Tics are involuntary, recurrent motor movements or vocalizations. They are the defining feature of Tourette syndrome and other chronic tic disorders. Tics often first appear in childhood and can persist into adulthood. While there is no cure for Tourette syndrome or chronic tic disorders, there are treatments available to help manage tics. If you or your child has tics, it is important to get an accurate diagnosis and appropriate treatment. This article will provide an overview of how healthcare providers test for and diagnose tics and tic disorders.
Observing tics
The first step in testing for tics is a clinical examination by a neurologist, psychiatrist, or other healthcare provider with expertise in movement disorders. The provider will take a full medical history, asking about the onset of tics, frequency, severity, triggering factors, and ability to suppress tics voluntarily. They will also ask about medication use, family history of tics, and other medical conditions. During the clinical exam, the provider will observe the patient for any motor or vocal tics. Common motor tics include eye blinking, shoulder shrugging, head jerking, mouth movements, and leg jerking. Common vocal/phonic tics include throat clearing, sniffing, grunting, and repetition of words or phrases. The examiner will note the type of tics present and whether they occur in bouts (clusters).
Questionnaires
Standardized questionnaires may also be used to screen for tics and determine their severity. Some common questionnaires include:
– Yale Global Tic Severity Scale (YGTSS): Assesses motor and vocal tic severity based on number, frequency, intensity, complexity, and interference over the previous week. Also includes an overall impairment score.
– Premonitory Urge for Tics Scale (PUTS): Assesses the patient’s experience of premonitory urges, which are uncomfortable sensations that precede tics.
– Adult Tic Questionnaire (ATQ): Contains questions about specific motor and vocal tics. Helps determine whether tics are present.
– Parent Tic Questionnaire (PTQ): Screens for tics in children based on parent report.
Diagnostic criteria
To diagnose Tourette syndrome or a chronic tic disorder, the provider will determine if the tics meet the following diagnostic criteria:
– Tics started before age 18 years.
– Tics occur many times most days or intermittently for more than one year.
– Tics occur in bouts and are preceded by urges.
– Tics are not caused by medications or substance use.
– Tics cause distress or impairment.
The specific tic disorder diagnosed depends on the types of tics present and age of onset:
| Diagnosis | Description |
|---|---|
| Tourette Syndrome | Multiple motor and vocal/phonic tics, starting before age 18 |
| Chronic motor tic disorder | Single or multiple motor tics only, starting before age 18 |
| Chronic vocal tic disorder | Single or multiple vocal tics only, starting before age 18 |
| Provisional tic disorder | Motor and/or vocal tics, starting before age 18 and occurring for less than one year |
| Other specified tic disorder | Tics do not meet criteria for a specific tic disorder |
Additional testing
Other tests may be ordered to rule out secondary causes of tics or other movement disorders:
Blood tests: May include tests to check thyroid function, lead levels, antistreptolysin O titer, and inflammatory markers. Abnormal results may indicate secondary causes of tics.
Neuroimaging: An MRI or CT scan of the brain may be done to look for abnormalities or rule out other neurological conditions. Neuroimaging is not required to diagnose TS or chronic tic disorders in most cases.
EEG: An electroencephalogram can help distinguish tics from seizure activity. It is not routinely performed unless a seizure disorder is suspected.
Psychological testing: May include IQ testing, personality inventories, tests of executive function, etc. This helps identify co-occurring conditions like ADHD, OCD, learning disabilities, anxiety, and depression.
Referral to a specialist
If initial testing indicates tics or a high suspicion for a tic disorder, referral to a neurologist or child neurologist is recommended. They can confirm the diagnosis, order additional testing, and recommend appropriate treatment options. A mental health evaluation is also advised to assess for co-occurring psychiatric disorders that may benefit from therapy or medication. Multidisciplinary care involving psychologists, counselors, social workers, and educational specialists provides comprehensive treatment for Tourette syndrome.
Home monitoring
Keeping a daily log of tics can help track frequency and severity over time. This may be especially helpful around the time of diagnosis or when starting a new medication. Parents should record details about their child’s tics, including:
– Type and location of motor and vocal tics
– Frequency throughout the day
– Duration of tic bouts
– Situations or activities triggering increased tics
– Ability to suppress tics voluntarily
– Premonitory urges and sensations before tics
– Interference with school, social activities, sleep, etc.
Adults and older children can keep their own daily tic diary. Reviewing the diary with providers helps guide treatment decisions.
Conclusion
Testing for tics involves a careful clinical examination by an experienced provider along with supporting information from questionnaires, medical history, and diagnostic testing. Referral to a neurologist or movement disorder specialist is recommended to confirm the diagnosis and initiate appropriate treatment. Keeping a daily log of tics at home provides valuable data to inform ongoing management of tic disorders. While there is no cure for chronic tic disorders like Tourette syndrome, an accurate diagnosis and tailored treatment plan can help manage symptoms and improve quality of life.