Persistent Vocal Tic Disorder: Symptoms and Treatment

Introduction:

Tics are movements that are sudden, spastic, and cannot be controlled or verbal outbursts. These sounds or movements are repeated but not in rhythm and are involuntary in nature. Only one of the tics is present in this situation, and neither occurs at the same time. Tics in this condition may last for a year. These tics cannot be stopped by the individual.

What Is Persistent Vocal Tic Disorder?

Tics are sudden outbursts of sounds, twitches, or movements that are repeated in an individual. These tics cannot be controlled by an individual. Mainly, there are three tic disorders.

• Tourette syndrome (TS) or Tourette disorder.

• Persistent (chronic) motor or vocal tic disorder.

• Provisional tic disorder.

These tic disorders vary according to the type of tic present and the duration of the symptoms.

Tourette Syndrome: TS has both motor and vocal tics, and tics symptoms lasted for one year.

Persistent Motor or Vocal Tic Disorder (PMVT): PMVT has any one of the tics symptoms- motor or vocal (not both together), and these symptoms last for one year.

Provisional Tic Disorder: This condition has either one or both tics symptoms, but these last for less than a year.

What Are the Types of Tic Disorders?

Tic disorders are classified into chronic motor or vocal and transient tic disorders and Tourette syndrome. Motor and vocal can be short-lived or chronic, and TS is considered a chronic tic disorder. Transient tic disorders last for less than a year and are generally motor tics, and the onset of symptoms must be before the age of 18 years of an individual. Studies have found that tics are usually seen among children who have learning disabilities and can be seen in children with autism spectrum (abnormal absorption with the self).

Chronic Motor or Vocal Tic Disorder:

• Tics of this type appear before the age of 18 years.

• Symptoms last for one year or more.

• Tics are motor or vocal but not both together.

• This type of disorder is less common than a transient disorder.

• Less than one percent of children are affected by this type of disorder.

• If a child is diagnosed at a young age, they have a better chance of healing, and tics usually go away within six years. If the youngster continues to experience symptoms after the age of 18, it will be tough to resolve the problems.

Tourette Syndrome:

TS is a rare but complex neurological condition characterized by various motor and vocal tics. It is the most serious type of tic disorder. According to studies, 50 % of all youngsters are not diagnosed with this type of disease. In the United States, just 0.3 % of people with TS are diagnosed.

The severity of TS symptoms fluctuates throughout time. Many people's problems improve as they get older. TS is frequently associated with other disorders, such as attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD).

What Are the Symptoms of Tic Disorders?

Various tics produce different types of symptoms. They are as follows:

• Motor Tics: Tics like movements of the head and shoulders, blinking eyes, jerking, clicking of fingers, banging, and touching people or things are motor tics. These tics appear first before vocal tics.

• Vocal Tics: Sounds like coughing, grunting, clearing of the throat, and repeating words or phrases are called vocal tics.

Tics can also be classified into simple and complex tics.

• Simple Tics: These tics are sudden and fleeting in nature and make use of a few muscles. Nose twitching, eye darting, or throat clearing.

• Complex Tics: These tics use many muscles for coordinated movements. Hopping, gesturing, stepping in a certain way, and repeating words or phrases are called complex tics.

Before the tics, a general urge which is uncomfortable, like itching and tingling, can be observed. Holding back the tic may be necessary. This requires effort and creates stress and tension. Relief can be observed after carrying out the tic.

Symptoms include:

• Symptoms worsen with emotions like excitement, anxiety, anger, and fatigue.

• Symptoms worsen during illness.

• Symptoms of tics vary widely with temperature.

• During sleep, it may get worse.

• Suddenly, it may vary over time.

• Tics may vary according to type and severity

• Symptoms may improve over time.

What Are the Causes and Risk Factors of Persistent Vocal Tic Disorder?

The exact cause of this condition is not known. Recent research has found that gene mutations may play a role in causing PMVT. They have also identified that brain chemicals like glutamate, serotonin, and dopamine are also important.

Tics may be caused by other reasons, like

• Head injury.

• Stroke.

• Infections.

• Poisons.

• Surgery.

• Other injuries.

• Diseases like Huntington’s disease or Crueitzfeldt-Jakob disease.

Risk Factors-

• Genetics: This condition runs in the family as genes play a role.

• Gender: Males are affected more than females.

What Are the Complications of Persistent Vocal Tic Disorder?

The complications with tic disorders, especially with TS, include

• Anxiety.

• ADHD.

• Depression.

• Autism spectrum disorder.

• Learning disabilities.

• OCD.

• Difficulty in getting sleep.

• Difficulty in speech and language.

• Effect on individual’s self-esteem and self-image.

• Difficulty in social functioning and experiencing a lower quality of life.

How to Diagnose Persistent Vocal Tic Disorder?

PMVT is diagnosed mainly by considering the signs and symptoms.

To be diagnosed with PMVT, the child should be under 18 years old. Consideration must be given to symptoms, and it should not be due to other reasons like medical conditions or drugs.

Other tests include blood tests and imaging tests like MRI ( magnetic resonance imaging).

How to Treat Persistent Vocal Tic Disorder?

• Exposure and Response Therapy: Getting adjusted to the uncomfortable situation with the aim of preventing the tic.
• Habit Reversal Therapy: Treatment that teaches actions that help compete for the tics so that tics do not occur.
• Medications: Medications reduce the symptoms of tics. Medications include antiseizure medications, botox injections, and muscle relaxants. Antidepressants can be used to reduce depression.
• Deep Brain Stimulation: Tics can be reduced by implanting a battery-operated device in the brain. These use electric impulses to reduce the tics.
• Coping and Self-Help Tips: Making lifestyle modifications may help lessen the frequency of tics.

Conclusion:

PMVT is a disorder that affects the quality of life of an individual. Hence, it is necessary to know about the condition and its symptoms, causes, and treatment. Knowing about the condition helps in identifying the disease at the earliest. Early diagnosis helps in getting effective treatment. This, in turn, helps in achieving good quality of life.