Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

Tics 1429

TICS

CHAD CHRISTINE, MD

history & physical

■Involuntary recurrent, jerk-like movements or vocalizations

■Uncomfortable sensation may precede & be relieved by movement

or vocalization

■Typically begin in childhood

■May occur transiently in children

■Worse w/ stress; diminish w/ activity

■Absent during sleep

■Sudden, recurrent, coordinated abnormal movements or vocaliza-

tions

■Simple tics: eye blinking, facial grimacing, head jerking

■Complex tics: more complicated movements that may appear pur-

poseful

■Simple vocal tic: throat clearing, grunting, sniffing

■Complex vocal tic: full or truncated words, may repeat words

tests

■Diagnosis made clinically

■Lab tests & brain imaging usually normal

differential diagnosis

■Degenerative diseases (Huntington’s disease, Hallervoden-Spatz) &

torsion dystonia excluded clinically

■Acquired injuries: head injury, stroke, encephalitis, developmental

neuropsychiatric disorders, toxins (carbon monoxide) excluded by

history & brain imaging

■Drugs: neuroleptics, stimulants, anticonvulsants excluded by history

& toxicology screen

■Childhood onset, motor & vocal tics likely represent Tourette syn-

drome

management

■What to do first: search for underlying cause

■Education about the disorder for family, friends & teachers

specific therapy

■Many will not require treatment

■Fluphenazine or pimozide (if not effective, haloperidol)