Tics and Tourette Syndrome (TS)

General Description of Tics

Tics consist of patterned involuntary (or semivoluntary) movements and vocalizations and can present as either motor or phonic (vocal) tics.

Motor tics. Motor tics typically develop as sudden, rapid, recurrent, involuntary movements involving the head and facial area, e.g., repeated eye blinking, facial twitching, neck stretching, head jerking, or shoulder shrugging. Less commonly, motor tics are more "coordinated," with distinct movements involving several muscle groups, such as repetitive squatting, skipping, or hopping. These complex motor tics may also include repetitive touching of others, deep knee bending, jumping, smelling of objects, hand gesturing, head shaking, leg kicking, or turning in a circle. The anatomic locations of motor tics may change over time.1-3 Rarely, motor tics, usually in combination with obsessive compulsive disorder (OCD), evolve to include behaviors that may result in self-injury, such as excessive scratching and lip biting.

Phonic (vocal) tics. Phonic tics are sudden, involuntary, recurrent, often loud vocalizations. They usually begin as single simple sounds that may progress to involve more complex phrases and vocalizations. For example, patients may initially have sounds and noises such as grunting, throat clearing, sighing, barking, hissing, sniffing, tongue clicking, or snorting. Complex vocal tics, in contrast, involve repeating certain phrases or words out of context, one's own words or sounds (palilalia), or words and phrases spoken by others (echolalia). Rarely, there may be involuntary, explosive utterances of obscene words or phrases (coprolalia).1-3

Tics vary in type and location. They can appear in the face at one point and, later, the shoulder, neck, or extremity. Although tics may occur in bursts, their inter-tic intervals are variable and range from seconds, to minutes, to hours or longer. Tics are exacerbated during times of stress, anxiety, fatigue, excitement, or after the school day. Conversely, tics may improve during periods of intense concentration or while performing activities that require fine motor skills. During sleep, tics usually diminish in intensity but often do not completely abate.1-4 Tics typically reach their peak intensity between the ages of 8 to 14 years. Most patients (65%-80%) have a reduction or resolution of symptoms by early adulthood.1-4

Tics may be preceded by premonitory urges, a sense or feeling (tightening, tingling, or tension) that occurs prior to the actual tic. These urges are noted more in adults than in children. Tics can be briefly suppressed voluntarily but, during this time, often result in a build-up of "inner tension" that resolves when the tic is performed.

Please see the following topics related to tics and Tourette syndrome below, and available on the left side of this page.

• Epidemiology and Age of Onset of Tics
• Diagnosis
• Description of Tourette Syndrome (TS)
• Epidemiology and Age at Onset of TS
• Etiology
• Pathophysiology
• Treatment of Tics and TS
• Summary
• References
• Additional Resources

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Tics/Tourette Syndrome Slide Set	Tics/Tourette Syndrome Patient Fact Sheets	Anatomical Illustrations