Neural tics are random and rapid movements that can be related to problems such as stress and anxiety or not occur for medical reasons. One of the most important causes of this problem is neurological diseases and brain injuries. In general, nervous tic is usually not a serious and worrisome issue and improves over time. But tic disorder like Tourette's syndrome can make people's daily life difficult, so it needs to be managed and treated. ### What is tic disorder? Tic disorders are irregular, uncontrollable and repetitive muscle movements that can occur in any part of the body. This disorder is more common in men and usually starts around 5 years old. ### Symptoms and signs of nervous tic Contractile and involuntary movements that are caused by tics, should be in terms of time and repetition according to the definition of nervous tic disorder. It means that they last for at least one month and are not caused by side effects of drugs or special diseases. The symptoms are also very diverse and one or more may be present in a person at the same time. We have listed the most common tick symptoms in the table below. #### **symptoms of nervous tic disorder** - - - Constriction of the nose - Prolonged staring - Unexplained cough - Snoring - Meaningless repetition of words - Constant sniffing - Continuous flashing - Involuntary movements of the mouth - Shrugging - Shaking the neck - Shaking or sudden movements of the legs - Shaking fingers - (like counting with fingers) - Touching or hitting objects or people - Touching and breaking - Producing meaningless sounds - Sudden change in loudness - Frowning and wrinkling of the face - Unnecessary turning of the eyes The frequency and severity of these symptoms may vary at different times. But they are often aggravated in the following conditions: - Increased stress and anxiety - Extreme happiness or any kind of excitement - During illness - On hot days and high temperatures - in sleep ### Causes of nervous tics Photo 2 alt: the cause of nervous tics Explanation: Nervous tics occur for reasons such as stroke, infection, trauma, surgery, physical injury, and consumption of poisons. Nervous tic is a complex disorder whose occurrence is related to a set of genetic factors, brain damage, neurochemical disorders and mood problems. The underlying causes and risk factors for tic are the following: - **Cigarette consumption during pregnancy**: Nicotine contained in cigarettes during fetal period can affect the nervous system by increasing oxidative stress. - **Damage to the cortical parts of the brain**: As a result of head injury or stroke, it can lead to bleeding and damage to the cortical and subcortical parts of the brain. As a result, an imbalance in the secretion of substances such as glutamate, serotonin and dopamine is likely. - **Genetic factors**: in the family of half of the people with tics, at least one person has nervous tics. Several genes predispose a person to tic and Tourette syndrome. Some of these genes are inherited and some are caused by gene mutation during pregnancy. - **Infection**: Microbes such as Streptococcus bacteria (causing Sydenham's disease), Borrelia bacteria (causing Lyme disease), Mycoplasma pneumoniae bacteria (causing pneumococcal disease) and herpes simplex virus (causing herpes) are factors related to movement tics by causing infection and inflammation in the brain. ### Types of nervous tics There are many types of nervous tics based on the location of the tic and the location of the conflict, which can be divided into 3 general categories: - Movement tic disorder - Voice tic disorder - Tourette syndrome Also, in terms of intensity and duration, we are facing two types of chronic tic and transient or temporary tic. #### 1- Transient nervous tic Transient tic disorder appears with one or more tics for **1 to 12 consecutive months**. The onset of tics must be before the age of 18. This type of tic usually improves over a year. The prevalence of transient nervous tics in primary school children is about 10% and mostly includes movement tics. Some research suggests that transient tics are more common among children with learning disabilities and exceptional children. Children on the autism spectrum are more likely to suffer from tics. #### 2- Chronic nervous tic Tics that appear before the age of 18 and last **more than 1 year** are classified as chronic tic disorder. Chronic tic is either vocal or motor and does not include symptoms of both models. Chronic tic disorder is less common than transient tic disorder and occurs in less than 1% of children. The younger the onset of motor or vocal tic disorder, the higher the chance of recovery and it usually disappears within 6 years. But in people who continue to experience symptoms after the age of 18, the probability of recovery is less. #### 3- Movement tic disorder The presence of **ticks in the movement components** such as hands, feet, eyes and muscles of different parts of the body is known as motor tics disorder. This model of nervous tic can be transient or become a chronic disorder; But it is mostly among the transient types. #### 4- Voice tic disorder Occurrence of **repetitive and involuntary sounds**, such as clearing the throat, repeating words or snoring, are called vocal tics. This type of tic is also sometimes short-term and improves over time and sometimes becomes chronic. The possibility of vocal tic becoming chronic is higher than motor tic. #### 5- Tourette syndrome Tourette's syndrome or TS is a chronic and complex disorder that is diagnosed by the presence of several motor and vocal tic patterns. Tourette's is the most severe and at the same time **the rarest type of nervous tic**. The prevalence of this syndrome is not known because half of the affected children are not diagnosed. Symptoms such as sleep disorders, hyperactivity, and high anxiety are warning signs of Tourette syndrome in children. The severity of TS symptoms also varies over time. In many people, symptoms improve with age. TS is often associated with other problems such as attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). ### Diagnosis and assessment of nervous tic Tic disorders are diagnosed based on individual symptoms and clinical history. The following criteria are important for the diagnosis of nervous tic: - The onset of symptoms must be before the age of 18. - Symptoms should not be a complication caused by medication or other temporary medical problems. - In the diagnosis of transient tic, one or more tics must occur for less than 12 consecutive months. - Chronic motor or vocal tic is if one or more tics occur daily for 12 months or more. - People with chronic tic disorder, other than Tourette's, experience motor tic or vocal tic alone. - The diagnosis of Tourette syndrome is based on the presence of daily motor and vocal tics for 12 months or more. - To rule out other causes, the doctor may prescribe blood tests and MRI scans or other imaging tests. ### Neural tic treatment methods Most of the time, the tic will improve by itself and over time within a year. But sometimes, in some people, they become a chronic disorder that lasts more than 1 year. The treatment of tic disorder depends on the type of tic and its severity. Severe tics that interfere with daily life can be managed with medication, occupational therapy, psychotherapy to control stress, improve underlying problems, and deep brain stimulation. #### 1- Deep stimulation of the brain Deep brain stimulation (DBS) is not commonly used to treat tics and is not yet FDA approved. However, if a person with Tourette's syndrome has severe symptoms and does not respond to 3 categories of drugs or gives a weak response, this method can be used. In DBS, depending on the severity of the symptoms, 1 to several electrodes are placed in the brain during surgery. By changing the brain waves, these electrodes affect the chemistry of the brain and in this way they are effective in controlling the symptoms of Tourette syndrome. #### 2- Medicine for nervous tics The medicine can be used in combination with other treatments or alone, depending on the individual's conditions and symptoms. Medication usually increases the time between tic recurrences, but cannot completely eliminate them. Medications currently used to control tics include: - - - Anticonvulsant drugs - Botox injection - Muscle relaxants - Drugs affecting dopamine - Antidepressants #### 3- Work therapy for nervous tics Occupational therapy is very helpful, especially in the case of vocal tics with stuttering. In this method, the therapist teaches the person how to control his nervous tic by performing forced movements and then gradually reduce the compensatory movement. ### Final speech Intense and unwanted stimulation of the muscles, which leads to the production of additional sounds or involuntary movements of the body, causes nervous tic disorder. The symptoms of tics range from jumping eyelids and arms and legs to stuttering, snoring, and shaking shoulders and neck. If the voice and movement symptoms are severe and continue for more than a year, the person has Tourette syndrome. There is no specific and perfect treatment for nervous tics. But with methods such as electrode implantation, occupational therapy, psychotherapy and drug therapy, the problems caused by it can be managed. ####