NHS 111 Wales - Health A-Z : Tics

Tics

Overview

Tics are fast, repetitive muscle movements that result in sudden and difficult to control body jolts or sounds.

They're fairly common in childhood and typically first appear at around five years of age. Very occasionally they can start in adulthood.

Tics are not usually serious and normally improve over time. But they can be frustrating and interfere with everyday activities.

Tourette's syndrome, a term that's used when tics have lasted for more than a year, is covered separately.

Types of tics

There are many types of tic. Some affect body movement (motor tics) and others result in a sound (vocal or phonic tics).

Examples of tics include:

blinking, wrinkling the nose or grimacing
jerking or banging the head
clicking the fingers
touching other people or things
coughing, grunting or sniffing
repeating a sound or phrase – in a small number of cases, this may be something obscene or offensive

Tics can happen randomly and they may be associated with something such as stress, anxiety, tiredness, excitement or happiness. They tend to get worse if they're talked about or focused on.

They often start with an unpleasant sensation that builds up in the body until relieved by the tic – known as an urge – although they can sometimes be partly suppressed.

When to see a GP

Tics are not usually serious and they do not damage the brain.

You do not always need to see a GP if they're mild and not causing problems. Sometimes they can disappear as quickly as they appear.

See a GP if you're concerned about your or your child's tics, you need support or advice, or the tics:

occur very regularly, or become more frequent or severe
cause emotional or social problems, such as embarrassment, bullying or social isolation
cause pain or discomfort (some tics can cause the person to accidentally hurt themselves)
interfere with daily activities, school or work
are accompanied by anger, depression or self-harm

A GP should be able to diagnose a tic from a description of it and, if possible, seeing it. Recording a short video can be helpful, but be careful not to draw too much attention to the tic while filming as this can make it worse.

Treatments for tics

Treatment is not always needed if a tic is mild and is not causing any other problems. Self-help tips, such as avoiding stress or tiredness, are often very helpful for the majority of people.

If a tic is more severe and is affecting everyday activities, therapies that aim to reduce how often tics occur may be recommended.

The main therapies for tics are:

Habit reversal therapy – this aims to help you or your child learn intentional movements that "compete" with tics, so the tic cannot happen at the same time.
Comprehensive behavioural intervention for tics (CBiT) - a set of behavioural techniques to help learn skills to reduce tics.
Exposure with response prevention (ERP) – this aims to help you or your child get used to the unpleasant sensations that are often felt just before a tic, which can stop the tic occurring.

There are also medicines that can help reduce tics. These may be used alongside psychological therapies or after trying these therapies unsuccessfully.

How long do tics last?

In most cases, tics will improve significantly over time or stop completely.

Sometimes they may just last a few months, but often they tend to come and go over several years.

They are normally most severe from around 8 years of age until the teenage years, and usually start to improve after puberty.

Causes of tics

It's not clear exactly what causes tics. They're thought to be due to changes in the parts of the brain that control movement.

They can run in families, and there's likely to be a genetic cause in many cases. They also often occur alongside other conditions, such as:

Tics can sometimes be triggered by taking illegal drugs, such as cocaine or amphetamines, and are occasionally caused by more serious health conditions such as cerebral palsy or Huntington's disease.

Treatment

Tics do not always need to be treated if they're mild, but treatments are available if they're severe or are interfering with everyday life.

Many tics will eventually go away or improve significantly after a few years. But, if untreated, more severe tics can cause issues such as difficulties at school or social problems.

Self-help tips

There are some simple things you can do that may help to improve your or your child's tics.

Avoid stress, anxiety and boredom – for example, try to find a relaxing and enjoyable activity to do (such as sport or a hobby). Read more advice about reducing stress, ways to reduce anxiety and helping an anxious child
Avoid becoming too tired – try to get a good night's sleep whenever possible.
Try to ignore your child's tic and not talk about it too much – drawing attention to it may make it worse.
Do not tell a child off when their tic occurs.
Reassure your child that everything's OK and there's no reason for them to feel embarrassed.
Let other people you're in regular contact with know about tics, so they're aware of them and know not to react when they occur.

If your child is finding school difficult, talk to their teacher about ways of dealing with this. For example, it may help if they're allowed to leave the classroom if their tics are particularly bad.

Similarly, if you have a tic that's making things difficult for you at work, speak to your employer to find out if any help and support is available.

The Tourettes Action website has more information about the support available.

Behavioural therapies

Behavioural therapy is often recommended as one of the first treatments for tics.

You may be referred to a specialist psychological treatment service if your doctor feels therapy might help.

One of the main types of therapy for tics is habit reversal therapy. This aims to:

teach you about your condition
make you more aware of when your tics occur and identify any urges you feel at the time
teach you a new response to do when you feel the urge to tic – for example, if your tic involves shrugging your shoulders, you may be taught to stretch your arms until the urge to tic passes

Comprehensive behavioural intervention for tics (CBiT) may also be used. This involves learning a set of behavioural techniques to help reduce tics.

A technique called exposure and response prevention (ERP) is also sometimes used. This aims to help you learn to suppress the feeling you need to tic until it subsides.

These techniques usually require several sessions with a therapist. They work best if you continue using them yourself after treatment finishes.

Medicine

There are several medicines that can help control tics. Some of the medicines used are outlined below.

Neuroleptics

Neuroleptics, also called antipsychotics, are the main medicines for tics. They work by altering the effects of the chemicals in the brain that help control body movements.

Examples include risperidone, pimozide and aripiprazole.

Side effects of neuroleptics can include:

weight gain
blurred vision
constipation
dry mouth

Some neuroleptics can have additional effects too, such as drowsiness, shaking and twitches.

Other medicines

There are also a range of other medicines that may be used to reduce tics and treat associated conditions.

These include:

clonidine – a medicine that can help reduce tics and treat symptoms of attention deficit hyperactivity disorder (ADHD) at the same time
tetrabenazine – a medicine that can reduce tics in people with an underlying condition that causes rapid, repetitive movements, such as Huntington's disease
botulinum toxin injections – these can be given into particular muscles to relax them and prevent tics, although the effect usually only lasts up to three months

These treatments each carry a risk of side effects. Speak to your doctor about this if you have any concerns.

Surgery

A type of surgery called deep brain stimulation has been used in a few cases of severe Tourette's syndrome.

It involves placing 1 or more electrodes (small metallic discs) in an area of your brain associated with tics.

The electrodes are placed using fine needles passed through small holes in your skull. This is done while you're asleep (under general anaesthetic).

Thin wires run from the electrodes to a pulse generator (a device similar to a pacemaker), which is placed under the skin of your chest. This gives out an electric current to help regulate the signals in your brain and control your tics.

There are still uncertainties about how effective and safe it is, so it is only considered in a small number of adults who have severe tics that haven't responded to other treatments.

The information on this page has been adapted by NHS Wales from original content supplied by

NHS website nhs.uk