Tics and Tourette Syndrome

Tics are rapid, purposeless, unvoluntary, unrhythmic, repetitive, frequent, unwanted, and discrete muscle movements. Sometimes they are referred to as jolts or twitches. Tics are classified as either simple or complex and as either motor or vocal tics. Motor tics include blinking, neck rotation, torso twisting, jumping, toe flexing, and countless other movements. Vocal tics include numerous vocalizations including coughing, making a hum or grunt sound, and saying a word or phrase. 

Neurologists who specialize in Tic Disorders provide comprehensive evaluations which ensure that a proper diagnosis is made and they then suggest effective care. Some patients with tics benefit from medication, while others respond better to behavioral intervention. Often both medication and behavioral strategies are used.

The most research-backed and effective behavioral intervention for tics is called Comprehensive Behavioral Intervention for Tics (CBIT). CBIT Therapy is a form of Habit Reversal Training that focuses on the management of tics by briefly and painlessly inhibiting muscles involved with unwanted and repetitive movements and sounds. Treatment is provided by licensed health professionals with a specialized certification in CBIT. Support often includes the following components.

• Sensory training to increase awareness of the tics.
• Recognition of internal triggers (premonitory urges).
• Competing Responses to physically block current tics and reduce the frequency of future tics.
• Environmental modification.
• Accommodation suggestions.
• Referrals to medical and mental health specialists.
• Education about tic related conditions.
• Advocacy.

Click here to learn more about CBIT .

Common tic disorders and their diagnostic criteria are described below:

Provisional Tic Disorder

• Patient has one or more motor or vocal tics.
• Tics are present for less than one year.
• Tics start before age 18.
• The tics are not due to a medication, other drugs, or a medical condition that can cause tics (for example, Huntington disease or postviral encephalitis).
• The patient has not been diagnosed with another tic disorder.

Persistent Tic Disorder

• The patient has one or more motor tics or vocal tics, but not both.
• The tics occur many times a day nearly every day or on and off throughout a period of more than a year.
• The tics start before age 18.
• The tics are not due to a medication, other drugs, or a medical condition that can cause tics.
• The patient has not been diagnosed with another tic disorder.

Tourette Syndrome (Tourette Disorder, Tourette's, TS)

• The patient has two or more motor tics and at least one vocal tic.
• The tics have been present for at least one year. The tics can occur many times a day (usually in bouts) nearly every day, or off and on for at least one year.
• The tics begin before age 18.
• The tics are not due to a medication, other drugs, or a medical condition.