Tics can be expressed symptomatically in three forms, Tourette’s disorder, chronic and transient tics. Accordingly, we will describe the three clinical pictures.
In Gilles de la Tourette’s disorder, only multiple motor tics and one or more verbal tics are essential. The tics occur several times a day over a period of more than a year. The location, frequency number, complexity, and severity of tics change over time. In their most typical presentation, they affect the head, upper extremities, trunk, or other parts of the body. Verbal tics include grunting, howling, sniffing, throat clearing, coughing, or speaking. And the coprolalia or irresistible impulse to say obscenities.
Both motor and verbal tics can be classified as simple or complex; the most frequent simple motors are blinking, neck jerks, shoulder shrugs, and facial grimaces. The most frequent simple vowels are coughing, throat clearing, grunting, etc. The most common complex motor tics are complex facial gestures, hitting, jumping, touching, or stomping on an object.
The most common complex vocal tics are words repeated out of context, coprolalia, and echolalia. They are frequently associated with depressed mood and shame.
Chronic and transient nervous tics
The clinical picture of chronic tics is characterized by the appearance of only one type of tic (not both, as in Gilles de la Tourette). Other features are the same except that the severity of symptoms and functional impairment are less.
Transient tics are motor and/or verbal tics that occur several times a day for at least two weeks, but not more than 12 consecutive months.
