Tics and Tourettes in Children

00:01 In this lecture, we are going to discuss Tics and also Tourettes in children.

00:07 So Tics are involuntary repetitive stereotyped movements or vocalizations.

00:15 They are purposeless.

00:16 They are just a movement that moves for no particular no good reason.

00:20 And they can be very simple, they can be fairly complex.

00:24 Tourettes Syndrome is a Tics disorder that is specific to children and adults who have the condition.

00:33 This is defined as multiple motor tics. and at least one vocal tic.

00:39 And typically this vocal tics and motor tics are not necessarily simultaneous.

00:46 So, tics which are incredibly common especially on boys can be defined as simple or complex.

00:53 Let's go through this.

00:55 Simple tics will be things like blinking, facial grimacing perhaps a shoulder shrug or a head jerk or simply clearing of the throat.

01:07 The clearing of the throat one though is also very common in adults.

01:11 Complex tics on the other hand, which are less common may include a brief period of bizarre gait.

01:18 The patient may kick or jump.

01:21 They can be really unusual body gyration.

01:24 or patients may develop unusual speech patterns.

01:28 Coprolalia is when patients say swear words involuntarily.

01:33 Echolalia is when they repeat words that are just said to them.

01:36 And Palilalia is when patients repeat their own words over and over again.

01:43 So, tics are common they typically occur and primarily at an onset of around 6 or 7 years of age.

01:51 They are much more common in boys.

01:54 Rarely, they arise from previous neurological insults such as brain damage.

01:59 And they are usually worse when the patient is stressed out.

02:04 They can be surpressed for a brief periods of time.

02:08 a patient with a tic disorder can control them under a certain circumstance.

02:13 But then need to suddenly relieve them.

02:15 I have a patient once with Copalalia who can control his Copolalia while he is in a classroom.

02:21 but would literally need to run outside and relieve is copolalia in private.

02:29 They may persist even during sleep.

02:32 And so, that is how we can distinguish between tics and other behavior.

02:38 They can also wax and wane and change over time.

02:42 Typically boys with simple tics may even change what their tic is over several months and then eventually ease off and withdraw.

02:53 Typically, tics trouble caregivers or observers far more than they trouble the child with the tic.

03:01 And that's actually key.

03:02 A child generally is not truly bothered by their problem.

03:08 So, in terms of management of tics, generally management is supportive.

03:14 Because most of the time these resolve on their own, There is not too much that we necessarily do.

03:21 Usually, tics resolve in less than a year especially the transient types happening in these young boys.

03:29 And 2/3 of the children will have complete resolution of their tics.

03:35 However, some tic disorders are more permanent such as Tourettes.

03:40 90 percent of patients with Tourettes will also have another co-morbidity.

03:45 These includes things like Attention Deficit Hyperactive Disorder Obssessive Compuslive Disease or learning disabilities.

03:56 For these patients with more severe tics, we can manage them with medications.

04:01 These are rarely indicated.

04:04 These are limited to cases that cause embarassment or interfere with activity.

04:09 Haloperinol is an example of drug that we use or pimozide.

04:14 Both of these drugs can be used help to control tics.

04:18 Other medications have also started to be used for tourettes specifically including: ADHD medications such as methylphenidate and medications containing dextroamphetamine which can help increase attention and concentration, although can exacerbate tics at times.

04:35 Also, central adrenergic inhibitors such as clonidine and guanfacine might help control behavioral symptoms such as impulse control problems and rage attacks. Side effects may include sleepiness - that's a common question on multiple choice tests.

04:57 Side effects of tic medications can be severe.

05:00 especially Haloperinol.

05:02 Side effects may include cardiac conduction problems anticholinergic side effects such as dry mouth Bone marrow suppression and Esophageal dysmotility.

05:13 They may develop dystonia or hyperprolactinemia They can develop neuroleptic malignant syndrome.

05:21 And this can cause excessive sedation.

05:25 That is all I have for you today about tics and tics disorders in children.

05:29 Thanks for your children.