Facial tic

Overview

A face tic is a stereotyped, involuntary action or sound that is often accompanied by foreboding emotions or cravings. The majority of tic disorders are hereditary or idiopathic in origin, and are thought to be caused by a developmental failure of inhibitory function in frontal-subcortical circuits that modulate volitional movements.

Oral drugs that are now available can help to lower the intensity of tics, but they seldom remove them. If you have a few really bothersome motor tics, botulinum toxin injections can help. Deep brain stimulation has been suggested as a therapy for the most severe instances, although it has yet to be confirmed.

Facial tic definition

Facial tics are short, recurrent twitches of facial muscles that you can't control for more than a few seconds. Attempting to stop them typically makes you feel uneasy until you give in and let the tic happen. Tics usually begin between the ages of 7 and 9, however they can begin as early as age 3. They may cause shame, but as youngsters grow older, they usually go away.

Tics and Tourette's syndrome are hyperkinetic movement disorders that mostly affect children. Tics are quick, fast, recurring, nonrhythmic motor movements or vocalizations that are usually accompanied by a strong desire. In individuals under the age of 18, Tourette's syndrome is characterized as the presence of both motor and phonic tics for more than a year. The majority of hyperkinetic movement problems improve with age. The clinical pearls in the diagnosis are highlighted in this review, as well as how it differs from other movement disorders.

Involuntary muscular movements that occur anywhere on the face are known as facial tics. However, they normally occur in the same location each time and are frequent enough to annoy the individual. Tics that are severe can have a negative impact on a person's quality of life.

Common types of facial tics include:

Rapid eye blinking or winking
Squinting
Flaring the nostrils
Clicking the tongue
Sucking the teeth
Raising the eyebrows
Opening and closing the mouth
Scrunching the nose
Mouth twitching

Some persons may also have vocal tics, such as clearing their throat or grunting, in addition to muscle tics. A person can temporarily repress a tic, but it will ultimately emerge.

Epidemiology

Primary Tic Disorders

The hallmark symptom of Tourette's syndrome is chronic tics (TS). The presence of both motor and verbal tics, beginning in childhood, changes in tic kinds and intensity, and a one-year duration are all diagnostic criteria. Chronic motor tic disorder and persistent vocal tic disorder are words used when chronic tics of both sorts cannot be detected. Transient tic disorder refers to tics that endure shorter than a year. TS may represent a complicated developmental neuropsychiatric brain illness, with very high comorbidity rates of both attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD).

TS is hypothesized to be caused by a developmental failure of inhibitory function in the frontal-subcortical circuits that control voluntary movements, which might result in defective surround-off inhibition.9 (the ability to suppress unwanted movements). Low tonic synaptic dopamine levels and excessive phasic release of dopamine in the basal ganglia are substantially implicated in this process, with current data pointing to low tonic synaptic dopamine levels and excessive phasic release of dopamine. An increase in presynaptic dopamine transporters or excessive dopaminergic innervation, according to some neuroimaging studies.

Secondary Tic Disorders

A secondary etiology for tics should be addressed, especially if it is accompanied by other movement problems or other neurologic abnormalities. Tics are common in disorders including mental retardation, autism, and pervasive developmental disorder, and they suggest the existence of a worldwide brain developmental issue. Tics can also be caused by a number of hereditary and neurological disorders, such as Wilson disease, neuroacanthocytosis, neurodegeneration with iron deposition in the brain, and Huntington disease.

Tics can also be caused by injuries to the frontal-subcortical circuits (trauma, carbon monoxide poisoning, hypoxic-ischemic encephalopathy, and stroke); infections of the central nervous system (neuroborreliosis, viral encephalitis); and immune disorders of the CNS (antiphospholipid antibody syndrome, Sydenham's chorea). Tics can be a symptom of tardive dyskinesia or withdrawal emergent syndrome caused by neuroleptic drugs. Lamotrigine, carbamazepine, cocaine, caffeine, and other stimulants have all been linked to the induction or worsening of tics.

Adult onset of a primary tic disease is uncommon, but it can happen in people who are genetically susceptible. A particular trigger (such as a stressful life event, psychiatric disease, drug exposure, or infection) can typically be established in such situations, as may a childhood and/or familial history of tics, ADHD, or obsessive-compulsive symptoms.

Clinical presentation

Sudden repeated motor and phonic tics are common symptoms of the disease. Clinically, this is a complicated condition with very individual severity, frequency, fluctuation, and localisation of speech and tics. Tics are assumed to be involuntary, however they may be temporarily repressed with the use of willpower. However, there is a "rebound" effect, in which the patient's accumulated tics resurface at a higher intensity than normal following suppression. Under stress, excitement, or weariness, tics might deteriorate.

Tic expressions, on the other hand, fade away when the patient is engaged in a mental or physical task that requires attention. Before the tics appear, the patient often feels tense within, and after the tics are performed, the patient feels soothed. Tics can occur at any stage of sleep, which is unusual. In addition, mental behavioral problems such as attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), self-injurious behavior, depression, or particular learning difficulties are frequently associated with the disease.

