Sudden, rapid, usually stereotyped, predominantly
clonic, irresistible movement -> relieve of symptom.
Can be controlled by will for short time but reappear
as soon as attention is diverted.
They correspond to purposive coordinated act
which normally serve the organism
Blinking, sniffing, throat cleaning, neck , shoulder or
Seen transiently in children, mentally retarded
Adult – relieved by sedation, psychotherapy
Motor -- Eye blinking, head jerking, shoulder
shrugging and facial grimacing.
Vocal -- Throat clearing, yelping
and, noises, sniffing and tongue clicking
Motor -- Jumping, touching other people or
things, smelling, twirling about, and only rarely, self-
injurious actions including hitting or biting oneself.
Vocal -- Uttering words or phrases out of context
GILLES DE LA TOURETTE SYNDROME
Incidence : 0.03 – 0.05% M:F - 3:1
Onset - mean 7 y (2-15y) 95% < 11y
1/3rd family members have tics
Rapid abrupt, intermittent, present in sleep, multifocal
simple or complex
Involve face, eyes, and proximal extremities
Vary spontaneously, Echopraxia, Copropraxia
Involuntary, words, grunts, bark, sniff, snuts, squeals,
The uncontrolled, often obsessive use of obscene
or scatological language, cursing, ethnic slurs
Thought to possessed by the devil.
Ostracized from their communities or punished for
Genetics: AD (Chr
4p and 8p)
Multiple motor tics
One or more vocal tics
No known cause
Age of onset less than 18 years.
A duration of greater than one year.
“Tourette Syndrome Study Group (1993)”
DSM IV CRITERIA OF TOURETTE SYNDROME
Age of onset between 5-15y
Multiple motor tics
Multiple vocal tics
Ability to suppress movement voluntarily for min to
Variation in the intensity of symptom over weeks to
Duration of more than a year
OCD/Tic tic disorder
Onset 3-12 years
Episodic course of
Association with group A
Marked improvement in late
teens or early twenties.
They get better, not worse,
as they mature
TS patients have a normal
1/ 3 of patients experience
remission of tic symptoms in
Samuel Johnson 1709-1784
“Good English Dictionary