Tic disorders are defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) based on type (motor or phonic) and duration of tics (sudden, rapid, nonrhythmic movements).
Tourette syndrome, Tourette’s syndrome, Tourette’s disorder, Gilles de la Tourette syndrome, GTS, Tourette’s or TS is aninherited neuropsychiatric disorder with onset in childhood, characterized by multiple physical (motor) tics and at least one vocal (phonic) tic. Persists more than one year and began before the age of 18 years old.
Tics are movements or sounds “that occur intermittently and unpredictably out of a background of normal motor activity”, having the appearance of “normal behaviors gone wrong”.
The tics associated with Tourette’s change in number, frequency, severity and anatomical location.
Waxing and waning—the ongoing increase and decrease in severity and frequency of tics—occurs differently in each individual.
Tics also occur in “bouts of bouts”, which vary for each person.
- Coprolalia (the spontaneous utterance of socially objectionable or taboo words or phrases)
- Echolalia (repeating the words of others)
- Palilalia (repeating one’s own words) occur in a minority of cases
- The most common initial motor and vocal tics are, respectively, eye blinking and throat clearing.
Simply said there are two kinds of tics: motor and vocal
Motor tics are eye blinking, facial grimacing, jaw movements, head bobbing/jerking, shoulder shrugging, neck stretching, and arm jerking. Some can be a combination of tics or movements that look lie they have some purpose like hopping, twirling, or jumping.
Vocal tics are sniffing, throat clearing, grunting, hooting, and shouts.
Words or phrases often don’t sound like they are a part of a conversation: barked, grunted, and appear to be inappropriate. In minority of cases the words are profane: swear words, ethnic slurs and other socially unacceptable words/phrases.
The fifth version of the DSM (DSM-5), published in May 2013, reclassified Tourette’s and tic disorders as motor disorders listed in the neurodevelopmental disorder category.
In contrast to the abnormal movements of other movement disorders (for example, choreas, dystonias, myoclonus, anddyskinesias), the tics of Tourette’s are temporarily suppressible, nonrhythmic, and often preceded by an unwanted premonitory urge. Immediately preceding tic onset, most individuals with Tourette’s are aware of an urge, similar to the need to sneeze or scratch an itch. Individuals describe the need to tic as a buildup of tension, pressure, or energy which they consciously choose to release, as if they “had to do it” to relieve the sensation or until it feels “just right”.
Examples of the premonitory urge are the feeling of having something in one’s throat, or a localized discomfort in the shoulders, leading to the need to clear one’s throat or shrug the shoulders. The actual tic may be felt as relieving this tension or sensation, similar to scratching an itch. Another example is blinking to relieve an uncomfortable sensation in the eye. These urges and sensations, preceding the expression of the movement or vocalization as a tic, are referred to as “premonitory sensory phenomena” or premonitory urges. Because of the urges that precede them, tics are described as semi-voluntary or “involuntary“.
While individuals with tics are sometimes able to suppress their tics for limited periods of time, doing so often results in tension or mental exhaustion. People with Tourette’s may seek a secluded spot to release their symptoms, or there may be a marked increase in tics after a period of suppression at school or at work.
Tics are believed to result from dysfunction in cortical and subcortical regions, the thalamus, basal ganglia and frontal cortex. Neuroanatomic models implicate failures in circuits connecting the brain’s cortex and sub cortex, and imaging techniques implicate the basal ganglia and frontal cortex.
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