Tic Disorders and Twitches - Know All About It

Introduction:

The type and frequency of tics may change over time. Tics can come and go but can worsen if an individual gets stressed or anxious. One might be worried that tics might never go away, but fortunately, that is not the case. Most tics are usually transient. They usually do not last more than three months at a time. Tic disorders differ from each other based on the type of tic present and the duration of symptoms.

Are Tics and Twitches the Same?

Though many people use the terms ‘tic’ and ‘twitch’ interchangeably, there lies a difference between these two forms of movement. These differences are as follows:

• Tics: There are two types of tics, namely vocal and motor tics. Motor tics are characterized by sudden, short-lasting movements, while vocal tics are characterized by uttered sounds that manifest suddenly during what is otherwise normal behavior. For example, a person with a tic might blink their eyes many times or twitch their nose frequently. Anyone can experience tics, but it is more common in children. Research shows that about 20 % of children experience tics. Boys are more susceptible to experiencing tics than girls.

• Twitches: Contrary to tics, a majority of muscle twitches occur as isolated episodes rather than repeated actions. These twitches are also referred to as myoclonic jerks. They are entirely uncontrollable (involuntary). An eyelid twitch may seem to mimic an eye-blinking tic, but twitching is different because it is uncontrollable. It most often occurs in adults. An example of muscle twitch is benign essential blepharospasm. Blepharospasm refers to the uncontrollable twitching of the muscles of one or both eyelids.

What Are the Various Types of Tic Disorders?

Health professionals use ‘The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders’, fifth edition (DSM-5-TR), to aid in the diagnosis of tic disorders. Based on this, tic disorders can be classified as:

• Persistent motor or vocal tic disorder.

• Tourette syndrome (also called Tourette disorder).

• Provisional tic disorder.

The following are the criteria for the diagnosis of various tic disorders:

• Persistent (Chronic) Motor or Vocal Tic Disorder: The criteria are as follows:

1. Have tics that manifest before 18 years of age.

2. Experience one or more tics (like blinking or shrugging the shoulders) or vocal tics (like clearing the throat, humming, and so on), but not both.

3. Experience tics that occur multiple times a day, almost every day, or on and off throughout a period of almost more than a year.

4. Not diagnosed with Tourette syndrome.

5. Experience symptoms that are not due to the consumption of certain medicines or drugs or due to a medical condition that can cause tics.

• Tourette Syndrome: The criteria are as follows:

1. Experience two or more motor tics and at least one vocal tic, though they might not always manifest at the same time.

2. Experience tics that manifest before 18 years of age.

3. Have been experiencing tics for at least a year. The tics can manifest numerous times a day (usually in bouts) almost every day, or on and off.

4. Experience symptoms that are not due to the consumption of certain medicines or drugs, or due to another medical condition like seizures, and so on.

• Provisional Tic Disorder: The criteria are as follows:

1. Experience tics that manifest before 18 years of age.

2. Symptoms that are present for not more than 12 months in a row.

3. Experience one or more motor tics or vocal tics.

4. Not diagnosed with Tourette syndrome or persistent motor or vocal tic disorder.

5. Experience symptoms that are not due to the consumption of certain medicines or drugs, or due to another medical condition like seizures, and so on.

What Are the Signs and Symptoms of Tic Disorders?

The classic symptom of tic disorders is the manifestation of one or more tics. These can be classified as follows:

• Vocal Tics: In this type of tics, symptoms include repeating words or phrases, coughing, and throat clearing or grunting.

• Motor Tics: Symptoms include jerking, banging, head and shoulder movements, blinking, touching things or other people, and clicking fingers. Motor tics usually appear before vocal tics, but this need not always be the case.

Tics can also be classified as:

• Simple Tics: Simple tics are sudden, fleeting tics that involve a few muscle groups. Examples include eye darting, nose twitching, or throat clearing.

• Complex Tics: Coordinated movements of several muscle groups occur in complex tics. Examples include gesturing, stepping or hopping in a particular way, or repeating words or phrases.

Usually, an uncomfortable urge like an itch or tingle precedes tics. Though there is a possibility to refrain from carrying out the task, this requires great effort which can result in stress and tension. One experiences relief after carrying out the tic.

How Can Tic Disorders Be Diagnosed?

Tic disorders are diagnosed depending on the signs and symptoms that one experiences. Various types of tic disorders are diagnosed based on various criteria mentioned above. A majority of children are under 11 years of age when they are diagnosed with tic disorders. This disorder is accompanied by other behavioral concerns as well. Blood tests and imaging techniques like MRI (magnetic resonance imaging) scan may also be suggested by the physician if needed to rule out other causes of tics.

How Can Various Tic Disorders Be Managed?

Various tic disorders can be managed in the following ways:

• Exposure and Response Prevention (ERP): ERP is a type of cognitive behavioral therapy that enables people to get accustomed to the uncomfortable urges that precede a tic, intending to prevent the tic.

• Habit Reversal Therapy: This is a type of treatment approach in which an individual is taught to use movements to compete with tics so that tics do not occur.

• Medication: Medication can be combined with therapies or can be used separately. Medication tends to decrease the frequency of tics but does not offer a complete resolution to the problem. Some of the medications include muscle relaxants, anti-seizure medications, Botox injections, and medications that interact with dopamine. Antidepressants may also be prescribed to reduce anxiety.

• Deep Brain Stimulation (DBS): Deep brain stimulation is usually suggested for those with Tourette syndrome whose tics are unresponsive to other treatments and affects their quality of life. In this approach, a battery-operated device is implanted in the brain. Certain regions of the brain that control movement are stimulated with electrical impulses to reduce tics.

• Self-Help Tips: The frequency of tics can be reduced through certain lifestyle changes like sleeping sufficiently, and reducing stress and anxiety. Other coping strategies include:

1. Joining a support group for those suffering from tic disorders.

2. One must remember that tics usually improve or resolve with age.

3. One can reach out to their friends, family members, or others for help and support.

4. Parents of children with tics can inform the child’s teachers, caretakers, or others who take care of them about their condition.

5. Parents must gently ignore times when a tic manifests, and refrain from pointing it out to the child.

6. Parents must boost their child’s self-esteem by encouraging friendships and other interests.

Conclusion:

Tics are characterized by irregular, uncontrollable, and repetitive movements of muscles. It is a cause for concern for those suffering from tics as they feel embarrassed about the sudden, uncontrollable movements, which can further worsen the tics. One must not allow the tic to dictate them. There are various ways to cope with tics, as mentioned above. One might feel empowered to deal with the condition by learning strategies to live with tics and not paying attention to the tic.