Tics Treatment in Mumbai, India

Tics are repetitive and involuntary muscular movements that can occur in any part of the body. These movements are uncontrollable and unknown to the individual, happening due to nervous system disorders. Symptoms for tic start showing early in life at the age of 2-5 years. Unwanted and continuous blinking of an eye is one of the most common examples of a tic disorder.

Associated Anatomy

Brain and nerves

Alternate Name

Tourette’s syndrome

Tics Symptoms

Symptoms of the disease vary across individuals and can change and get more complex with time. An uncontrolled, repetitive, and irregular movement including sound or muscular involvement is a common sign of tics. Other symptoms varying from simple to complex tics include:

• Blinking of eye
• Head jerk
• Shrugging of shoulders
• Tapping of foot
• Twitching and scratching
• Imitating other people’s movements
• Pinching oneself or others
• Sniffing
• Clearing the throat or coughing
• Grunting
• Clicking of tongue
• Whistling
• Squeaking
• Making obscene comments or gestures unknowingly
• Repeating phrases or sounds

Tics Causes

The exact cause of tic disease is still unknown, but from the studies to date, tics can occur because of:

• Genetic Factors: Although the exact mechanism is not known, genetic factors play a significant role in causing tics. Genes inherited over generations can express themselves abnormally, leading to changes in neurotransmitters like serotonin and dopamine, resulting in sudden and rapid movements.
• Environmental Factors: Infections, toxins, or certain drugs can alter the region in the brain responsible for controlling movements in the body.

Tics Stages

Tics can be simple or complex, depending on the severity of symptoms.

• Simple Tics - are mild and include simpler movements like blinking and jerking with vocals such as coughing or throat clearing.
• Complex Tics - are more severe and the motor movements are intensive. Vocals include echoing and repeating words or phrases. Complex motor tics include jumping, sniffing, twisting, or shrugging.

Tics Treatments

As the causes of tics are not well known, no specific treatment has been developed to cure the condition. However, if the symptoms are severe and interfere with the patient’s daily routine or quality of life, several treatment options are available to help manage and reduce the symptoms:

Medications

• ADHD Stimulants, Antidepressants, and Dopamine Blockers: These medications help alleviate symptoms but do not cure tics. Due to the potential side effects and varied responses among patients, their use may be limited.

• Neuroleptics (Antipsychotic Medications):
  Neuroleptics such as haloperidol, aripiprazole, and risperidone work by blocking dopamine receptors in the brain, which helps reduce the severity of tics. These medications are often prescribed when tics are significantly disruptive to daily life, but they may also come with side effects like weight gain or drowsiness.

• Alpha-2 Adrenergic Agonists:
  Medications such as clonidine and guanfacine are also effective in controlling tics, particularly in patients with co-occurring ADHD. These drugs are often considered when neuroleptics are not suitable or well-tolerated.

Therapy

• Behavioral Therapy and Psychotherapy:
  Individuals suffering from tics can benefit from habit reversal training (HRT) or behavioral intervention. This therapy teaches patients to recognize the urge to tic and consciously perform new, voluntary movements to interrupt the tics before they occur.

Botox Injections

• Botulinum Toxin Injections:
  Injections containing botulinum toxin (Botox) can be administered into specific muscles to temporarily restrict their movement, helping to reduce the severity of motor tics in localized areas.

Tics Prevention

Prevention of tics involves implementing proactive strategies to reduce the frequency and severity of involuntary movements and sounds.

Primary Prevention

• Prevention from tic is almost impossible as the cause is still unknown
• By avoiding stress, the severity of tics can be reduced as stress worsens the symptoms
• Tics can be caused if a person is suffering from Lyme disease (a bacterial infection), so prevention from infections can prevent tics

Secondary Prevention

Tics cannot be prevented, but can be managed easily by,

• Relaxation exercises like yoga
• Good sleep
• Focusing on other things than tics
• Maintaining a healthy lifestyle
• Accepting that the individual is suffering from tics

Typical Test of Tics

No laboratory tests or screening methods can identify tics. Diagnosing tics solely depends on the observations. Neurologists may run some scans like MRI or CT scans to rule out other possible disorders with similar symptoms. First symptoms are visible in the teenage years and are repeatedly occurring for a span of one year. The immediate caregiver plays the most important role in describing symptoms to help with an accurate diagnosis.

Tic Disorders Risk Factors

The factors that increase the risk of tic disorders are:

• Men are more inclined to tics when compared to women, they are three times more likely to have the disease
• Tics can be a cumulative effect of certain genes, so genetic bias is more likely to happen
• Studies reveal that tics are inherited as a dominant gene, so the chances of inheritance of genes are 50%, from parents to child
• Environmental factors like smoking during pregnancy, lower weight of child during birth and other complications during pregnancy might increase the risk
• Having a family history of tics, increase the chances of having the disorder
• Severe viral or bacterial infections, brain injury or trauma can also alter the brain functionality and lead to the sudden onset of tics

Tics Complications

Medicines used in the treatment of tics can result in common side effects like anger, anxiety, depression, difficulty in sleeping and concentrating and other learning complications. A person suffering from tics may also suffer from low self-esteem and is very conscious. Complications like behavioural changes, OCD (obsessive-compulsive disorder), ADHD (attention-deficit hyperactivity disorder) and social changes can be seen in individuals.

Epidemiology

• Tics disorder is more prevalent in boys than girls
• More number of tic disorder cases are seen in children of the white race when compared to the population worldwide
• 1 out of every 162 children suffers from tic syndrome
• Half of the children who are suffering from tics are left undiagnosed. The average age of dominance of tic syndrome is 6-12 years

Prognosis

Expected prognosis

Individuals suffering from tics can lead a normal life with an average life expectancy. With time, people manage to live with the symptoms and learn how to overcome them. Anxiety, OCD (obsessive-compulsive disorder), low self-esteem and self-harming behaviours are common known side effects of tics. Many clinical studies are ongoing to determine the exact cause and gain a better understanding of the genetic relation.

Natural Progression

Tics are not a progressive disorder. Though it is a life-long disease, it does not worsen with time. In fact, symptoms associated with tics gradually decrease from adolescent years to later stages in life. Tics have no known effect on the intelligence of an individual.

Pathophysiology

Recent advancements in studies show that tics occur when there are certain changes in the region of the brain responsible for controlling movements in the body. Also, modifications in neurotransmitters like dopamine can induce tics.

Related Blogs

• Anxiety Disorders
• Living with Depression
• Neurological Disorders: What is It, Types And Symptoms?
• Everything You Need to Know About Epilepsy