Teak : Causes, Symptoms, Diagnosis & Treatment

Last Updated: 22/09/2022

Tic is a type of hyperkinesis. Represents involuntary stereotyped movements that resemble arbitrary. In most cases, it occurs in childhood. It is provoked by neuroses, residual organic insufficiency due to harmful effects in the prenatal period and early childhood. Seen in Tourette's syndrome. Sometimes it occurs secondary to other CNS lesions. The cause is determined on the basis of a survey, examination, data from a psychodiagnostic examination, CT, MRI, and other procedures. Treatment - psychotherapy, psychocorrection, drug therapy, physiotherapy. Operations are sometimes shown.

general characteristics

Tics are non-rhythmic movements or sounds that occur unexpectedly and are stereotyped over and over again. In most cases, they are observed in childhood, weaken or disappear after the completion of puberty. There are the following variants of tic acts:

1. Motor:

  • Simple: squinting eyes, blinking, twitching head or shoulder, etc.
  • Difficult: bouncing, repeating movements after another person, indecent motor acts (for example, taking off your pants or demonstrating offensive gestures), etc.

2. Vocal.

  • Simple: grunting, snorting, coughing, whistling.
  • Difficult: repetition of own or other people's words and phrases, obscene curses.

Motor tics are also divided into clonic and tonic. In the first case, the movements are short-term, fast, sudden, in the second - slower, with a relatively prolonged muscle contraction. They can be local (involving the muscles of one area, such as the eye area), multiple (spreading over several areas, such as the face and shoulder), and generalized.

Taking into account the cause of the occurrence, tics are primary (neurosis-like, neuropathic, neurotic, in patients with Tourette's syndrome) and symptomatic (in other diseases). The circumstances of the development of seizures depend on the cause of the tics. With residual organic pathology, the symptom occurs due to overexcitation. In patients with early neuropathies, overwork plays a decisive role. In neurosis, the main factors are fear, anxiety and anxiety.

Why Tics Occur

neurosis-like tics

Primary tics, which are of residual organic origin, confirmed by the corresponding changes in the EEG. They develop under the influence of negative factors during pregnancy (bad habits and diseases of the mother, fetal hypoxia, preeclampsia, prematurity, complications in childbirth) or in the first years of life (neuroinfection, TBI, intoxication). They usually make their debut at 7-1 years old.

Characterized by a steady course, the presence of a clear "tic focus" with a tendency to spread tics. They do not decrease during periods of rest (on vacation), on the contrary, they often appear for the first time in a favorable psychological environment. Most often, they begin with blinking, in the absence of treatment they spread to other parts of the face (grimacing), shoulders, sometimes the upper body, less often legs.

Tourette syndrome

Pathology is genetically determined, more often transmitted through an autosomal dominant, less often through an autosomal recessive or polygenic pathway. As a rule, it manifests at 5-6 years of age by grimacing, winking, blinking, twitching the shoulder girdle, clapping the palms, and other movements in the face and upper half of the body. Motor tics are complemented by sound tics. Then hyperkinesis spreads to the lower part of the body and legs, and becomes more complicated. Echopraxia, copropraxia, accidental self-harm are possible.

neuropathic tics

Develop against the background of early childhood neuropathy. They first appear at the age of 3-8 years. Children are anxious, restless, prone to stereotypical movements, mobile, but with insufficiently developed coordination, which causes an increased likelihood of injury. Often suffer from vegetative disorders and meteorological dependence. Tics, as a rule, are local, sometimes spreading over several zones, appear or become more frequent with overwork, an excess of impressions.



Neurotic tics

They can develop at any age, starting from 3 months, provoked by mental trauma and emotional upheaval: sudden fear, expectation of bad things, unusual circumstances of communication, external conflicts and internal contradictions. Often they are part of the clinical picture of obsessive-compulsive disorder. Rarely develop with other neuroses in children.

Tics are realized, briefly give in to conscious control, followed by "return" in the form of increased tic movements. Arise or become more frequent in a state of passive attention, overwork, strong excitement. Characterized by instability, frequent change of one tick by another. Children with obsessive-compulsive disorder try to overcome the "bad habit". Attempts to delay on the part of the child or parents (remarks, prohibitions) worsen the psycho-emotional state, provoke aggressiveness, irritability, headaches.

Symptomatic tics

Secondary tics are observed in diseases and pathological conditions accompanied by damage to the extrapyramidal system. Distinctive features are constancy (a rare change in localization, strength and frequency), the impossibility of conscious suppression, a combination with other neurological disorders and pathopsychological disorders. The main provoking factors are:

  • encephalitis of various origins;
  • hereditary cerebral pathologies;
  • traumatic brain injury;
  • vascular damage (developmental anomalies, malformations, etc.);
  • taking medications: psychostimulants, antipsychotics, anticonvulsants.