A single muscle group is involved in simple motor tics. Complex motor tics frequently involve more than one muscle area and might even appear as though the person is purposefully doing the tic. The following are examples of simple motor tics:

Nose wrinkling
Head twitching
Eye blinking
Lip biting
Facial grimacing
Shoulder shrugging

Complex motor tics include:

Kicking
Skipping
Jumping
Mimicking movements by others
Smelling objects

Facial tics diagnosis

Tics are uncontrollable twitches, gestures, or noises that people do frequently. Tics sufferers are unable to stop their bodies from doing these actions. A person suffering from a motor tic, for example, may repeatedly blink. Alternatively, a person with a vocal tic may unintentionally emit a grunting sound.

Health practitioners utilize the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to assist identify tic disorders.

Three tic disorders are included in the DSM-5:

Tourette’s disorder (also called Tourette Syndrome [TS])
Persistent (also called chronic) motor or vocal tic disorder
Provisional tic disorder

The tic disorders differ in terms of the kind of tic present (motor or verbal, or a combination of both) and the duration of the symptoms. People with TS exhibit tic symptoms for at least a year and have both motor and verbal tics. People with chronic motor or vocal tic disorders have either motor or vocal tics and have been experiencing tic symptoms for at least a year. People with provisional tic disorders have motor or verbal tics, or both, but their symptoms have been present for less than a year.

Management

Treatment for facial tics varies according on the tic's nature and intensity. Many tics, such as those caused by transitory tic condition, may fade away over time if not treated. Tics that interfere with school or work performance may require therapy. Tics that endure a long time, such as those caused by Tourette's syndrome, may require more intensive therapy.

Treatment for tics may include:

Medication

Alpha-adrenergic agonists, neuroleptic medications, and dopamine blockers are some of the pharmaceuticals used to treat tics. Doctors may suggest Botox injections in the case of chronic facial tics or twitches. Botox injections can temporarily block facial muscles, which may be enough to prevent tic recurrence.

Any underlying diseases causing the tic, such as Tourette's syndrome or ADHD, can also be treated with medication.

Psychotherapy

Doctors may prescribe that a person meet with a psychotherapist on a regular basis to help them alter or remove their tics. Some persons may benefit from behavioral modification and habit reversal strategies to assist them overcome their tics and enhance their quality of life.

The person is usually taught to recognize when the tic is going to happen as part of the therapy. When a person is able to accomplish this, the therapist will urge them to try to replace the tic with another behavior. This may assist a person replace a physical habit with one that is less distracting or does not interfere with everyday functioning over time.

Surgery

In severe cases of facial tics, such as those caused by Tourette's syndrome, several surgical treatments may be helpful.

Deep brain stimulation is one surgical treatment option. Electrical currents may be able to reach particular parts of the brain via electrodes implanted in the brain, according to some experts, which might assist control brain waves and eliminate tics.

Deep brain stimulation may help ease symptoms of Tourette's syndrome, according to a recent study, but further research is needed to find the appropriate parts of the brain to stimulate.

Traditional Chinese medicine for treating facial tic

Dopaminergic receptor blockades and alpha-adrenergic agonists continue to be the first-line treatments for individuals requiring pharmaceutical therapy. Pharmacological therapies, on the other hand, have had limited therapeutic efficacy for certain individuals and have been hampered by a variety of adverse effects, including extrapyramidal symptoms, drowsiness, sleep disruption, and metabolic abnormalities.

Furthermore, nonpharmacologic treatment, such as cognitive-behavioral therapy, is currently unavailable in China. As a result, effective and safe therapies for TDs are desperately needed. Acupuncture has shown some benefits in the treatment of TDs in recent clinical investigations, and it is well tolerated.

Acupuncture, according to TCM philosophy, may regulate the balance of "Qi and blood," synchronize passageways, and dredge "meridian and collateral" by stimulating acupoints. Furthermore, the study discovered that acupuncture can improve blood infusion in malfunctioning brain areas.

Tourette’s syndrome

Tourette syndrome (TS) is a common hereditary neurological illness marked by persistent motor and vocal tics that appear before maturity. Repetitive, stereotyped actions or vocalizations, such as blinking, sniffing, facial motions, or abdominal muscle tensing, are common in affected persons.

Tics are aberrant movements or vocalizations that come in a variety of forms. They can be classified as motor or vocal/phonic, as well as simple or sophisticated. A single muscle or a group of muscles is involved in simple motor tics. Eye blinking, nose sniffing, coughing, neck twitching or jerking, eye rolling, and jerking or postured motions of the limbs are examples of basic motor tics.

Complex motor tics are unintended motions or activities that generally include many muscle groups. Touching oneself or others, striking, leaping, shaking, or executing a mimicked motor activity are all examples of complicated motor tics.

