Tic

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Classification according to ICD-10
F95 Tic disorders
F95.0 temporary tic disorder
F95.1 chronic motor or vocal tics
F95.2 combined vocal and multiple motor tics (Tourette's syndrome)
ICD-10 online (WHO version 2019)

A Tic ( French tic , [nervous] twitching ') or Tick is a disease symptom. It describes a short and involuntary, regularly or irregularly recurring and sometimes complex motor contraction of individual muscles or muscle groups. They are counted among the extrapyramidal hyperkinesias . In social contact, tics usually only become noticeable when they show up as violent physical movements or vocalizations. Tics occur in the context of various neurological and neuropsychiatric diseases - but they are primarily known as the leading symptom of Tourette's syndrome .

Classification

A distinction is made between primary , idiopathic tic disorder (such as Tourette's syndrome ) and secondary tic disorder (e.g. tics as one of the symptoms of another underlying disease). Depending on the severity and severity, a distinction is made between four subgroups of tics, which occur particularly in the head and shoulder area:

  • Simple motor tics , e.g. B. frowning, blinking eyes, jerking head movements, raising eyebrows, shrugging shoulders, grimacing
  • Simple vocal tics , e.g. B. clearing your throat, clicking your tongue, coughing, smacking, grunting, sniffing
  • Complex motor tics , e.g. B. jumping, touching other people or objects, twisting the body, copropraxia (performing obscene gestures), self-harming behavior
  • Complex vocal tics , e.g. B. throwing out incoherent words and short sentences, coprolalia (uttering obscene words), echolalia (repetition of heard sounds and scraps of words), palilalia (repetition of words you have just spoken)

Vocal tics differ from motor tics in that they involve groups of muscles that contribute to vocalization (e.g. diaphragm , tongue , throat muscles , etc.). While simple motor and vocal tics usually proceed quickly and have an unintended effect, complex tics can often appear arbitrary due to their sometimes slower, more structured course. You can suppress a tic for a short period of time, but you can't stop it. The tic patient has no control over when a tic appears or when it goes away.

Diagnosis according to ICD-10

In the ICD-10 , tic disorders are classified under 'behavioral and emotional disorders with onset in childhood or adolescence' (F9). This means that the diagnosis of a tic disorder must begin before the age of 18. There are three main forms of tic disorder:

  • Transient tic disorder : Single or multiple motor or speech tics occur many times a day, most days; this over a period of at least four weeks and a maximum of twelve months.
  • Chronic Motor or Vocal Tics : Motor or vocal tics (but not both) occur many times a day, most days; this over a period of at least twelve months. In the given year there is no remission that lasts longer than two months.
  • Combined vocal and multiple motor tics ( Tourette's syndrome ) : Multiple motor tics and one or more vocal tics exist for a period of time during the disorder, but not necessarily simultaneously. The tics occur many times a day, almost every day; this for more than a year. In the given year there is no remission that lasts longer than two months.

Differential diagnosis

The tics that occur are to be distinguished from:

Epidemiology, Distribution and Age Relevance

Tics occur v. a. in childhood (about 4–12% of all children). Often, however, at this age they are of a temporary nature; that is, they go away within six months. Tics are around three times more common in boys than girls. The familial accumulation of tics has been proven.

In milder forms, the tics usually stop at the beginning of adulthood. In more severe forms, the symptoms persist in adulthood, but often in a weakened form. The most severe and therefore most impressive form of the disease is also called Tourette's syndrome , after the first person to describe it, the French neurologist Georges Gilles de la Tourette .

About half of the patients with chronic multiple tics or with Tourette's disorder also have a hyperkinetic disorder (ADHD). Obsessive- compulsive symptoms or self-harming behaviors are also often seen in patients with Tourette's syndrome . Complex tics almost always develop after simple tics. In the context of an obsessive-compulsive disorder, tic symptoms can also occur without having to achieve the full picture of Tourette's syndrome.

causes

The exact cause of the development of the most common, primary tic disorder is still not known, but a genetic basis is considered certain. In a broad, pan-European series of studies ( EMTICS ), research is to be conducted by 2017 into the precise role genetics play in tic disorders and what other influencing factors (e.g. infections and autoimmune factors) are important. A hereditary disorder in the basal ganglia is believed. Organic tics as a result of general brain damage (e.g. encephalitis ) or a lesion of the basal ganglia (of the striato - pallid system) are less common . Increasingly, the striatofrontal dysfunction is blamed for the development of tics, which would explain that the tic disorder is a common comorbidity of ADHD .

Special shape

The tic douloureux (French: the painful tic ) is a special form with a different cause : a short, violent and often repetitive attack of pain with facial twitching ("facial cramp") in trigeminal neuralgia .

therapy

In addition to comprehensive information and advice for caregivers (especially parents and teaching staff in the case of affected children), moderate treatment success can be achieved in mild cases through psychoeducation and behavioral habit reversal training . Depending on the severity of the tic disorder, various therapeutic approaches are available. Depth psychological psychotherapy as well as psychoanalysis are considered unsuitable in the therapy of tics, since the cause of tics is organic and not psychogenic. Behavioral therapeutic approaches other than habit reversal training are controversially discussed in terms of their effect. Although it is a neurobiological (medical) disorder, improving the patient's self-awareness of the tics (e.g. through protocols and detailed descriptions) can in some cases relieve symptoms. In addition, relaxation processes (e.g. progressive muscle relaxation ) and positive reinforcement (e.g. token system ) are used.

