A tic is an involuntary, rapid, intermittent, non-rhythmic, stereotyped, repetitive contraction of a group of muscles. Tic disorders temporarily or permanently affect family life, social status, school and work success. Tics are divided into motor and vocal tics. Simple motor tics are rapid, short-term movements such as blinking, facial movements, or shrugging. Complex motor tics are more persistent, well-managed or quasi-administrative movements; For example, gestures such as touching, hitting oneself, jumping, or swearing out of nowhere. Simple vocal tics may consist of sounds such as clearing the throat, coughing, sniffing or blowing the nose. Complex motor tics repeating some short phrases, repeating one’s own words (palillali), repeating the words of others (echolalia); cursing or cursing out of nowhere (coprolalia) and paroxysmal changes in loudness. It usually occurs in short-term, seizures and intermittent periods. Tics can occur alone or in combination with other tics. While they increase with tension, they decrease when attention is focused on another subject or when the person feels relaxed, and they often disappear during sleep. It is mostly experienced as an irresistible behavior and can be suppressed for varying periods of time. It is said that tics have been seen for a long time in history.
Tic Disorder was first introduced to the literature by the French neurologist Jean Marc Itard in 1825, and in 1885 Gilles de la Tourette gave his name to the syndrome, which he defined as the triad of tics, coprolalia and echolalia. Motor or vocal tic disorders are a disorder that can be seen all over the world, regardless of cultural and ethnic characteristics and socioeconomic status. Transient tics are common in children. It has been reported that tics can be seen in 4-24% of school-age children. Transient tics are seen in 1-13% in boys and 1-11% in girls among children. The most common age group is 7-1l. It is 2 times more common in boys. At the age of 10-11, the frequency was determined as 5.9% in boys and 2.9% in girls. In a study conducted with nearly 5 thousand children in Sweden, chronic tic tic was found to be 7 per thousand and transient tic was 4.5% between the ages of 7-15. Although the etiology of Tic Disorder has not been fully elucidated; It is thought that genetic, environmental factors, neurobiological and neurotransmitters interact with each other and cause the disorder. Genetic transmission is particularly high in Tourette’s syndrome. It is thought to arise from the incompatibility of complex brain structures that provide coordination between “intention” and “action” in the brain in neurobiological processes.
Tics increase in stressful situations. It has been argued that emotional problems and negative interpersonal relationships in school-age children with Tic Disorder negatively affect the course of the disease. Especially when the tics are misunderstood by the family and the teacher, the child is warned or punished to stop the tics, which initiates a vicious circle in which the severity of tics increases. On the other hand, factors such as being ridiculed by peers not only increase the severity of the tic, but also negatively affect the child’s psychosocial functionality. The most common tics are blinking, grimacing, jaw, neck, shoulder or extremity movements, sniffing, wheezing, snorting, or throat clearing. In the natural course of TS, motor tics usually begin at the age of 3-8 years, vocal tics appear a few years later. Tics typically follow an increasing and decreasing course in severity, intensity, and frequency. Vocal tics usually appear between the ages of 8 and 15, a few years after the onset of movement tics. The complexity of tics also increases with age. These complex sounds and movements are of individual character. The first temporary movement tics experienced by children in the school age period are sudden, involuntary and unconscious movements. Children often become aware of these movements with the reactions of those around them. Around the age of 10–11, most children talk about “premonitory urges,” described as tension or itching, accompanied by distress or anxiety but relieved by the tic.
As awareness of pre-tic feelings increases, patients begin to gain voluntary control over tics. However, this voluntary control is short-lived and causes distress. When the tics are completely or almost completely controlled, the distress created by the “pre-tic feelings” makes the person mentally and physically tired, and this situation may be more disturbing than the tics themselves. Throughout the course of the disease, the severity of tics fluctuates clinically. Tic episodes tend to be in clusters. Tics can be exacerbated by stress, fatigue, temperature changes, and external stimuli. Voluntary movements, focusing on other activities, reduce tics. Diagnosis For diagnosis, a comprehensive history should be taken, including the patient’s pregnancy and birth history, early development, medical history, and family history. It is necessary to be careful about whether there are any comorbid conditions.
ADHD and OCD symptoms should also be reviewed in detail, since they are commonly seen together in patients with tic disorders. In addition to the presence and absence of symptoms, the impact of these problems on the patient and family should also be evaluated. In addition, the functional status, which is indicated by the quality of academic and professional success, social cohesion and interpersonal relations, should also be reviewed. In the treatment, a plan should be made that includes the psychological and social status as well as drug therapy. Although these cases respond to drug treatment, regression of symptoms in adulthood is more difficult if these cases are not treated in childhood. The severity of tic symptoms usually peaks between the ages of 8 and 12. The decrease in the severity of the symptoms usually ends in the early 20s.