Simple phonic tics are vocalizations or noises that are simple in nature. Grunting, coughing, throat clearing, swallowing, blowing, or sucking noises are examples. Vocalizations of words and/or complicated sentences are known as complex phonic tics. These expressions might be complicated and socially incorrect at times.

Signs and symptoms

Tics are a wide range of abnormal motions or vocalizations. They can be simple or complicated, and they can be motor or vocal/phonic. A single muscle or set of muscles is used in simple motor tics. Eye blinking, nose sniffing, coughing, neck twitching or jerking, eye rolling, and jerking or postured motions of the limbs are only a few examples of basic motor tics.

Pathophysiology

The pathophysiology of TS is yet unclear. The concept that TS is a hereditary, developmental neurotransmission condition is supported by biochemical, imaging, neurophysiologic, and genetic research.

The pathophysiology of TS, as well as obsessive-compulsive disorder (OCD) and attention deficit–hyperactivity disorder (ADHD), has been linked to the basal ganglia and inferior frontal cortex (ADHD). However, neuropathological examinations have revealed no significant structural abnormalities in these locations.

According to volumetric MRI studies, the natural asymmetry of the basal ganglia is lost in afflicted people. The left putamen ordinarily predominates in healthy right-handed males, but this does not appear to be the case in TS, suggesting a developmental anomaly.

The involvement of the thalamus in the pathophysiology of TS is poorly understood. A recent investigation employing traditional volume and surface morphology measurements revealed thalamic enlargement of more than 5% in afflicted individuals of all ages. These findings show that TS may include previously unknown motor circuits and raise the prospect of activity-dependent hypertrophy.

Prognosis

TS nearly always lasts the rest of one's life. Fortunately, by the age of 18, around half of all patients are practically tic-free. The intensity of tic attacks peaks in early to mid adolescence and then declines. Tics can last throughout adulthood, although their intensity is usually reduced. Many people with tics have very regular lives. Mild tics, on the other hand, might be unpleasant.

One of the authors' patients, for example, is a guy with mild TS who has a successful professional job and a happy family life. He is used to his tics and does not want any therapy that has a significant negative effect on him. However, he finds his symptoms bothersome and would want to be rid of them if given the option. He claims, "It's as if I'm on stage for 16 hours a day. Every waking minute, I strive not to tic in front of others." Others with TS experience more severe symptoms. Occasionally, the symptoms might be incapacitating.

The most frequent type of impairment is one that is social in character. Patients who make loud vocalizations or big motions either face harsh judgment or withdraw from numerous activities. Prejudice is pervasive in the workplace and in schools. Tics also disrupt a person's conduct and cognition. Most patients report that their tics lead them to lose track of a conversation or that they take longer to accomplish a task.

Self-harm is a regular occurrence. Self-injury is sometimes purposeful and the result of a comorbid issue (eg, suicide during an episode of major depression). Sometimes self-injury is unintentional; for example, striking one's face repeatedly as a sophisticated tic.

What Do Doctors Do?

Facial tics are frequently temporary and will go away on their own. If a person has a tic that lasts more than a year, they should contact a doctor. Anyone who has tics that are severe, chronic, or involve many muscle groups should see a doctor for a correct diagnosis.

Although it is not always feasible to prevent facial tics, many of them do not require treatment and go away on their own. For persons who have chronic tics, there are treatments available to assist them control the tic. Some people may benefit from learning stress-relief strategies and consulting a therapist.

What Else Should I Know?

People who have tics frequently believe that their tic is the worst one ever. Of course, it isn't, but it is a concern for many individuals who have tics. And such fears can lead to unwarranted emotions of humiliation, exacerbating the tic. Nobody wants to aggravate tics, but is there a method to alleviate them? While tics cannot be cured, there are several simple things you may do to reduce their impact:

Don't pay attention to it. If you are aware that you have a tic, disregard it. Concentrating on it just makes matters worse.
Avoid stressful circumstances as much as possible Because stress aggravates tics.
Get adequate rest. Tics can be exacerbated by fatigue. So make sure you get a good night's sleep!
Let it all hang out! Holding back a tic may transform it into a ticking time bomb, ready to erupt. Have you ever had a cough and tried to prevent it? Didn't go so well, did it? It was most likely far worse. Tics are really similar.
Is it a tic? What is the tic? If a buddy has a tic, don't draw attention to it. Your pal is probably aware of the tic. Making a point of it simply makes the person think about it more.

Conclusion

The phrase "facial tic" refers to involuntary movements of the face, particularly those around the eyes and corners of the mouth. These motions are often short and do not last long. They are not frequently accompanied with the "squeezing" of the muscles surrounding the eyes that is associated with blepharospasm.

When a tic is minor and not creating any other difficulties, it is not usually necessary to seek treatment. Self-help advice, such as avoiding stress or exhaustion, are frequently highly beneficial to the majority of individuals. If a tic is severe and interfering with daily activities, treatments aimed at reducing the frequency of tics may be prescribed.