Tics

Question 1

Joe age 13.5 year-old 7th grader is seen for disruptive behavior at school
Unable to sit still, has throat clearing and some facial
grimacing noted over past 10 months. Gets teased about
the grimacing. Parents are concerned about problems
focusing on school work for about a year as his grades
have dropped from As & Bs to Bs & Cs and he has been
more irritable at home and school. • What is your diagnosis?

Answer 1

Provisional Tic Disorder
– Single or multiple motor or vocal tics present some
time during the illness
– Tics present for <1year since tic onset
– Onset before age 18 years – Not due to physiologic effects of a substance (e.g.,
cocaine) or medical condition (e.g., Huntington’s or
post viral encephalitis – Tourette’s disorder criteria never met

Question 2

Simple motor tics

Answer 2

Simple Motor Tics:
– Sudden, brief, stereotypic, repetitive movements
– (eye blinks, grimacing, jaw snaps, lip pouts, tensing
or rapid jerking of a body part such as the arm, head or neck ).
– Can be embarrassing or painful

Question 3

Complex Motor Tics:

Echopraxia

Copraxia

Answer 3

Complex Motor Tics:
– Often slower than simple tics, or an orchestrated
series of what appear as more purposeful, longer movements. These include

also
Echopraxia (imitating movements or gestures of other
people)
• Hopping, clapping touching objects, others, or self, gyrating and bending, thrusting arms, facial gestures, kissing, pinching, tearing paper while writing
– Copraxia (obscene, aggressive or otherwise
inappropriate gestures, e.g., Giving the finger)
– Self-injurious—violent head jerks, tongue biting,
punching one’s self, or eye poking.

Question 4

Echolalia & Palilalia

Answer 4

Echolalia
• Repeating others’ words

Palilalia
• Repeating one’s own words

Question 5

Coprolalia

Answer 5

Coprolalia, often explosive
• Obscene, aggressive or otherwise socially unacceptable words or phrases
– Includes racial slurs
• The most socially impairing complex symptom
• Not spoken in anger or meant to offend
• Usually the first syllable of an inappropriate word
or words that interrupt an otherwise appropriate
flow of words

Question 6

Tourette’s Disorder Criteria

Answer 6

-Multiple motor and 1 or more vocal tics present
some time during the illness
• Wax and wane; not necessarily concurrent.
• Occur several times/day over > 1 year since tic onset.
• Onset before age 18 years
• Not due to physiologic effects of a substance
(e.g., cocaine) or medical condition (e.g.,
Huntington’s or post viral encephalitis

Question 7

Persistent Motor

Persistent Vocal

Tic disorders

Answer 7

Single or multiple motor or vocal tics present some time during the illness, but NEVER BOTH

• Wax and wane;
• Occur several times/day over > 1 year since tic onset.
• Onset before age 18 years
• Not due to physiologic effects of a substance
(e.g., cocaine) or medical condition (e.g.,
Huntington’s or post viral encephalitis) • Tourette’s disorder criteria never met

Question 8

Genetics of Tic Disorders

Answer 8

Tic Disorders

• Autosomal dominant
• Relatives of those with TD at markedly increased risk for tic disorders (possibly from
10-100 x for first degree relatives compared to
general population).
• Monozygotic twins have concordance of 77-94% for chronic tic disorders (CTD).
• Dizygotic twins 23% concordance for CTD .