In severe, complex and chronic cases and in the case of severe comorbidities , pharmacological treatment is just as necessary as it is often in the case of vocal tics, the occurrence of other comorbidities and the full-blown Gilles de la Tourette syndrome . The drugs of choice are neuroleptics (e.g. tiapride, pimozide, haloperidol) and, if there are accompanying symptoms, antidepressants (especially selective serotonin reuptake inhibitors ). Psychoeducation and social psychiatric support can support drug therapy if necessary. Treatment with cannabis can also have a mitigating effect on the symptoms. This requires a regulation within the framework of the Narcotics Act.

literature

Web links

Individual evidence

  1. ↑ Harrap's Universal Dictionnaire Français-Allemand / Allemand-Français. 1999, ISBN 0-245-50401-X .
  2. ↑ Heiko Bewermeyer: Neurological differential diagnosis: Evidence-based decision making and diagnostic paths . Schattauer Verlag, 2011, p. 418ff.
  3. ↑ a b c d Manfred Döpfner : Tic disorders. In: Gerhard W. Lauth , Udo B. Brack , Friedrich Linderkamp (Ed.): Behavioral therapy with children and adolescents. 2001, ISBN 3-621-27447-2 , pp. 339-346.
  4. ↑ Anton Scamvougeras: Challenging Phenomenology in Tourette Syndrome and Obsessive-Compulsive Disorder: The Benefits of Reductionism. In: Canadian Psychiatric Association. (February 2002). Retrieved June 5, 2007.
  5. ↑ Website of the EMTICS study: http://www.emtics.eu/
  6. ↑ Andrea G. Ludolph, Veit Roessner, Alexander Münchau, Kirsten Müller-Vahl: Tourette syndrome and other tic disorders in childhood, adolescence and adulthood. In: Dtsch Arztebl Int. 2012; 109 (48), pp. 821-828; doi: 10.3238 / arztebl.2012.0821 .
  7. ^ S1 guideline tics of the German Society for Neurology. In: AWMF online (as of 2012).
  8. ^ MM Robertson: Gilles de la Tourette syndrome: the complexities of phenotype and treatment. In: Br J Hosp Med (Lond). 2011 Feb; 72 (2), pp. 100-107.
  9. ↑ BS Peterson, DJ Cohen: The treatment of Tourette's Syndrome: multimodal, developmental intervention. In: J Clin Psychiatry. 1998; 59 Suppl 1, pp. 62-72.
  10. ↑ Kirsten R. Müller-Vahl: Treatment of Tourette's Syndrome. Department of Clinical Psychiatry and Psychotherapy, Hannover Medical School. 2005. p. 16ff.
  11. ↑ Kirsten R. Müller-Vahl: Treatment of Tourette's Syndrome. ( Memento of the original from November 10, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF) Department of Clinical Psychiatry and Psychotherapy, Hannover Medical School. 2005, p. 16ff. Retrieved November 10, 2013. @1@ 2Template: Webachiv / IABot / www.tourette-gesellschaft.de
  12. ^ B. Michael, MS Himle: Brief Review of Habit Reversal Training for Tourette Syndrome. In: J Child Neurol. August 2006 vol. 21 no. 8, pp. 719-725.
  13. ↑ JC Du, TF Chiu, KM Lee, et al .: Tourette syndrome in children: an updated review. In: Pediatr Neonatol. 2010 Oct, 51 (5), pp. 255-264.
  14. ↑ EC Miguel, MC do Rosario-Campos, RG Shavitt et al .: The tic-related obsessive-compulsive disorder phenotype and treatment implications. In: Adv Neurol. 2001; 85
  15. ↑ Steinhausen: Mental disorders in children and adolescents. 5th edition. Urban & Fischer, 2002.
  16. ↑ V. Roessner, KJ Plessen, A. Rothenberger, A. Ludolph, R. Rizzo, L. Skov, G. Strand, J. Stern, C. Deadlines, PJ Hoekstra, the ESSTS Guidelines Group: European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment. In: Eur Child Adolesc Psychiatry. 2011; 20 (4), pp. 173-196.
  17. ↑ Kirsten R. Müller-Vahl, Udo Schneider, Heidrun Prevedel, Karen Theloe, Hans Kolbe, Thomas Daldrup, Hinderk M. Emrich: Delta 9-tetrahydrocannabinol (THC) is effective in the treatment of tics in Tourette syndrome: a 6-week randomized trial . In: The Journal of Clinical Psychiatry . tape 64 , no. 4 , April 2003, ISSN  0160-6689 , p. 459-465 , PMID 12716250 .
  18. ^ Kirsten R. Müller-Vahl: Treatment of Tourette syndrome with cannabinoids . In: Behavioral Neurology . tape 27 , no. 1 , January 2013, ISSN  1875-8584 , p. 119-124 , doi : 10.3233 / BEN-120276 , PMID 23187140 .