Please see next page "All about Symptoms" which explains the types of "tics" and gives many examples of each type of "tic"
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The varied symptoms of TS can be divided into motor, vocal, and behavioral manifestations. Simple motor tics are fast, darting, meaningless muscular events. They can be embarrassing or even painful. They are easily distinguished from simple muscular twitches or rapid fasciculations, like blinking. Complex motor tics are often slower, more purposeful in appearance, and more easily described with terms used for deliberate actions. Complex motor tics can be virtually any type of movement that the body can produce including hopping, clapping, tensing arm or neck muscles, touching people or things, and obscene gesturing.
At some point in the continuum of complex motor tics, the term "compulsion" seems appropriate for capturing the organized, ritualistic character of the actions. The need to do and then redo or undo the same action a certain number of times is compulsive in quality and accompanied by considerable internal discomfort. Complex motor tics may greatly impair school work, ie: when a child must stab a notebook with a pencil or must go over the same letter so many times that the paper is worn thin. Self-destructive behaviors, such as head-banging, eye poking, and lip biting may occur.
Vocal tics extend over a similar spectrum of complexity and disruption as motor tics. With simple vocal tics, patients emit linguistically meaningful words, phrases, sentences. Vocal symptoms may interfere with the smooth flow of speech and resemble a stammer, stutter, or other speech irregularities. Often, but not always, vocal symptoms occur at points of linguistic transition, such as at the beginning of a sentence where there may be blocking or difficulties in the initiation of speech, or at phrase transitions. Patients suddenly may alter speech volume, slur a phrase, emphasize a word, or assume an accent.
The most socially distressing complex vocal symptom is coprolalia, the explosive utterance of foul or "dirty" word or more elaborate sexual and aggressive statements. While coprolalia occurs in only a minority of TS patients (from 5-40%), it remains the most well known symptom of TS. It should be emphasized that a diagnosis of TS does not require that coprolalia is present.
Some TS patients may have a tendency to imitate what they have just seen, heard, or said. For example, the patient may feel an impulse to imitate another's body movements, to speak with an odd inflection, or to accent a syllable just the way it has been pronounced by another person. Such modeling or repetition may lead to the onset of new specific symptoms that will wax and wane in the same way as other TS patients.
The symptoms of TS can be characterized as mild, moderate, or severe by their frequency, their complexity, and the degree to which they cause impairment or disruption of the patient's ongoing activities and daily life. For example, extremely frequent tics that occur 20-30 times a minute, such as blinking, nodding, or arm flexion, may be less distruptive than an infrequent tic that occurs several times an hour, such as loud barking, coprolalic utterances, or touching tics.
There may be tremendous variability over short periods of time in symptomatology, frequency, and severity. Patients may be able to inhibit or not feel a great need to emit their symptoms while at work or school. When they arrive home, however, the tics may erupt with violence and remain at a ditressing level throughout the remainder of the day.
It is not unusual for patients to "lose" their tics as they enter the doctor's office. Parents may plead with a child to "show the doctor what you do at home," only to be told that the youngster "just doesn't feel like doing them" or "can't do them" on command. Adults will say "I only wish you could see me outside of your office," and family members will heartily agree.
A patient with minimal symptoms may display more usual severe tics when the examination is over. Thus, for example, the doctor often sees a nearly symptom-free patient leave the office who begins to hop, flail, or bark as soon as the street or even the bathroom is reached.
In addition to the moment-to-moment or short-term changes in symptom intensity, many patients have oscillations in severity over the course of weeks and months. The waxing and waning of severity may be triggered by chances in the patient's life, for example, around the time of holidays, children may develop exacerbations that take weeks to subside. Other patients report that their symptoms show seasonal fluctuation. However, there are no rigorous data on whether life events, stresses, or seasons, in fact, do influence the onset or offset of a period of exacerbation. Once a patient enters a phase of waxing symptomatology, a process seems to be triggered that will run its course, usually within 1-3 months.
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