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Neurology (Expert Forum)
MULTIPLE FACIAL TICS
Answered by
Lama Chahine, MD - Neurology
Cleveland Clinic
Cleveland - OH
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.
MULTIPLE FACIAL TICS
by lee2009, May 10, 2009 09:46AM
I have facial tics. I would like to know if the drug Tetrabenazine could help me. I am desperate for some answers.
Thank you.
Thank you.
Doctor's Answer
by Lama Chahine, MD, May 10, 2009 03:47PM
, May 10, 2009 03:47PM
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.
I am not sure whether or not your diagnosis of tics was a diagnosis you received from a neurologist, but if not, the contraction of your face may be due to hemifacial spasm, a type of muscle contraction referred to as segmental myoclonus. Hemifacial spasm can be due to an abnormality in the lower part of the brain called the brainstem or surrounding structures. However, in most patients, no MRI abnormality is found, and the cause in most people is thought to be due to dysfunction of the 7th cranial nerve with no specific cause found. The treatment often is with botox injections to medically paralyze part of the muscle. Hemifacial spasm is a clinical diagnosis.
If you have been diagnosed with tics, tics are of several types. They are movements of vocalizations that are associated with an urge that is only briefly suppressible. They can be simple motor tics, such as blinking of the eyes or shrugging of the shoulders, or they can be complex motor tics, resembling a purposeful movement. Tics can also be vocal, such as grunting or verbalizing. Tics can occur in isolation or they may occur as part of Tourette's syndrome. In order for Tourette's to be diagnosed, there must be both motor and vocal tics that occur for over 1 year and start before the age of 18, and are not attributable to other causes.
Sometimes, certain movements a person has may resemble tics but in fact the movements may be something else, such as a complex habit or what is called a stereotypy. Other possibilities include myoclonus or even seizures. You may benefit from evaluation by a neurologist and even a movement disorder specialist, who may be able to better characterize your movement and confirm whether or not it is in fact a tic. He/she can evaluate you and confirm the diagnosis of tics. Together, you can decide whether or not treatment of your tics is indicated and which treatment is best.
The treatment of tics, whether in isolation, or as part of Tourette's, involves one of several medications. These include medications that block dopamine, the chemical in the brain thought to contribute to the occurrence of tics. The important thing to remember is that unless tics are socially disabling, causing discomfort for the person who has them or impairing function, they do not necessarily have to be treated. Any medication has side effects, and treatment should therefore be weighed against no treatment at all.
Medications that are used to treat tics are in general medications that block the chemical dopamine in the brain. Once class of medications useful for the treatment of tics are antipsychotics, such as haloperidol, pimozide, or fluphenazine (these are the generic names, trade names will vary by country) (they are used to treat psychosis such as occurs with schizophrenia but are also used to treat tics). Another type of this class of medications is risperdone, olanzapine (zyprexa), and ziprasidone. Tetrabenazine is also a dopamine-blocking medication, used more often for a wavy type of abnormal movement called chorea, it can also be used for tics but less commonly so. Tenex, which is generic name guanfacine, and clonidine, which is not a dopamine blocker but acts differently, are also medications that can also be used for tics. Each have their side effects but they are in general safe and are often effective in suppressing tics. Some recent research has shown that behavioral therapy may be helpful to some individuals.
As you can see there are several options for the treatment of tics, each has its risks and side effects but if the tics are bothersome to the patient (either physically or socially due to embarrassment) treatment may be indicated, and I recommend you discuss this further with your neurologist.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.
I am not sure whether or not your diagnosis of tics was a diagnosis you received from a neurologist, but if not, the contraction of your face may be due to hemifacial spasm, a type of muscle contraction referred to as segmental myoclonus. Hemifacial spasm can be due to an abnormality in the lower part of the brain called the brainstem or surrounding structures. However, in most patients, no MRI abnormality is found, and the cause in most people is thought to be due to dysfunction of the 7th cranial nerve with no specific cause found. The treatment often is with botox injections to medically paralyze part of the muscle. Hemifacial spasm is a clinical diagnosis.
If you have been diagnosed with tics, tics are of several types. They are movements of vocalizations that are associated with an urge that is only briefly suppressible. They can be simple motor tics, such as blinking of the eyes or shrugging of the shoulders, or they can be complex motor tics, resembling a purposeful movement. Tics can also be vocal, such as grunting or verbalizing. Tics can occur in isolation or they may occur as part of Tourette's syndrome. In order for Tourette's to be diagnosed, there must be both motor and vocal tics that occur for over 1 year and start before the age of 18, and are not attributable to other causes.
Sometimes, certain movements a person has may resemble tics but in fact the movements may be something else, such as a complex habit or what is called a stereotypy. Other possibilities include myoclonus or even seizures. You may benefit from evaluation by a neurologist and even a movement disorder specialist, who may be able to better characterize your movement and confirm whether or not it is in fact a tic. He/she can evaluate you and confirm the diagnosis of tics. Together, you can decide whether or not treatment of your tics is indicated and which treatment is best.
The treatment of tics, whether in isolation, or as part of Tourette's, involves one of several medications. These include medications that block dopamine, the chemical in the brain thought to contribute to the occurrence of tics. The important thing to remember is that unless tics are socially disabling, causing discomfort for the person who has them or impairing function, they do not necessarily have to be treated. Any medication has side effects, and treatment should therefore be weighed against no treatment at all.
Medications that are used to treat tics are in general medications that block the chemical dopamine in the brain. Once class of medications useful for the treatment of tics are antipsychotics, such as haloperidol, pimozide, or fluphenazine (these are the generic names, trade names will vary by country) (they are used to treat psychosis such as occurs with schizophrenia but are also used to treat tics). Another type of this class of medications is risperdone, olanzapine (zyprexa), and ziprasidone. Tetrabenazine is also a dopamine-blocking medication, used more often for a wavy type of abnormal movement called chorea, it can also be used for tics but less commonly so. Tenex, which is generic name guanfacine, and clonidine, which is not a dopamine blocker but acts differently, are also medications that can also be used for tics. Each have their side effects but they are in general safe and are often effective in suppressing tics. Some recent research has shown that behavioral therapy may be helpful to some individuals.
As you can see there are several options for the treatment of tics, each has its risks and side effects but if the tics are bothersome to the patient (either physically or socially due to embarrassment) treatment may be indicated, and I recommend you discuss this further with your neurologist.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