In addition, secondary tics are sometimes found after streptococcal infections (eg, tonsillitis) and other infectious diseases. Occur or worsen during the recovery period or some time after the normalization of the condition.


With neuralgia, special tic movements are noted - painful tics, which are muscle twitches against the background of intense pain. Detected in the following diseases:

  • Trigeminal neuralgia. It is accompanied by repeated bouts of prosopalgia lasting several minutes, which is a “shooting”, similar to a “electric shock”, pain sensations that spread from the side surface to the center of the face.
  • Neuralgia of the ear. Paroxysms of throbbing or burning pain occur in front of the auditory canal and in the ear area, give to the jaw, neck, nape, shoulder. Last from a few minutes to an hour or more. Possible hypersalivation.
  • Pterygopalatine ganglionitis. Episodes often begin at night and last from several hours to several days. Accompanied by pain in the eyeball, temple, hard palate and neck. Pronounced vegetative disturbances are characteristic, a tendency to spread to neighboring anatomical zones.


Diagnostic measures are carried out by a neurologist. If a neurotic character of tics is suspected, patients are referred to psychotherapists and psychiatrists. With neuralgia, consultations with a dentist and an otolaryngologist are recommended to identify diseases that can provoke nerve compression. During the conversation, the time of occurrence and the dynamics of the development of ticks are established.

As part of a neurological examination, the localization, severity and prevalence of tic movements, the patient's ability to conscious control are assessed. Neurological abnormalities are identified that may indicate the cause of tics. The program of additional examination includes such procedures as:

  • Electroencephalography. Produced to detect paroxysmal activity, indicating the presence of residual organic disorders. A hyperventilation test is recommended, the results of which may reveal increased convulsive readiness.
  • Neuroimaging. CT and MRI of the brain are performed to differentiate Tourette's syndrome from other diseases accompanied by early paroxysmal hyperkinesis, determine the etiology of symptomatic tics, and determine the cause of nerve trunk compression in neuralgia.
  • Psychodiagnostic examination. Questionnaires, special tests and projective methods are recommended to assess the state of the cognitive and emotional spheres, distinguish between neurosis-like and neurotic tics, and identify provoking factors depending on age.
  • Other techniques. Tourette's syndrome is characterized by an increase in the amount of catecholamines and their metabolites in the urine, changes according to ENG and EMG. To establish the genesis of neuralgia, ultrasound of the salivary glands, otoscopy, audiometry, radiography of the paranasal sinuses may be required.




Conservative therapy

The treatment program for primary tics is compiled according to general principles with slight variations due to the etiology of the symptom:

  • Correction of the daily routine. It is important to minimize the circumstances that cause tics to occur. Recommended moderate intellectual and physical activity with the organization of breaks before the onset of severe fatigue. You need regular good nutrition, enough sleep, limiting time for computer games, using gadgets, watching TV.
  • Psychotherapy. Effective cognitive-behavioral therapy, art therapy. A good result is observed during animal therapy. If there are problems in education, an unfavorable situation in the family, family psychotherapy is indicated. As part of group therapy, patients are taught self-regulation and relaxation skills, new ways of behavior, and conflict resolution.
  • Psychocorrection. It is required when detecting a developmental delay, the presence of concomitant pathologies (ADHD, etc.). Includes exercises to improve memory, attention, spatial perception, improve the ability to self-control. Helps improve academic performance, reduce school stress.
  • Drug therapy. It is indicated with insufficient effectiveness of non-drug methods. With neurotic disorders, antidepressants and anxiolytics are prescribed. With severe tics that interfere with learning and reduce the quality of life, antipsychotics are recommended. Additionally, vitamins, nootropics, vascular agents are used.
  • Physiotherapy, biofeedback therapy. Physiotherapy exercises, classical and segmental massage, acupuncture, laser reflexotherapy, electrosleep, medicinal electrophoresis of the cervical-collar zone, galvanization, water procedures are useful. As part of biofeedback, the patient learns to control the state of the muscles, to voluntarily relax them when tics occur.

The selection of drugs for secondary tics is carried out taking into account the type of causative pathology. With neuralgia, anticonvulsants, antispasmodics, antihistamines are used. Perform therapeutic blockades. Physiotherapeutic procedures are prescribed to reduce pain and inflammation.


If the conservative therapy of the trigeminal nerve is not effective enough, microsurgical decompression is performed or the sensory nerve root is destroyed by gamma radiation using stereotaxic techniques. Perhaps the intersection of the branches of the nerve trunk by percutaneous radiofrequency destruction.

Patients with lesions of the ear node may be shown sanitizing operations on the middle ear, removal of stones or neoplasms of the salivary gland, other otolaryngological and dental interventions. Adult patients with Tourette's syndrome perform deep brain stimulation, however, the technique is still considered experimental, it is not used in children.