Tic

A tic (French tic " ( nervous ) twitch " ) or tick is a disease symptom. It describes a short and involuntary, regularly or irregularly recurring and sometimes complex motor contraction of individual muscles or muscle groups. You will be counted as extrapyramidal hyperkinesis. In the social contact flashy tics are usually only if they show up as severe physical movements or vocalizations. Tics occur in various neurological and neuropsychiatric diseases, but are known primarily as a symptom of Tourette's syndrome.

Symptoms

One differentiates primary, idiopathic tic disorder (cause unknown ) from the secondary, symptomatic tic disorder (cause unknown). After markedness and severity are four subgroups of tics that occur especially in the head and shoulder area, differentiated:

• Simple motor tics (eg frown, eye blinking, head jerking movement, raising the eyebrows, shrug, grimacing )
• Simple vocal tics ( throat clearing, click your tongue, cough, lip smacking, grunting, sniffling )
• Complex motor tics (eg, Jumping, touching other people or objects, body twists, copropraxia (version obscene gestures), self-injurious behavior),
• Complex vocal tics (such as the ejection of incoherent words and short sentences, coprolalia ( the ejection of obscene words), echolalia (repeating belonged sounds and word fragments ), palilalia (repeating itself just spoken words ) ).

Vocal tics differ from motor tics fact that this muscle groups are involved that contribute to vocalization (eg, diaphragm, tongue, pharyngeal muscles, etc.). While simple motor and vocal tics usually run fast and act unintentionally, complex tics by their partly slower, more structured sequence can often seem arbitrary. One can suppress a tic over a short period of time, but can not unlearn it. The Tic- patient can not control both the time of onset and the disappearance of tics.

Diagnosis according to ICD -10

In ICD -10 tic disorders among the ' behavioral and emotional disorders with onset in childhood or adolescence ' (F9 ) to be classified. That is, for the diagnosis of tic disorder the onset before the age of 18 must be. There are three main types of tic disorders:

• Transient tic disorder: Single or multiple motor or linguistic tics occur many times a day, on most days over a period of at least four weeks and a maximum of 12 months.
• Chronic motor or vocal tics: motor or vocal tics (but not both ) occur many times in a day, on most days over a period of at least twelve months. In the given year, there is no remission, which lasted more than two months.
• Combined vocal and multiple motor tics ( Tourette 's syndrome): While the disorder have multiple motor tics and one or more vocal tics existed for some time, but not necessarily at the same time. The tics occur many times a day, nearly every day for more than a year. There was no remission in the given year, which lasted more than two months.

Epidemiology, distribution and age Relevance

Tics occur mainly in childhood (at about 4-12 % of all children). Often, however, they are at this age transitory nature, ie they disappear within 6 months. Tics occur in boys at about three times as often as girls. The family history of tics has been demonstrated.

For lighter course forms the tics stop usually at the beginning of adulthood. In more severe forms symptoms persist even in adulthood, but often in a weakened form. The heaviest and therefore most impressive progressive form is also referred to by the describer, the French neurologist Georges Gilles de la Tourette as so-called Tourette's syndrome.

Patients with chronic multiple tics or Tourette's disorder have about half of the cases, in addition to a hyperkinetic disorder ( ADHD). In patients with Tourette's syndrome and obsessional symptoms or self-injurious behaviors are frequently observed. Almost always develop complex tics for simple tics. Also in the context of OCD tic symptoms may occur concomitantly, while preserving the frame of Tourette's syndrome must be achieved.

Differential Diagnosis

Diagnosis, the tics occur are distinctions to be drawn

• Neurologically based movement disorders ( dyskinesias ) that occur in conjunction with basic medical disorders (eg, Huntington's disease, PANS / PANDAS, post- viral encephalitis, brain injury ) or as a result of drug ingestion ( eg, antipsychotics, stimulants );
• Stereotype movements (eg vast body movements, take things in their mouths, bite themselves ) that are observed in a stereotyped movement disorder or a pervasive developmental disorder
• Compulsions, which are typically complex, usually occur as a response to obsessive thoughts and run according to strict rules.

Causes

The exact cause of the formation of the most common primary tic disorder is still unknown, but a genetic basis is considered safe. In a broad, pan-European study series ( EMTICS ) should be explored to 2017, the exact function has the genetics in the context of tic disorders and what other factors (eg, infections and autoimmune factors ) is important. It is considered a hereditary disorder in the basal ganglia. Less common are organic tics as a result of a general brain damage (eg, encephalitis) or a lesion of the basal ganglia ( the striato - pallidären system ). Increasingly, the striatofrontale dysfunction is blamed for the emergence of tics, which would explain that the tic disorder is a frequent comorbidity of ADHD.

Special form

As with other special forms shall cause the tic douloureux ( double the painful tic ): a short, violent and often repetitive attack of pain with facial spasms in trigeminal neuralgia.

Therapy

Depending on the severity of tic disorder, various therapies available. " Psychodynamic - oriented psychotherapy as well as psychoanalysis must be classified as unsuitable in the treatment of tics, because the cause of tics is organic and not psychogenic. Behavioural approaches are controversial in terms of their effect. "

In addition to a comprehensive education and counseling of caregivers ( in affected children esp. parents and teachers ) some relief success can be achieved with simple symptoms through psycho-education and behavioral therapy. Although it is a neurobiological (medical) disease, an improvement in the self-perception of the patient in relation to the tics (eg, protocols and precise description ) and the learning of incompatible reactions ( Habit Reversal Training) in some cases provide relief of symptoms. In addition, with relaxation techniques (eg, progressive muscle relaxation) and positive reinforcement is carried out ( for example, token system ).

In serious, complex and chronic cases and in the case of severe comorbidities, pharmacological treatment is just as necessary as in the case of vocal tics, upon the occurrence of other comorbidities and the full image of Gilles de la Tourette's syndrome. Agent of choice are highly potent neuroleptics from the class of dopamine receptor blockers ( eg Tiaprid, pimozide, haloperidol ) and with appropriate accompanying symptoms antidepressants ( esp. selective serotonin reuptake inhibitors). Psychoeducation and social psychiatric accompaniment can support a drug therapy if necessary.