Tics; sudden, involuntary, repetitive movements, expressions, or gestures. They can be defined in four groups:
-Simple motor tics (blink, grimace, neck turning, mouth stretching, etc.),
-Simple vocal tics (throat clearing, sniffling, wheezing sound) etc)
–Complex motor tics (touching, sniffing, tidying up, etc.)
–Complex vocal tics (repeating certain phrases/words frequently, repeating the last sounds/phrases heard) etc)
Its frequency and severity may show a different course even in the same person. The frequency and severity of the same tic may decrease or increase over time, one can sometimes be replaced by another, and more than one can be seen in a row, such as blinking first, then sniffing and turning the neck.
It appears in different forms in clinical practice. Transient Tic Disorder consists of one or more simple motor and/or motor tics, lasting more than a month and less than a year, regardless of frequency and severity. Chronic Motor or Vocal Tic Disorder is the presence of one or more motor and/or vocal tics for more than one year, but the motor and vocal tics are not present at the same time, and there is no three-month tic-free period. In the type called Tourette’s Disorder, one or more motor and vocal tics are seen at the same time and for more than one year, and there is no three-month tic-free period.
The cause has not been fully revealed, but many theories have been put forward. It can be expected to be seen more frequently in relatives with a history of tic, autosomal dominant genetic predisposition is a factor that increases the incidence of the disease. In some neuroimaging studies, structural differences in brain regions such as the basal ganglia, etc., between the disease and recovery periods of these patients have led to the establishment of a relationship between tics and anatomical changes in the relevant regions. In addition to these findings, positive response to some drugs in treatment; It supports the role of changes in the biochemistry of neurotransmitters such as dopamine, serotonin, which have a role in the brain-behavior relationship, in the development of tic. Hormonal changes that occur with age, perinatal (close to birth) problems, psychological (source of stress) factors are other theories put forward.
It is 1.5-3 times more common in men. Some studies with children have shown that 1-13% of boys and 11% of girls experience tic or tic-like behaviors at some point in their lives. The age of onset is most common between the ages of 7-11.
Short-lived, rarely exceeding a second. It is done involuntarily, but it can be suppressed or delayed, albeit for a short time. It most commonly starts from the face and neck region, and the most common is in the form of blinking. It usually looks like normal behavior, but sometimes it can look weird or ugly, and it can take on an appearance that is harmful to the child or the environment. It can become more frequent under stress. In some cases, it can even prevent other activities and impair the quality of life. It reduces the child’s self-confidence and impairs his assertiveness in the family and social environments. Anxiety accompanying tics and depression as a result of the clinical picture appear as important life difficulties. Its association with other behavioral problems is also common. Tics are common in Attention Deficit Hyperactivity Disorder and Obsessive Compulsive Disorder. A detailed neurological examination should also be performed in a patient presenting with tics; Because there are neurological diseases in which tics and tic-like behaviors can be seen, as well as movement disorders such as choreiform and athetoid movements that can be confused with tics, myoclonus, hemiballismus can also indicate important neurological diseases.
Before starting the treatment of tics, a detailed history is taken and a complete diagnosis is made, the frequency and severity of tics are evaluated, and other accompanying psychiatric problems are distinguished. Since it is known that tics increase during stress periods, the first thing to do in treatment is to reveal what these stress factors are, to try to eliminate them or to increase the child’s ability to cope with anxiety (stress management). In the treatment of simple tics, even this may be sufficient. In the presence of complex tics and at the point where the child’s quality of life deteriorates, drug treatments, behavioral treatments, and family education aiming at positive attitudes towards the child are other common treatment methods. In addition, surgical operations focused on some brain regions are gaining importance as alternative treatment methods that have been emphasized in recent years.
