II. Epidemiology

  1. Incidence of tic in children under age 10 years: 20%
  2. Motor Tics more common than verbal tics

III. Definition: Tics

  1. Non-rhythmic, purposeless movements or vocalizations
  2. Sudden and rapid actions

IV. Pathophysiology

  1. Basal Ganglia disorder involving Dopaminergic and serotinergic Neurons

V. Symptoms

  1. Timing
    1. May be repeated compulsively until feels right
  2. Palliative
    1. Suppressible with concentration and distraction
  3. Provocative
    1. Worse with stress or excitement
    2. Dramatic tic outburst may occur after prolonged tic suppression
  4. Tic aura precedes a tic in 80% of cases
    1. Example: Shoulder burning sensation before a Shoulder shrug tic

VI. Types: Timing

  1. Transient (Duration less than 12 months, accounts for up to 15% of cases)
    1. See Secondary Causes of Tic Disorder
  2. Chronic (Duration longer than 12 consecutive months)
    1. Primary Vocal and Motor: Tourette's Syndrome

VII. Types: Simple Tics

  1. Simple Vocal Tics
    1. Throat clearing
    2. Sniffing
    3. Animal sounds (e.g. barking)
    4. Coughing
    5. Yelling
    6. Hiccuping
    7. Belching
  2. Simple Motor Tics (clonic/brief, dystonic/prolonged or tonic/sustained)
    1. Eye blinking
    2. Nose twitching
    3. Sticking Tongue out
    4. Head turning or neck Stretching
    5. Shoulder jerking
    6. Muscle tensing
    7. Flexing fingers
    8. Kicking

VIII. Types: Complex Tics

  1. Complex Vocal Tics
    1. Parts of words or phrases repeated
    2. Talking to oneself in multiple characters
    3. Assuming different intonations
    4. Coprolalia (Use of Profanity)
    5. Echolalia (repeating another person's words)
    6. Paliphrasia or Palilalia (repeating one's own words)
  2. Complex Motor Tics
    1. Copropraxia (obscene gestures)
    2. Echopraxia (Imitating another person's gestures)
    3. Flapping arms
    4. Facial grimace
    5. Picking at clothing
    6. Complex touching movements
    7. Jumping
    8. Shaking feet
    9. Pinching
    10. Poking
    11. Kissing self or others
    12. Spitting
    13. Hair brushing
    14. Throwing motions

IX. Diagnosis: Transient Tic Disorder (DSM-IV)

  1. Motor or Vocal Tics (single or multiple)
  2. Tics occur multiple times per day on most days for 1-12 months
  3. Onset before age 18 years
  4. Not due to a Tic Secondary Cause

X. Differential Diagnosis

  1. See Secondary Causes of Tic Disorder
  2. Chorea
    1. Abrupt, non-repetitive irregular movements (multifocal and migratory)
    2. Example: Syndeham's Chorea
  3. Dystonia
    1. Stereotypic, slow sustained muscle contraction without variation
    2. Results in abnormal Posture
    3. Example: Blepharospasm
  4. Myoclonus
    1. Fast, sudden, involuntary muscle jerking
    2. Example: Myoclonic Epilepsy

XI. Labs

  1. General
    1. Thyroid Stimulating Hormone (TSH)
  2. Rapid onset varying with Upper Respiratory Infection
    1. Throat Culture
    2. Antistreptolysin O
    3. Anti-DNAse B

XII. Management

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Ontology: Tic disorder (C0040188)

