Tics are sudden, repetitive muscle movements or vocalizations that are difficult to control. They are quite common, affecting up to 20% of children and 5% of adults at some point. The good news is that there are treatments available that can help reduce or even eliminate tics for good.
What are the causes of tics?
The exact cause of tics is unknown, but they are thought to be related to dysfunction in the basal ganglia region of the brain. This area helps control coordinated muscle movements. Factors that can increase tic severity include:
- Stress or anxiety
- Fatigue
- Illness
- Certain medications
- Caffeine or other stimulants
In many cases, tics are associated with other conditions like:
- Tourette syndrome – This is a disorder characterized by multiple motor and vocal tics lasting for over a year.
- OCD – Obsessive compulsive disorder often co-occurs with tics.
- ADHD – Attention deficit hyperactivity disorder is also commonly linked to tics.
When do tics first appear?
Tics often first emerge in childhood between the ages of 5-7 years old. The average age of tic onset is 6 years old. Tics tend to worsen during adolescence, hitting peak severity around age 12. Many children will find their tics naturally improve into adulthood.
Tics can also appear suddenly in adulthood, although this is less common. Adult-onset tics may be caused by:
- Head injury
- Stroke
- Infection
- Stress
- Medication side effects
What are the different types of tics?
There are two main categories of tics:
Motor Tics
These involve involuntary body movements such as:
- Eye blinking
- Facial grimacing
- Shoulder shrugging
- Head jerking
- Leg kicking
Motor tics can be simple or complex. Simple tics are brief, sudden movements. Complex tics are longer and involve a cluster of movements.
Vocal Tics
These cause involuntary sounds such as:
- Throat clearing
- Sniffing
- Grunting
- Barking
- Saying words out of context
Some people may repeat certain words or phrases uncontrollably, a vocal tic known as coprolalia. However, this only affects about 10-15% of people with tics.
What treatment options help reduce tics?
While there is no cure for tics, many treatment options can help manage symptoms. The main options include:
Behavioral Therapy
Cognitive behavioral therapy (CBT) from a therapist trained in tic disorders can help reduce tics. This may include:
- Habit reversal training – The person practices a competing response that prevents the tic from happening.
- Exposure with response prevention – The urge to tic is intentionally triggered in a controlled setting, but the person resists carrying out the tic.
Medications
Prescription medications that may be used include:
- Alpha-adrenergic agonists like clonidine or guanfacine
- Antipsychotics such as risperidone or aripiprazole
- GABA receptor agonists like baclofen or benzodiazepines
- Botulinum toxin injections for localized tics
Lifestyle Changes
Making certain lifestyle adjustments can help minimize tics, such as:
- Getting enough sleep
- Reducing stress through yoga, meditation, etc.
- Avoiding triggers like caffeine
- Doing regular aerobic exercise
Deep Brain Stimulation
For severe, treatment-resistant tics, deep brain stimulation may be an option. This involves surgically implanting electrodes in the brain which deliver mild electrical pulses to regulate abnormal nerve signals.
Can tics be cured permanently?
For many people, tics naturally improve over time without any treatment. By adulthood, over half of individuals with childhood tics will find they disappear completely or occur less frequently/severely.
With consistent tics treatment using behavioral therapy and/or medication, it is possible for tics to go into permanent remission. However, it often takes time and diligence to find the right treatment approach for each individual.
Here are some general guidelines for gaining lasting tic relief:
- Stick with the treatment plan – It can take up to 10-12 weeks to see improvement.
- Find an experienced therapist – Look for one who specializes in treating tic disorders.
- Consider medication – Work closely with your doctor to find the most effective medication with minimal side effects.
- Make lifestyle changes – Reduce stress, get enough sleep, limit caffeine, etc.
- Practice habit reversal techniques daily – This can retrain the brain.
While tics may come and go over time, with consistent effort it is possible to achieve a complete cessation of symptoms. Some key signs that tics are in permanent remission include:
- No tics for an extended period (often 6-12 consecutive months)
- No urge to tic
- Tics do not worsen with common triggers like stress
- No tic symptoms even when focusing on the issue or discussing it
For children, reaching adulthood with no tic recurrence for over a year is a strong indicator of permanent remission.
What happens if you leave tics untreated?
Trying to ignore or delay treatment for chronic vocal or motor tics is not recommended. Here are some potential consequences of leaving tic disorders untreated:
- Tics may worsen over time
- New, more severe tics could develop
- Tics can negatively impact daily life and activities
- Social isolation or bullying could occur due to tics
- Anxiety, depression, and low self-esteem may result
- Higher chance tics will persist long-term without treatment
Treating tics as early as possible with behavioral interventions gives the best chance of long-term remission before adulthood. Working closely with a therapist and doctor can help identify the optimum treatment approach.
When to see a doctor for tics
It’s advisable to see a doctor if you notice tic symptoms persisting for more than a year. Red flags to get evaluated immediately include:
- Sudden onset of tics in adulthood
- Rapid worsening or change in tics
- Vocal tics like coprolalia (unwanted utterances)
- Tics significantly impacting daily activities or causing injury
- Tics accompanied by other neurological symptoms
A neurologist or psychiatrist familiar with tic disorders can properly diagnose, evaluate severity, and start treatment. Tics combined with issues like obsessive compulsive disorder or rage outbursts may warrant seeing a specialist.
Coping tips for living with tics
Even if tics cannot be fully cured, there are many ways to manage symptoms and improve quality of life. Useful coping strategies include:
- Find support through tic disorder advocacy and awareness groups.
- Educate friends and family about your condition.
- Avoid tic triggers like stress, fatigue, heat, caffeine.
- Ask people to ignore minor tics or vocalizations.
- Consider workplace accommodations if needed.
- Use relaxation techniques, biofeedback, massage.
- Stay confident and positive, focus on your abilities.
With the right treatment plan and support system, many people with chronic tic disorders can thrive socially, academically, and professionally.
Conclusion
Gaining permanent relief from chronic tics is possible, especially with early and consistent treatment. The most effective approach involves behavior therapy, medication, lifestyle changes, and practicing habit reversal techniques. While tics may fluctuate over time, working closely with experienced providers gives the best chance of eventual remission. Being patient through the ups and downs is important. With the right coping strategies, people can still live their best lives despite having a tic disorder.
