary school age. The majority of those affected are boys. The reason for this gender difference is not yet known.
Often, tics are only a temporary phenomenon. The symptoms usually diminish with age.
The diagnosis of a tic disorder or Tourette syndrome involves several steps.
To rule out a connection between the tics and other conditions, such as epilepsy, doctors first perform an EEG (electroencephalogram).
This is followed by an evaluation of liver, thyroid, and kidney function, as dysfunction in various organs can also trigger tics.
The neurologist examines family history to identify a genetic predisposition.
Major life changes (such as parental divorce or the death of a family member) can trigger severe crises and tics in children and adolescents. These tics are often temporary, provided that the underlying condition is successfully treated.
Special questionnaires for parents and family members facilitate diagnosis and the assessment of severity. Respondents must record their observations over several weeks.
The treatment of tic disorders consists of:
In mild cases of the disorder, support from teachers and parents can be helpful. It is recommended to pay as little attention to the tics as possible. This reduces the impact of the disorder on the person’s life. Medication and therapy are not necessary for mild cases.
In cases of severe symptoms, strong willpower alone is not enough. The person affected is significantly impaired and needs the help of a psychotherapist.
Cognitive behavioral therapy has proven effective in these cases. Habit reversal training has been shown to be particularly effective.
Learning relaxation techniques such as autogenic training or progressive muscle relaxation can lead to a significant reduction in symptoms.
Long-term tic disorders can severely impair quality of life. In children and adolescents, severe tics or Tourette syndrome often lead to depression and suicidal thoughts.
If psychotherapeutic support is insufficient, medication is necessary. Children should receive only the lowest dose that effectively alleviates symptoms.
Possible medications include:
Surgery provides relief only in exceptional cases.
Mild tic disorders are temporary in most cases. The condition peaks around age 12. After that, the symptoms usually become less severe.
15 to 20 percent of people with Tourette syndrome suffer from coprolalia. This severe form of vocal and motor tics leads to significant limitations for the patient—at school, at work, and in their personal life. Ongoing psychological support is necessary. A cure for Tourette syndrome is not yet available.
Patients with tic disorders require special attention. Positive examples show that inclusion and participation in social life are possible. This requires comprehensive information and good cooperation between parents, doctors, therapists, and teachers.
