Chronic motor tic disorder

Answer 1

Definition

Chronic motor tic disorder involves quick, uncontrollable movements or vocal outbursts (but not both).

Alternative Names

Chronic vocal tic disorder; Tic - chronic motor tic disorder

Causes, incidence, and risk factors

About 1 to 2% of the population has chronic motor tic disorder. The condition is more common than Tourette syndrome. However, it is not as common as transient tic disorder.

Chronic tics may be forms of Tourette syndrome.

Symptoms

• Excessive blinking
• Grimaces of the face
• Quick movements of the arms, legs, or other areas
• Sounds (grunts, throat clearing, contractions of the abdomen or diaphragm)

People can hold off these symptoms for a short period of time, but they feel a sense of relief when they carry out these movements. Patients typically describe them as responding to an inner urge and may have abnormal sensations in the area of the tic prior to the tic occurring.

Tics may continue during all stages of sleep. They may get worse with:

• Excitement
• Fatigue
• Heat
• Stress

Signs and tests

The doctor can usually diagnose a tic during a physical examination. Tests are generally not needed.

To be diagnosed with the disorder:

• You must have had the tics nearly every day for more than a year
• You have not had a tic-free period longer than 3 months

Treatment

Treatment depends on how bad the tics are and how the condition affects you. Medicines and psychotherapy are used only when the tics have a major impact on daily activities, such as school and job performance.

Drugs used to treat tics include dopamine blockers, such as fluphenazine, haloperidol, pimozide and risperidone. These medicines can help control or reduce tics, but they have side effects such as movement disorders and cognitive dulling.

Botulinium toxin injections is used to treat certain form of dystonic tics.

In recent years, brain stimulation using permanently implanted electrodes in the brain has shown promising results.

Expectations (prognosis)

Children who develop this disorder between ages 6 and 8 usually do very well. Symptoms may last 4 to 6 years, and then stop without treatment in early adolescence.

When the disorder begins in older children and continues into the 20s, it may become a life-long condition

Complications

There are usually no complications.

Calling your health care provider

There is usually no need to see the health care provider for a tic unless it is severe or disrupts your life.

If you cannot tell whether your movements are a tic or something more serious (such as a seizure), call your health care provider.

References

Jankovic J. Movement disorders. In: Goetz, CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 34.

Lang A. Other movement disorders. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 434.

Answer 2

Definition

Chronic motor tic disorder involves quick, uncontrollable movements or vocal outbursts (but not both).

Alternative Names

Chronic vocal tic disorder; Tic - chronic motor tic disorder

Causes, incidence, and risk factors

About 1 to 2% of the population has chronic motor tic disorder. The condition is more common than Tourette syndrome. However, it is not as common as transient tic disorder.

Chronic tics may be forms of Tourette syndrome.

Symptoms

• Excessive blinking
• Grimaces of the face
• Quick movements of the arms, legs, or other areas
• Sounds (grunts, throat clearing, contractions of the abdomen or diaphragm)

People can hold off these symptoms for a short period of time, but they feel a sense of relief when they carry out these movements. Patients typically describe them as responding to an inner urge and may have abnormal sensations in the area of the tic prior to the tic occurring.

Tics may continue during all stages of sleep. They may get worse with:

• Excitement
• Fatigue
• Heat
• Stress

Signs and tests

The doctor can usually diagnose a tic during a physical examination. Tests are generally not needed.

To be diagnosed with the disorder:

• You must have had the tics nearly every day for more than a year
• You have not had a tic-free period longer than 3 months

Treatment

Treatment depends on how bad the tics are and how the condition affects you. Medicines and psychotherapy are used only when the tics have a major impact on daily activities, such as school and job performance.

Drugs used to treat tics include dopamine blockers, such as fluphenazine, haloperidol, pimozide and risperidone. These medicines can help control or reduce tics, but they have side effects such as movement disorders and cognitive dulling.

Botulinium toxin injections is used to treat certain form of dystonic tics.

In recent years, brain stimulation using permanently implanted electrodes in the brain has shown promising results.

Expectations (prognosis)

Children who develop this disorder between ages 6 and 8 usually do very well. Symptoms may last 4 to 6 years, and then stop without treatment in early adolescence.

When the disorder begins in older children and continues into the 20s, it may become a life-long condition

Complications

There are usually no complications.

Calling your health care provider

There is usually no need to see the health care provider for a tic unless it is severe or disrupts your life.

If you cannot tell whether your movements are a tic or something more serious (such as a seizure), call your health care provider.

References

Jankovic J. Movement disorders. In: Goetz, CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 34.

Lang A. Other movement disorders. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 434.

Reviewed By

Review Date: 03/21/2010

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Luc Jasmin, MD, PhD, Department of Neurosurgery at Cedars-Sinai Medical Center, Los Angeles, and Department of Anatomy at UCSF, San Francisco, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.