Tics are another type of involuntary rapid movement similar to tremor but involving smaller groups of muscles. Tics are more “jerky” in quality, and tend to recur with the same or a very similar pattern in the same muscles. They most commonly involve the face, mouth, eyes, head, and neck or shoulder muscles. There are two kinds of tics, motor (pertaining to movement) and vocal (pertaining to speech).

Simple motor tics include eye blinking, head swaying, foot tapping, and shoulder shrugging. Complex motor tics use more than one muscle group and often appear to have a purpose. Some involve imitating a series of movements that the person has observed (echopraxia) or performing obscene or rude gestures (called copropraxia).

Vocal tics are involuntary expressions, such as noises (coughing, throat clearing, barking), words (sometimes obscenities), or repetitive phrases (in some cases with increasing rapidity). In simpler terms, vocal tics are any tics that involve the larynx, tongue, throat sinuses or mouth.

When both motor and vocal tics are present and persist for more than one year, a diagnosis of Tourette’s syndrome (TS) is likely. A number of other disorders often occur along with tic symptoms. For example, conditions associated with TS include attention-deficit hyperactivity disorder (ADHD/ADD), obsessive-compulsive behavior, and learning disabilities.

Tics: Symptoms

Symptoms vary greatly among people with tic disorders, ranging from tics that are barely noticeable to those that are severe and incapacitating. Fatigue, anxiety, excitement, and stress often aggravate symptoms.

Common symptoms include:

• Vocalizations: grunts, throat clearing, abdominal or diaphragmatic contractions.
• Involuntary muscular movements: involving the mouth or eyes, head twitching, shoulder shrugging.

Less common, complex tic symptoms include:

• Bending over to touch the floor.
• Smoothing clothing.
• Jumping.

Tics: Diagnosis

Diagnosis of a tic is typically made during physical examination. No tests are usually necessary.

Tics: Treatment

Mild tics generally do not require treatment unless they are socially embarrassing or interfere with your day-to-day activities.

Severe tics can be treated with medications that affect certain cells in the nervous system. The most frequently prescribed medications are the following alpha 2-adrenergic agonists, which are also used to treat ADHD:

• Clonidine hydrochloride (Catapres®)
• Guanfacine (Tenex®)

Additionally, certain neuroleptic medications (which are often used in the treatment of psychosis) may be used in small doses to help reduce tic symptoms. These include:

• Risperidone (Risperdal®)
• Olanzapine  (Zyprexa®)
• Thiothixene (Navane®)
• Clozapine (Clozaril®)
• Quetiapine  (Seroquel®)
• Ziprasidone (Geodon®)
• Aaripiprazole (Abilify®)

Neuroleptic medications tend to work more quickly than the alpha 2-adrenergic agonists. Patients generally know within a matter of days or a few weeks whether or not these drugs are an effective treatment for their disorder.

Your neurologist may suggest Botulinum toxin (Botox®) injections as an option for controlling your symptoms. Studies have shown significant decreases in both tic frequency and urge to tic in patients who received this therapy.

Behavioral therapy is also a viable and often highly successful treatment for tic symptoms. Your doctor may suggest what is called “habit reversal” therapy. This process involves making you aware of the tic and training you to engage in a response that would be muscularly competing or incompatible with the tic.

Tics: Resources

American Academy of Neurology (AAN)
1080 Montreal Ave.
St. Paul, MN 55116
Phone: (651) 695-2717
Toll-Free: (800) 879-1960
Fax: (651) 695-2791

Tourette Syndrome Association
42-40 Bell Boulevard
Bayside, NY 11361
Phone: (718) 224-2999
Fax: (718) 279-9596
Email: ts@tsa-usa.org