Motor and Vocal Tics

Motor tics are involuntary movements caused by spasm-like contractions of muscles, most commonly involving the face, mouth, eyes, head, neck or shoulders. Vocal tics are sounds uttered unintentionally. Some combinations of motor and vocal tics are diagnosed as Tourette's syndrome; tics also can be caused by other conditions.

Tics are often sudden and repetitive. While tics may appear to be intentional, they are not. A person may be able to suppress a tic for a short time, but the tic movement or sound will recur as the urge becomes stronger.

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Symptoms

Motor tics can be simple or complex. Simple motor tics involve only one muscle group or body part. They usually are not harmful, but can be embarrassing or painful.

Some simple motor tics include:

  • Quick eye blinks or eye jerks
  • Tongue movements, including sticking out the tongue
  • Head twitches or head jerks
  • Squatting and hopping
  • Shoulder shrugs

Complex motor tics can be a combination of many simple motor tics or a series of movements that involve more than one muscle group. Complex motor tics are slower and often appear as if the person is performing a movement intentionally. These types of tics can interfere greatly with daily life and may be harmful, such as head banging or lip biting.

Some complex motor tics include:

  • Facial grimacing
  • Touching people or things
  • Obscene gesturing or gyrating movements

Like motor tics, vocal tics can be simple or complex. Simple vocal tics involve sounds made by moving air through the nose or mouth, including:

  • Grunting
  • Barking
  • Hissing
  • Sniffing
  • Snorting
  • Throat clearing

Complex vocal tics may involve words, phrases and sentences. Patients with a complex vocal tic may repeat their own words (palilalia) or other people’s words (echolalia), and may use obscene words (coprolalia). These vocal tics may interrupt the flow of a normal conversation or occur at the beginning of a sentence, much like a stutter or a stammer.


Causes and Risk Factors

Generally tics start in childhood and tend to improve during adulthood. If the tic begins in a person’s teens or early adulthood, it will likely be a lifelong condition. Tics may get worse when a patient experiences stress, sleep deprivation, excitement, heat or caffeine.

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Diagnosis

A good medical history and a physical examination is usually all that is needed to diagnose a motor or vocal tic disorder. The doctor will ask how long the tic has been occurring. If a patient has experienced a tic daily for a year, and has not had a tic-free period longer than three months, the diagnosis is a tic disorder. Often tics are complicated by symptoms of obsessive-compulsive disorder (OCD); patients with this condition may need to be seen by a psychiatrist.

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Treatments

In most cases, motor and vocal tics are not dangerous or disruptive to a person's everyday life and no treatment is necessary. For those with severe tics that interfere with quality of life, tics may be managed with medications that include neuroleptics and other sedatives. Specific psychiatric medications or psychotherapy may be needed in cases of OCD.

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