Overview
Oliver Sacks, neurologist & writer famously wrote about “Witty-Ticcy Ray” a surgeon with Tourette syndrome. Not an uncommon neurological syndrome in children tics are characterized by sharp involuntary movements and vocalizations.
Tics are irregular, uncontrollable, unwanted, and repetitive movements of muscles that can occur in any part of the body. Movements of the limbs and other body parts are known as motor tics. Involuntary repetitive sounds, such as grunting, sniffing, or throat clearing, are called vocal tics.
Multi-modal
Assessment
Signs
Tic disorders usually start in childhood, first presenting at approximately 5 years of age. In general, they are more common among males compared with females.
The defining symptom of tic disorders is the presence of one or more tics. These tics can be classified as:
- Motor tics: These include tics, such as head and shoulder movements, blinking, jerking, banging, clicking fingers, or touching things or other people. Motor tics tend to appear before vocal tics, although this is not always the case.
- Vocal tics: These are sounds, such as coughing, throat clearing or grunting, or repeating words or phrases.
Tics can also be divided into the following categories:
- Simple tics: These are sudden and fleeting tics using few muscle groups. Examples include nose twitching, eye darting, or throat clearing.
- Complex tics: These involve coordinated movements using several muscle groups. Examples include hopping or stepping in a certain way, gesturing, or repeating words or phrases.
Tics are usually preceded by an uncomfortable urge, such as an itch or tingle. While it is possible to hold back from carrying out the tic, this requires a great deal of effort and often causes tension and stress. Relief from these sensations is experienced upon carrying out the tic.
Multi-modal
Diagnosis
Diagnosis
While the diagnosis is clinical, brain imaging, electrophysiology, blood tests to rule out reversible causes or indeed contributing factors and a thorough pre-rehabilitation assessment including evaluation for co-morbidities (associated conditions) will be required in all instances. At Buddhi Clinic our assessment includes standard outcome indicators for activities of daily life, quality of life, neuro-disability and mental health.
Treatment
At Buddhi Clinic we study these in-depth, our founder having served the national Tourette clinic at Queen Square for four years. Children with tic disorders often have co-morbid problems- attention deficit & hyperactivity (ADHD), learning disorders, oppositional defiance, conduct problems and a range of behavioral issues. The problem is therefore seldom merely cosmetic and restricted to involuntary movements and gestures. From determining biological causality (such as Wilson’s disease) for the symptom, to combining drugs and non-pharmacological treatments to achieve good outcomes in our Buddhi program, we at the neuropsychiatry center have demonstrable interest & expertise.
