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Tic DisorderAka: Transient Tic Disorder, Motor Tic, Vocal Tic

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  1. See Also
    1. Tourette's Syndrome
    2. Tic Secondary Cause
    3. Tic Management
  2. Epidemiology
    1. Incidence of tic in children under age 10 years: 20%
    2. Motor tics more common than verbal tics
  3. Definition: Tics
    1. Non-rhythmic, purposeless movements or vocalizations
    2. Sudden and rapid actions
  4. Pathophysiology
    1. Basal ganglia disorder involving Dopaminergic and serotinergic neurons
  5. 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
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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
  11. 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
  12. Management
    1. See Tic Management
  13. References
    1. Bagheri (1999) Am Fam Physician 59(8):2263
    2. Kenney (2008) Am Fam Physician 77:651
    3. Rampello (2006) J Neurol 253:1

Tic, Motor (C0751900)

ConceptsSign or Symptom (T184)
MSHD020323
EnglishMotor 'tics', Motor Tic, Motor Tics
SourcesMSH, OMIM
Derived from the NIH UMLS (Unified Medical Language System)



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