Tics are rapid and sudden motor manifestations that result from the involuntary contraction of one or more muscle groups; are involuntary, stereotypical, recurrent, unpredictable, non-rhythmic and temporarily controlled by willpower; Childhood tics are amplified by stress or anger and can be relieved by distraction or concentration.
Childhood tics are the most common movement disorder in pediatrics. The foreboding impulse appears to be the involuntary part of a tick and a movement is often made to relieve the impulse.
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- Young children with quick tics describe them as sudden without too much warning or voluntary participation.
Tics usually start between the ages of 4 and 7. For most children, early tics occur when they blink, smell, scratch their throats, or cough repeatedly; are more common in men than in women, with a ratio of 3 to 1.
Tics vary considerably in severity and frequency. Many children with mild, transient tics between the ages of 4 and 6 do not receive medical attention. In about 55% to 60% of young people, tics will be minimal in late adolescence or early adulthood. .
In another 20 to 25%, tics become rare, but occasional. In about 20% of cases, tics persist in adulthood (some of which even report worsening).
Certain characteristics define these motor manifestations. Are
Tics are classified into simple or complex motors or vowels; the simplest are manifested by sudden movements or short, repetitive sounds.
Complex motor tics are sequentially coordinated movements, but inappropriately, for example, shaking the head repeatedly, repeating the gestures of others (ecopraxia) or making obscene gestures (copropraxis).
Complex vocal tics are characterized by elaborate sound productions, but placed in an inappropriate environment, such as repetition of syllables, blocking, repetition of their words (palilalia), repetition of heard words (ecolalia) or pronunciation of obscene words. (coprolalia).
In children with tics, there is a widespread presence of impulse control issues, subtle differences in neuropsychological and motor functioning, as well as a high rate of psychiatric or developmental comorities, such as ADHD (30% to 60%), compulsions (30%). 40%), anxiety (25%), disruptive behavior (10% to 30%), mood swings (10%), obsessive-compulsive disorder (5% to 8%), autism spectrum disorder (5%) difficulties with motor coordination. Some children also experience episodic anger.
Tics have a complex multigenetic etiology and are highly inherited. The concordance between monozygotic twins is 87%.
In the past, tics were considered behavioral or stress-related and were called “nervous habits” or “contractions,” we now know that tics are neurological movements that can be aggravated by anxiety, but this is not causal.
The underlying mechanisms involve several neural networks in the brain, between the cortex and the central gray nuclei (fronto-striated-thalamus circuits), but they also involve other areas of the brain, such as the limbic system, the middle brain, and the cerebellum. .
Anomalies of interoceptive consciousness and central sensorimotor processing have also been reported.
Behavioral interventions include several techniques, although the specific treatment for each child depends on prior assessment, response to treatment and incidences during treatment (Bados, 2002).
Habitat reversal therapy (HRT) and exposure and response prevention (ERP) are evidence-based interventions for tics. TRH and ERP will reduce combined severity and frequency scores (Yale Global Tic severity index) from 40% to 50%.
The usual investment treatment proposed by Azrin (Azrin and Peterson, 1988) involves teaching the patient to recognize the foreboding impulse and perform an action called competitive response, which reduces the possibility of their irritating tic.
Includes 11 main techniques organized in five phases
Response prevention exposure practice leads to the need for addiction and therapy encourages the patient to feel and tolerate the need for tics (exposure) without performing it (response prevention). In a fixed-term session, the patient is asked to contain their tics and a therapist records how long they can do so.
No answers or accessories are used. Patients have several aids in each session and the period during which they can maintain tics gradually increases.
Regular and systematic control of exposure and response can tolerate tick pulses and, over time, improves the patient’s ability to control them.
During the session, the therapist refers to impulses asking the patient how strong they are; the suggestion of this action exposes the patient to the anguish of having a tic while talking about himself.
The decision to use them depends on the nature of the tics and is usually reserved for severe and annoying tics that cause pain or injury. Current evidence indicates that clonidine (a presynaptic alpha-2 agonist) is the first-line drug.
In contrast, antipsychotics/antidopaminrgics appear to be more effective in adults and clinical practice confirms the good efficacy of aripiprazole in children.
Benzodiazepines are not regularly used in the treatment of tics, but are common in an acute and severe clinical situation. They can be used to reduce anxiety during tic attacks, but it is best to avoid them, as there may be a rebound effect.