Definition (MSH) Disorders characterized by recurrent TICS that may interfere with speech and other activities. Tics are sudden, rapid, nonrhythmic, stereotyped motor movements or vocalizations which may be exacerbated by stress and are generally attenuated during absorbing activities. Tic disorders are distinguished from conditions which feature other types of abnormal movements that may accompany general medical conditions. (From DSM-IV, 1994)
Concepts Mental or Behavioral Dysfunction (T048)
MSH D013981
ICD9 307.20, 307.2
ICD10 F95.9 , F95
SnomedCT 191988002, 191989005, 35042001, 155005001, 192621007, 112086008, 192626002, 393585001, 191991002, 386783003, 568005
DSM4 307.20
English Tic Disorders, Tic disorder, TICS, TIC DISORDERS, Tic Disorder NOS, Tic disorder unspecified, Tic disorder, unspecified, Tic Disorder, Tic disorders, TIC DIS, [X]Tic disorders, tic disorder, tic disorder (diagnosis), Tic NOS, Tic Disorders [Disease/Finding], disorders habit, tic disorders, tic disorder nos, habit disorder, Tic disorder unspecified (finding), [X]Tic disorders (finding), Tic NOS (finding), Tic disorder unspecified (disorder), Tic, Tics, Tic (finding), Tic disorder (disorder), tic, spasm; tic, tic; spasm, Tic, NOS, Tic disorder, NOS, Tic [dup] (finding), Tic disorder NOS
German TIC, Tic-Stoerung, unspezifisch, Tics, Ticstoerung, nicht naeher bezeichnet, Ticstoerungen, Tic-Syndrome, Tic, Tic-Störungen
French Tics anormaux, Trouble de tic, non précisé, Tics, TICS, Troubles des tics, Tic
Italian Tic, Patologie con tic, Disturbo a tipo tic, non specificato, Disturbi da tic
Dutch niet-gespecificeerde tic-stoornis, tics, spasme; tic, tic; spasme, Ticstoornis, niet gespecificeerd, tic-stoornissen, tic, Ticstoornissen, Tic-stoornissen
Portuguese Tiques, Perturbação de tiques NE, TIQUES, Tique, Anomalias por tiques, Transtornos de Tique
Spanish Tics, Trastorno de tics no especificado, TICS, Tic disorder unspecified, [X]trastornos por tics (hallazgo), [X]trastornos por tics, tic, SAI (hallazgo), trastorno de tic no especificado (trastorno), [X]trastornos de tics, tic, SAI, trastorno de tic no especificado (hallazgo), trastorno de tic no especificado, tic (hallazgo), tic, trastorno de tics (trastorno), trastorno de tics, Tic, Trastornos de tics, Trastornos de Tic
Japanese チック障害、詳細不明, チック, チックショウガイショウサイフメイ, チック, 外傷後チック障害, チック障害-音声, チック障害-一過性, チック障害-外傷後, チック障害-慢性運動性および音声, 音声チック障害, 慢性運動性および音声チック障害, 一過性チック障害, チック障害
Swedish Tickrubbningar
Czech tikové poruchy, Tikové poruchy, Tik, Tiková porucha, blíže neurčená, Tiky
Finnish Nykimishäiriöt
Russian TIK, ТИК
Korean 상세불명의 틱 장애, 틱 장애
Polish Zespół tików, Zaburzenia tikowe, Choroba tików
Hungarian Tic, Tic-ek, Tic betegségek, Tic betegség, nem meghatározott
Norwegian Tics

Ontology: Transient Tic Disorder (C0040702)

Concepts Mental or Behavioral Dysfunction (T048)
MSH D013981
ICD9 307.21
ICD10 F95.0
SnomedCT 192622000, 56573006
DSM4 307.21
English Tic Disorder, Transient, Tic Disorders, Transient, Transient Tic Disorders, TRANSIENT TIC DIS, TIC DIS TRANSIENT, transient tic disorder, transient tic disorder (diagnosis), transient tic disorders, Transient tic disorder, Transient tic disorder (disorder), Transient tic disorder, NOS, Transient Tic Disorder
French Tic transitoire
German Ticstörung, transitorische, Voruebergehende Ticstoerung, Vorübergehende Ticstörung
Korean 일과성 틱 장애
Czech přechodná tiková porucha
Italian Disturbo da tic transitorio
Norwegian Forbigående tics, Tics, forbigående
Dutch Passagre ticstoornise, Tic-stoornis, voorbijgaande
Spanish trastorno de tics transitorios (trastorno), trastorno de tics transitorios, Trastorno Transitorio por Tic
Portuguese Transtorno de Tique Transitório

Ontology: Tic, Motor (C0751900)

Concepts Sign or Symptom (T184)
MSH D020323
English Motor 'tics', Motor tic, Motor Tic, Motor Tics, Tics, Motor, motor tics, motor tic, Motor tics, Tic, Motor
Dutch motorische tic, Tic, motorische
German motorischer Tick, Tic, motorischer
Portuguese Tique motor, Tique Motor
Spanish Tic motor, Tic Motor
Japanese 運動性チック, ウンドウセイチック
Czech tik motorický, Motorický tik
Italian Tic motorio
Hungarian Motoros tic
Norwegian Motorisk tic
French Tic moteur