Tics and Tourette Syndrome: What is it?

Tics usually first appear in elementary school—they come and go—and things usually get better after puberty . Only about 10% of childhood tic disorders persist visibly into adulthood. Boys and men are slightly more often affected.

Tics are not just whims or nervous movements; these are organically conditioned movement disorders. However, because of their symptoms, they are classified as psychiatric illnesses. A distinction is generally made between simple tics (such as coughing, clearing, blinking) and complex tics (such as shouting words, mimicking movements). Despite widespread belief, shouting obscene words and obscene gestures is very rare.

Severe tics cause considerable suffering to affected people, which is caused not only by the tics themselves, but also by inadequate feedback from the environment and often by other, concurrently occurring mental disorders . Tics can usually be successfully treated. However, not every tic disorder requires the sufferer to take medication .

Tics are often associated with stress

Tics are mostly perceived as uncontrollable, but with some effort they can be suppressed for a period of time. They can intensify after a stressful experience, while they appear less often and with less intensity during rest and sleep. Motor tics are basically normal movement patterns that appear repeatedly, or in series, and do not correspond to the given situation. Tics fluctuate throughout the day and year in both intensity and frequency: less frequent in the morning, stronger in the afternoon and evening.

For children, fluctuations are manifested within the school year, reaching three peaks:

• at the beginning of the school year,
• at the end of the 1st semester,
• at the end of the 2nd semester.

Tics occur in varying degrees of intensity, from light and barely noticeable to severe and marked, or limiting. Asymptomatic intervals may also occur. Common comorbidities and disorders are ADHD (60 to 90%), obsessive compulsive disorder , anxiety disorders , and depression . These disorders often have a greater impact on the sufferer than the tics themselves.

Tourette syndrome

If motor and vocal tics persist for at least one year, we are talking about Tourette syndrome. The mentioned chronic tics are named after the French neurologist Gilles de la Tourette, who in 1895 described nine patients with the mentioned symptoms. However, the first to describe them was actually Jean Marc Gaspard Itard, some 60 years earlier.

Tourette syndrome is characterized by simple or complex motor and vocal tics. Muscle twitches appear mainly in the head and upper limbs. Among other things, they lead to the following manifestations:

• blinking
• mouth opening
• rapid head turning,
• movements away from the body.

In addition, there is sniffing, coughing, throwing out individual vowels or inappropriate words, repeating words or whole sentences.

Other tic disorders

Chronic motor tic disorder and transient tic disorder are distinguished from Tourette’s syndrome – especially in childhood . Chronic motor tic disorder differs from Tourette syndrome only in the absence of vocal tics. In most cases, transient tic disorder can be characterized by (mild) motor and vocal symptoms, which last for a maximum of a year.

Causes of tics

The cause of tic disorders is thought to be problems in the control circuits suppressing movements, which mainly affect the brainstem . Imaging methods (e.g. MRI , PET , SPECT ) can demonstrate reduced volume of the caudate nucleus (part of the basal ganglia ) and adjacent structures. Furthermore, problems with central control mediated by dopamine and serotonin are assumed (see the article Neurotransmitters : messengers inside the brain ).

Tics also have a genetic cause; however, it is not clear which genes are affected. Spontaneous mutations can also occur . The risk of the disease, if there is a family burden, is around 10 to 20%. However, no genetic test can yet predict how likely an offspring is to inherit tics. Experts also discuss other stress factors, such as the influence of the immune system or infection .