TIC

[lee2009]

I have this VERY bothersome tic.  I have been to many Neurologists.  Nobody can seem to help to me.  This latest Neurologist prescribed 1mg of Tenex, which I have been taking for 2 weeks and do not see any change.  Can Tenex help a Tic.

Do you have any other suggestions?  I am Desperate.  

[Lama Chahine, MD]

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.

It sounds like you have been suffering from tics. While I can not directly recommend a treatment without examining you and obtaining a history, I will try to provide  you with some information.

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.You may benefit from evaluation by 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 and whether or not you have Tourette's. Together, you can decide whether or not treatment of your tics is indicated.

I will continue this answer on a separate post due to word count limitations imposed by the website.

[Lama Chahine, MD]

answer continued

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. In very severe cases of Tourette's in young people, there is a surgery called deep brain stimulation which can be tried, but this is still new and under research.

Tenex, which is generic name guanfacine, and clonidine are 2 medications that can 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. Another 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). However, these medications commonly cause bothersome side effects. Another type of this class of medications is risperdone, olanzapine (zyprexa), and ziprasidone.

TIcs increase in times of stress and can also be seasonal, worsening during particular times of the year. Avoiding stress and treating underlying psychiatric problems such as anxiety may help the tics.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.