Transient Tic Disorder

Tics
• A “tic” is a sudden, rapid, recurrent, non-
rhythmic, stereotyped motor movement or
vocalization
• A tic may be simple (involving only a few
muscles or simple sounds) or complex
(involving multiple groups of muscles
recruited in orchestrated bouts or words or
sentences)
 Motor Tics (Simple)
• Generally lasting less than several hundred
milliseconds
• Examples include:
• eye blinking
• nose wrinkling
• neck jerking
• shoulder shrugging
• facial grimacing
• abdominal tensing
 Motor Tics (Complex)
• Longer in duration than simple tics; usually lasting
seconds or longer
• Examples include:
• hand gestures
• jumping, touching, pressing, or stomping
• facial contortions
• repeatedly smelling an object
• squatting and/or deep knee bends
• retracing steps and/or twirling when walking
• assuming and holding unusual positions (including
“dystonic” tics, such as holding the neck in a particular
tensed position)
 Vocal Tics (Simple)
• Meaningless brief sounds
• Examples include:
• Throat clearing
• Grunting
• Sniffing
• Snorting
• Chirping
 Vocal Tics (Complex)

• More clearly involve speech and language

• Examples include:
• sudden, spontaneous expression of single words or
phrases
• speech blocking
• sudden and meaningless changes in pitch, emphasis, or
volume of speech;
 When Do Tics Occur?

• Tics are often more frequent when an

individual relaxes in private (e.g., watching TV)
and less frequent when an individual engages
in directed, effortful activity (e.g., reading)
• Tics may be exacerbated during periods of
stress
 Etiology
• Genetics
• Brain abnormality
• Neurotransmitter
Diagnostic criteria for transient tic disorder
(DSM-IV-TR 307.21) are as follows:
• Single or multiple motor and/or vocal tics (eg,
sudden, rapid, recurrent, nonrhythmic,
stereotyped motor movement or
vocalizations) are present
• The tics occur many times a day, nearly every
day for at least 4 weeks, but for no longer
than 12 consecutive months
• The onset is before age 18 years
• The disturbance is not due to the direct
physiologic effects of a substance (eg,
stimulants) or a general medical condition (eg,
Huntington disease or postviral encephalitis)
• Criteria have never been met for TS or chronic
motor or vocal tic disorder
• Specify if this is a single or recurrent episode
 Treatment
• Treatments are purely symptomatic
• Tics are often not the worst problem
• Chronic disorder : longterm benefit
• symptoms frequently improve or worsen over
any period of time
• Dopamine D2 receptor antagonist therapy :
chlorpromazine
• Dopamine agonist : levodopa
• Other treatment : Guanfacine, clonidine,
noerpinephrine, etc
• Behavioral therapy : Habit Reversal Therapy
TERIMA KASIH