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Tics and tourette's syndrome
Tics are involuntary, repetitive movements that affect 1-2% of children. Tourette's syndrome is a neurological disorder characterized by both motor and vocal tics that typically begin in childhood. Tics can range from simple movements like eye blinking to more complex actions and inappropriate vocalizations. Tourette's syndrome is often accompanied by conditions like ADHD and OCD. While tics can cause distress, treatment options include behavioral therapies and medication to control symptoms.
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Tics and tourette's syndrome
- 1. Tics & Tourette's Syndrome K.Kavindya M. Fernando JMJ 1
- 2. Tics & Tourette'sSyndrome • Tics are extremely common • Simple motor tics found in 1-2% of children • Tics are associated with many other behavioural, learning and psychiatric disorders • May cause great distress to both the child and their family and can have a negative impact on self-esteem JMJ 2
- 3. Tics • Sudden, • Repetitive, •Non-rhythmic, • Stereotyped • Motor movement or vocalizations, • Involving discrete muscle groups JMJ 3
- 4. Simple tics • Sudden,brief, • Meaningless movements or sounds, • That usually involves only one group of muscle • Examples • Neck jerking • Eye blinking • Grunting • Snorting • Throat clearing JMJ 4
- 5. Complex motor tics •Typically more purposeful appearing movements, • That last for rather longer • Examples • Facial movements • Jumping • Touching • Even self-harming JMJ 5
- 6. Complex vocal tics •Involve words or phrases • May include repetition of what was just heard or said (echolalia & palilalia), • Or socially inappropriate phrases (Coprolalia) JMJ 6
- 7. Tics • Also defineas • Transient or chronic • Chronic = ticks for more than 12 months • Tics may triggered or worsened by • Excitement, fatigue and visual cues JMJ 7
- 8. JMJ 8 Tic disorders Tourette’s syndrome Chronic motor or vocaltic disorder Transient tic disorder Tic disorder not otherwise specified
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- 10. Clinical features • Motortics appear in early life (3-8 years) • Initially simple tics (blinking) • Which gradually turns to complex motor tics • Touching, licking and making obscene gesture (copropraxia) • vocal tics also present • Peaks at about 20 years • Reduce after this age JMJ 10
- 11. Clinical features • Ticsexacerbated by • Anxiety • Boredom • Fatigue • Excitement • Tics reduced by • Sleep • Alcohol • Calming surroundings JMJ 11
- 12. Prevalence • 10-15% schoolgoing children • Commoner in males (5:1) • Do not seem to vary between races or socio- economic groups JMJ 12
- 13. Co-morbidities • ADHD • OCD •Learning disorders • Dyslexia • Mood • Anxiety disorders JMJ 13
- 14. Differential diagnosis • Abnormalmovements due to neurological or neuropsychiatric disorders • Sydenham’s chorea • Huntington’s disease • Wilson’s disease • Tuberous sclerosis • Abnormal movements caused by medications • Antipsychotics & anti epileptics – cause dystonic movements • Stimulants & opioids – may cause or exacerbate tics JMJ 14
- 15. Aetiology • Biological factors •Genetics (autosomal dominant disorder) • Neuroimaging • Reduced volume in caudate nucleus • Increased volume in prefrontal cortex • Dopamine dysregulation • Increase dopamine in straitum & prefrontal cortex • Autoimmunity • Tics & OCD may be caused by antibodies produced against streptococcus cross reaction in the basal ganglia JMJ 15
- 16. Aetiology • Social &psychological factors • Some life events (changing home/ school) • Low birth weight child • Exposure to high level of (in utro) • Caffaine • Alcohol • Tobacco in utro JMJ 16
- 17. Management • General measures •Psychoeducation of child, family & school • Collaboration with the school • Good treatment of co-morbidities • Information about and referral to support group • Pharmacological management • Alpha 2 agonists • Antipsychotics JMJ 17
- 18. Management • Psychological treatment •Cognitive behavioural therapy • Exposure response prevention • Relaxation techniques • Habit reversal training JMJ 18
- 19. Pharmacological treatment • Notthe 1st line due to adverse effects • Used in following situations • Severely disabling tics, • Interference with activities of daily living • Risk to self & others • Co-morbid ADHD/OCD or learning disability JMJ 19
- 20. Pharmacological treatment • Clonidine& guanfacine • Most commonly used drugs • Reduce tics by 30% • Local injection of botulinum toxin • Has been used in older children & adults JMJ 20
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