pediatrics
Tic Disorders and Tourette Syndrome in Children and Adolescents
Symptoms and Signs of Tic Disorders
Patients tend to manifest the same set of tics at any given time, although tics tend to vary in type, intensity, and frequency over a period of time. They may occur multiple times in an hour, then remit or barely be present for ≥ 3 months. Typically, tics do not occur during sleep. Tics can be Motor and/or vocal Simple or complex (See table.) Simple ticsare a very brief movement or vocalization, typically without social meaning. Complex ticslast longer and may involve a combination of simple tics. Complex tics may appear to have social meaning (ie, be recognizable gestures or words) and thus seem intentional. However, although some patients can voluntarily suppress their tics for a short time (seconds to minutes) and some notice a premonitory urge to perform the tic, tics are not voluntary and do not represent misbehavior. Stress and fatigue can make tics worse, but tics are often most prominent when the body is relaxed, as while watching TV. Tics may lessen when patients are engaged in tasks (eg, school or work activities). Tics rarely interfere with motor coordination. Mild tics rarely cause problems, but severe tics, particularly coprolalia (which is rare), are physically and/or socially disabling. Sometimes tics are explosive in onset, appearing and becoming constant within a day. Sometimes children with explosive-onset tics and/or related obsessive compulsiveness have a streptococcal infection—a phenomenon sometimes called pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections ( Delayed complications of streptococcal infection ). Many investigators do not believe that PANDAS is distinct from the spectrum of tic disorders. Type Type Motor Motor Vocal Vocal Simple Blinking Grimacing Head jerking Shoulder shrugging Grunting or barking Sniffing or snorting Throat clearing Complex Combinations of simple tics (eg, head turning plus shoulder shrugging) Copropraxia: Using sexual or obscene gestures Echopraxia: Imitating someone's movements Coprolalia: Uttering socially inappropriate words (eg, obscenities, ethnic slurs) Echolalia: Repeating one's own or another's sounds or words 