DEAR DOCTOR K:
My young daughter will suddenly blink her eyes or twitch her nose repeatedly, for no good reason. The doctor says she has “tics,” a condition of her nervous system. Will this go away, and is it serious?
Tics are upsetting — both to the person who has them and to the people who see them. We like to feel in control of our world. A sudden, uncontrollable, rapid repetitive movement (called a motor tic) says we’re not in control. So it’s understandable that both you and your daughter should be concerned.
Tics are pretty common in kids. They are thought to be inherited neurological disorders. They also can be caused by head injury or certain drugs, such as stimulants. They are not a psychological problem, although fatigue, anxiety and stress often make symptoms worse.
People with tic disorders describe an urge building up inside them before the tic appears, followed by a feeling of relief after the tic is over. After making an effort to suppress a tic, the person usually has a burst of tics to relieve a buildup of the inner sensation.
If a stimulant medication is causing your daughter’s tic, it might be worth stopping it, or substituting another stimulant drug in its place. Mild tics do not require treatment unless they are socially embarrassing or interfere with your child’s life.
If your daughter is disturbed by her tics, psychological counseling and behavior training can be effective. For example, a child may be taught to recognize that a tic is beginning and perform another movement that is incompatible with the tic.
When both motor and vocal tics are present and last for more than one year, the disorder is named Tourette’s syndrome. This condition often begins in childhood, but continues into adulthood. Unfortunately, treatment is not always successful.
Several years ago another reader asked me about Tourette’s syndrome, and I recalled a memorable cross-country flight I once took. Every few minutes, the woman sitting next to me would jerk her head and cry out “Eeeahhhh.” I realized she probably had Tourette’s syndrome and couldn’t control it, but I was annoyed: It was going to be hard to concentrate on my reading.
She must have seen my expression because she said: “I’m so sorry, sir, but I have a medical condition that causes this. I wish I could control it, but I can’t. And I’ve got to get to my sister in Seattle.” I will never forget the expression of shame on her face.
Some people have severe tics that cause them to hurt themselves, by hitting or biting, for instance. Severe tics can be treated with medications that affect certain chemical messengers in the nervous system. A number of other medications, including injections of botulinum toxin (Botox and others), may also be effective.
It is rare for kids with tics to develop Tourette’s syndrome. I’ll bet your daughter’s tics will go away.
(This column is an update of one that ran originally in January 2103.)