Seventeen-year-old Kartik got easily flustered. He was also academically inconsistent. Other than this, he seemed like any regular teenager—until he started making sounds ranging from grunts one week to throat clearing the next. At first, the family thought it was a mannerism but when it persisted, they began to snap at him, telling him to “stop it”. Soon, the mannerisms developed into constant blinking, shrugging and jerking of the knee. Both sounds and movements appeared to be involuntary, beyond his control.
What are tics?
Worried, Kartik’s parents approached the family doctor who diagnosed it as a neurobiological condition resulting in what is called a “tic”. These involuntary gestures are due to a chemical imbalance in the wiring of the brain where neurotransmitters (such as serotonin, dopamine and norepinephrine) behave in abnormal ways. Most tics are transient, lasting up to three months; tics are chronic if they persist for a year or more. Usually, children aged between 7 and 18 exhibit motor tics (physical movements), while others may exhibit vocal tics.
Anupam Sibal, group medical director, Apollo Hospitals, and senior consultant paediatric gastroenterologist and hepatologist, says, “The diagnosis involves a physical examination. No special tests are necessary. An EEG (electroencephalogram)—a test that records electrical messages from the brain—is recommended to rule out seizures.”
In Kartik’s case, both tics and seizures were manifested, indicating that he had a condition called Tourette Syndrome (TS) or Tourette Disorder. Dr Sibal explains that the causes of tic disorders are not fully understood. Researchers believe they are the end result of several causes.
So, could Kartik be cured? That was the question uppermost in his mother’s mind. Sameer Malhotra, head of the department of psychiatry and psychotherapy, Fortis Hospital, New Delhi, says: “There may not be a sure remedy, but it can be minimized and managed. Whether partial or complete in its manifestation, the tic’s association with other neurological disorders like attention deficiency, obsessive-compulsive disorder, anxiety, bipolar disorder, autism spectrum disorder, sleep disorders or depression has to be established.”
Stress was a critical trigger in Kartik’s case. The family followed the psychotherapist’s advice. Family and friends were given details of his medical condition and urged not to make a big deal of it.
Kartik was also observed to see whether his tics were simple or complex. Simple motor tics appear suddenly and separately from other tics, involving fewer muscles—blinking or grimacing, for instance. Complex motor tics involve more muscle groups—touching a body part or another person repeatedly or self-harm behaviour, such as banging one’s head. Simple vocal tics include throat clearing, sniffing, humming; complex vocal tics include repeating other people’s words (echolalia) or involuntary swearing (coprolalia).
No harm done
Dr Malhotra says 85% children find that their tics diminish or vanish after adolescence. Those that persist can become permanent. There are no India-specific figures on tic prevalence, though it is estimated that it ranges from four to five cases per 10,000 people. Tics are one-and-a-half to three times more common in men.
Parents are now more alert to changes in their child’s mannerisms, but many cases still go unreported. Jyoti Prakash Wali, former professor of medicine, AIIMS, says, “The family physician is usually the first to know. He makes a referral to the neurologist to rule out organic problems. Then the person is directed to a psychiatrist for counselling and medication.” The disorder is not debilitating but needs monitoring. If speculation about composer Mozart, writer Samuel Johnson and some great soccer players is true, channelizing the energies of those with tics will reduce their intensity—and help create masterpieces, too!
WHEN TO CALL THE DOCTOR
• Performance at work affected
• Relationships suffering due to tics
•Difficulty with daily activities—eating, bathing, dressing
• Repeated falls or injuries
•Tics coincide with or follow recent episode of strep throat or streptococcal infection
• Also suffering from OCD (obsessive-compulsive disorder), ADHD (attention deficit hyperactivity disorder) or depression
HOW TO REDUCE IMPACT
• Stop obsessing
•Try and avoid stressful situations
• Do not continuously draw attention to the tic
• Sleep well
• Let it out—as you would a cough or a sneeze
• Reduce cola intake
• Review medical history—complications during birth; chronic physical/ mental illness in the family; abuse; exposure to anabolic steroids
• Try psychotherapy
• Take tranquillizers under medical supervision