Basically, one can distinguish between 2 different tic forms:
- Motor simple tic
- Vocal tic
whereby the vocal tic is only a special type of motor tic of the voice, speech and respiratory organs. These 2 tics are in turn differentiated into "simple" or "complex" tics.
Motor tic
Simple motor tics are involuntary, abrupt onset, non-purposeful movements. Their type, intensity and frequency can vary over time. The movements often occur repeatedly in the same way, but are not rhythmic; they can occur singly or in series. They are most often localized in the area of the head (winking, blinking, grimacing, shaking the head, nodding...).
In more severe cases, complex (combined) motor tics can occur in which several muscle groups are involved or in which entire movements are performed, such as hopping, jumping, stomping and circling, but also biting, hitting or scratching.
Vocal tic
Simple vocal (phonetic) tics are represented by the involuntary utterance of sounds and noises, such as clearing the throat, sniffling, coughing, barking, pronounced breathing sounds, etc.
Special manifestations of complex vocal tics are coprolalia (= pathological tendency to pronounce indecent, obscene words), echolalia (= constant repetition of sentences and words of interlocutors) and palilalia (= pathological compulsion to speak own sentences and words repeatedly). The rate of speech increases while the volume decreases. In addition, there is shouting, humming or whistling.
Symptoms
The severity of the symptoms fluctuates for no apparent reason over days, weeks, months, years. In addition, it can vary depending on the situation. Tics can occur several times a day in series as well as in some cases even disappear for weeks and months, only to reappear quite unexpectedly. With regard to the number, frequency, type and localisation of the tics, periodic changes are described. This also applies to a constant increase and decrease in severity.
Stressful or exciting situations may increase the frequency and severity of tics. In phases of relaxation - e.g. at home, in the evening - tics can occur more frequently in some children and adolescents.
For the majority of patients, it is possible to suppress the tics voluntarily, at least temporarily.
Children with tic disorders often show behavioral problems related to increased impulsivity, hyperactivity and distractibility. A low frustration tolerance as well as compulsions, anxieties and depressive episodes also occur frequently in tic disorders and require separate clarification. Learning problems are also more common in chronic tic disorders.
Therapy of the simple tic
Drug therapy
Drug treatment can rarely suppress the tics completely. A realistic therapy goal is a tic reduction of about 50%. Since tics often regress spontaneously, one should only think about it if the tic persists in the same form and in the same place for more than 6 months and impairs the child in its psycho-social development. Often these children are stigmatized, teased or bullied or simply shunned.
Within the atypical antipsychotics, risperidone is used to treat tic disorders. Because undesirable side effects (fatigue, weight gain) are not uncommon, the benzamides tiapride and sulpiride are often used.
Non-drug therapies
Non-drug measures should be seen primarily as a supplement to coping with the illness, although behavioural therapy - especially in adolescents/adults - can significantly reduce tics in individual cases.
Psychotherapy
Behavioural therapy using "Habit Reversal Training" (HRT) or "Exposure and Response Prevention Training" (ERPT) has proved particularly effective among the psychotherapeutic methods. This can lead to a tic reduction of 30 percent. However, these measures must take into account the age of the children with the disease. This is because most younger children (i.e. under the age of 10) are not yet able to recognise the sensations preceding the respective tic and to react with a "tic counter-response".
The HRT procedure serves to improve the perception of sensations preceding the respective tic and to develop a motor counter-response to the first possible tic signs (muscle tension, tingling), i.e. to perform a movement directed against the tic that is inconspicuous in everyday life. The ERPT method aims to break the automatism that a tic must always follow a pre-existing sensation.
Relaxation techniques
Pure relaxation techniques such as autogenic training or progressive muscle relaxation according to Jacobsen only very rarely lead to a real improvement in tic disorders. However, they are useful when children or adolescents are unable to calm down over a longer period of time due to the severity of the tics.
A particularly severe form: Tourette's Syndrome...
Tourette's syndrome is a form of tic disorder in which there are or have been different motor tics and one or more vocal tics, although these do not always have to have occurred simultaneously. This also includes tic disorders that occur several times a day, without regression for a period of at least 12 months and before the age of 18 have developed.
Typical are the simple and complex vocalizations with explosive repetitive sounds, such as throat clearing, grunting and the use of obscene words or phrases.
In the majority of those affected, Tourette's syndrome is accompanied by other disorders (comorbidity), such as. ADHD, obsessive-compulsive disorders, affective disorders, or anxiety disorders. Only about 10 to 20 percent of children with Tourette syndrome do not have any other disorder.
Children with Tourette's syndrome are prone to aggressive behavior with sudden outbursts of rage, and older adolescents are more likely than average to exhibit self-injurious behavior.
Those affected usually suffer greatly from the symptoms, which cannot be controlled or can only be controlled to a certain extent. Often the children and adolescents are shunned and ostracized by others because of the unusual symptoms. Adults perceive - mostly due to a lack of knowledge of the disorder - the young patient as a troublemaker and label him as badly behaved. They sometimes develop low self-esteem and are prone to depression and anxiety symptoms.
Genetics
Decisive genetic deviations have not yet been found. It is assumed that a large number of deviations are involved and therefore no statements can be made so far (as of December 2015) about heritability in specific individual cases.
Course
Many of those affected by Tourette's syndrome in childhood experience an abatement of the symptoms in the course of or after puberty, others also show the full picture of Tourette's syndrome as adults.
Therapy
Therapy options exist through
- Behavioral Therapy
- Drugs
School
Children with complex tic disorders may have to be granted disadvantage compensation at school in accordance with the Severely Disabled Persons Act. In justified individual cases, integration assistance can also be applied for according to the Child and Youth Welfare Act VIII SGB be§35.