Tics and Tourette’s disorder

Tics are characterized by sudden, recurrent, nonrhythmic movements or vocalizations that can vary from mild to moderate to disruptive and may sometimes be painful. They are involuntary.

Tics can appear in any area of your body, such as your face, shoulders, hands, or legs. For instance, motor tics might cause you to blink a lot or shrug your shoulders. When it comes to vocal tics, you might find yourself making grunting sounds or feeling like you need to clear your throat.

If someone has motor and vocal tics for over a year, it's called chronic tic disorder. Tics that last less than a year are known as provisional tic disorder. When a person has both multiple motor tics and one or more vocal tics for more than a year, it's diagnosed as Tourette's disorder. Research shows that about 1% of children and around 0.01% of adults experience chronic tic disorder. Tics are most common among children, with about 15-20% of kids experiencing transient tics that tend to clear up on their own. Brain development is believed to play a key role in helping tics improve over time.

Tic disorders can lead to a range of challenges, including social embarrassment, physical discomfort, or emotional struggles. These issues might affect daily life and school success. Additionally, tic disorders often come with other neuropsychiatric symptoms, which can sometimes be even more challenging than the tics themselves.

“ I could not stop the sensation to twitch my mouth. It would happen when I was watching TV, in the classroom, on the school bus, and, slowly, even while eating. It started to interfere with my eating

It would begin with an unpleasant sensation, an urge building throughout my body. I could not delay or suppress it. When I tried to suppress it, I felt huge discomfort that could only be relieved by twitching my mouth.

My tics changed over time.

I started to blink often.

My friends noticed and asked me to stop. The more I tried, the more it came. It seemed like something had possessed me. It became a social stigma. I became a kid laughingstock.

This worried my parents a lot. My mother would often be teary-eyed, asking me to relax, not do homework, and lie down. I would feel anxious about missing my homework. This reinforced my tics, and I developed anxiety and a depressed mood.

My tics improved after a few months, but I was left with depressed mood for a long time.”

                                              -Maria, a 24-year-old media working professional

Are Tics neurological?

Tics have a strong neurological basis.

Key facts about the neurology of tics:

•  Involuntary Nature: Tics are not voluntary habits. They frequently originate from an uncomfortable physical "urge" in the body, which can only be temporarily alleviated by performing the tic.

• Brain Pathways: Research indicates that they are associated with dysfunctional neural pathways, such as the cortico-striato-thalamo-cortical circuits,

  

  and irregular neurotransmitter processing, including dopamine.

• Triggers: Although primarily neurological in nature, tics are significantly affected by environmental and emotional influences. Factors such as stress, excitement, anxiety, and fatigue frequently temporarily exacerbate tics.

Types of Tics

• Simple Tics: Sudden, brief movements or sounds that involve just a few muscle groups, like blinking your eyes, shrugging your shoulders, sniffing, or clearing your throat.

• Complex Tics: Distinct, coordinated, and longer-lasting patterns of movements or sounds—such as touching objects, hopping, or repeating particular phrases or even obscene words—can really stand out. These behaviors often act as ways for individuals to communicate or self-regulate, and by understanding them, we can develop greater empathy and support.

Causes and Triggers

 While precise etiology remains under investigation, tic disorders are generally understood to involve a combination of genetic and neurobiological factors. Tics are involuntary actions; however, individuals may experience a mounting, uncomfortable physical sensation known as a "premonitory urge" that is momentarily alleviated by executing the tic. Tics are not entirely within an individual's control and tend to exacerbate in response to:

§  Stress and anxiety: Extreme feelings, whether it is anger, excitement, or boredom, often cause a temporary flare-up.

§  Fatigue and exhaustion: Being physically tired, sick, or bored can lower the body's threshold for controlling tics.

§  Excitement or severe boredom: Strong emotions like anger, excitement, or being flustered often cause a temporary flare-up.

§  Attention and Suggestion: Concentrating heavily on the tic, or even discussing tics (especially in teens), can temporarily increase them

Management and Treatment

Many mild tics are temporary and don't require treatment.

Tics are not inherently physically hazardous or life-threatening; however, appropriate treatment and support are crucial if they interfere with daily functioning. While minor tics generally diminish without intervention, severe or unmanaged tics may lead to social or academic difficulties or injury from forceful movements.

Manage your tics:

 1.   Develop "Competing Responses"

One can train the body to do less noticeable actions until the urge passes:

1.    For head jerking: Gently tuck your chin and elongate the back of your neck.

2.    For shoulder shrugging: Hold your shoulders down gently, as if holding light weights.

3.    For vocal tics: Practice slow, controlled breathing through your nose or mouth.

2. Manage Stress and Environment

Tics notoriously spike when the body is stressed, overly tired, or anxious.

·      Prioritize sleep: Stick to a consistent, healthy sleep schedule.

·      Create a calm space: Be in a quiet room/no worries about being watched.

·      Make adjustments: Set a timer to stand up or move around for a few minutes every 15-20 minutes.

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3. Home Remedies and Comfort Aids

For physical tics, natural relief is brought through specific adjustments

•  Mouth tics: Sucking on ice, chewing gum.

• Relaxation aids: Deep breathing, mindfulness, or taking a warm Epsom salt bath.

• Safe items: Keep plenty of pillows nearby if you have severe or harmful motor tics.

 Tics can be treated

 Seek professional assistance when your tics become distressing, painful, or interfere with your daily activities. It is advisable to consult a clinical psychologist, occupational therapist, neurologist, or behavioral specialist.

Several evidence-based treatments can help control symptoms:

• Behavioral Therapy: Specialized therapies, such as the Comprehensive Behavioral Intervention for Tics (CBIT), assist individuals in recognizing the urge to tic and in training them to perform a competing response.

• Medication: In more severe cases, physicians may prescribe specific medications, such as alpha-agonists or dopamine blockers, to diminish the frequency and severity of the tics.