By Deron V. Sharpe, MD, Pediatric Neurologist - Dothan Pediatric Clinic
Tourette Syndrome, also known as motor and vocal tics disorder, is common among children causing them to make sudden, brief, and purposeless movements. These tics often involve movements of the neck, blinking the eyes, grimacing, shrugging of shoulders, sniffing, snorting, or clearing the throat.
Vocal tics are frequently confused with allergy-related symptoms but will not commonly have other signs or symptoms to support an allergy diagnosis. Motor events can be like stereotypies (discussed in my last article), but with tics there is a tension, or irritation, that builds with attempts to suppress the movement. The child may say the movements are out of their control/involuntary but would be more appropriately termed as difficult to resist (think of a gnat or fly landing on your face; you choose to brush it away and it can be hard to resist doing so).
Tic onset can be explosive and typically occurs between 2 and 15 years of age. The tics are typically most bothersome between 8 to 12 years of age, and commonly improve with age, but not always. Half will report that their tics have resolved by age 18. Tics can be distracting, uncomfortable, and frustrating to the one affected. Social influences such as teasing and exclusion tend to be the major motivation to symptomatic treatment.
Testing should not be performed when symptoms are very consistent with Tourette Syndrome. Doctors should consider inflammatory states (PANDAS, Sydenham, vasculitis) and neurometabolic disorders (Wilson, Huntington) when evaluating tics, but these are accompanied by other symptoms and the diagnosis can typically be easily narrowed. Most children with tics do not require treatment. The diagnosis of Tourette Syndrome or Primary Tic Disorder is generally reassuring, as they are not a sign of progressive neurological or mental illness.
Families should expect that symptoms will often wax and wane on their own but may be exacerbated by medications (stimulants for ADHD and some medications used for mood or seizures), caffeine, and mood/stress. Some can benefit from the use of medications to suppress the sensations that bring on the movements, but these should not be used if the tics do not bother the child’s life.
Neuroleptics (a drug class commonly used to treat schizophrenia) are with the strongest influence with tic symptom reduction, but drugs with fewer side effects like Guanfacine are often tried first. Generally, tics are quick to grab the attention of parents but then relieving when they know the course is benign.