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Facial tics

Definition

A facial tic is a repeated spasm, often involving the eyes and muscles of the face.

Alternative Names

Tic - facial; Mimic spasm

Causes, incidence, and risk factors

Tics most often occur in children, but may last into adulthood in some cases. Tics occur three to four times as often in boys as girls. Tics may affect as many as one-fourth of all children at some time.

The cause of tics is unknown, but stress appears to make tics more severe.

Short-lived tics (transient tic disorder) are common in childhood.

Certain medications, such as methylphenidate (used to treat hyperactivity in children), were previously thought to cause tics in children already prone to the disorder. However, recent studies do not support this idea, and suggest that these medications can be used in children with tics who also have attention-deficit disorder (which often occurs in the same group of children).

A chronic motor tic disorder also exists. It may last for years. This form is very rare compared to the common short-lived childhood tic. Gilles de la Tourette syndrome is a separate condition in which tics are a major symptom.

Symptoms

• Repeated, uncontrolled spasm-like muscle movements, such as:
  • Eye blinking
  • Grimacing
  • Mouth twitching
  • Nose wrinkling
  • Squinting
• Repeated throat clearing or grunting

Signs and tests

The health care provider will usually diagnose a tic during a physical examination. No special tests are needed. In rare cases an EEG may be done to rule out seizures.

Treatment

Short-lived childhood tics are not treated. Calling the child's attention to a tic may make it worse or cause it to continue. A nonstressful environment can reduce the frequency of tics, and help them go away more quickly. Stress reduction programs may also be helpful.

If tics are disabling, medications such as clonidine or risperdal (Risperidone) may help control them.

Support Groups

Expectations (prognosis)

Simple childhood tics should go away on their own over a period of months. Chronic tics may continue for a longer period of time.

Complications

In most cases, there are no complications.

Calling your health care provider

Call for an appointment with your health care provider if tics:

• Affect many muscle groups
• Are persistent
• Are severe

Prevention

Many cases cannot be prevented. Reducing stress may be helpful. Sometimes counseling can help your child learn how to cope with stress.

References

Bostic JQ, Prince JB. Child and adolescent psychiatric disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 69.

Jankovic J, Lang AE. Movement disorders: Diagnosis and assessment. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann; 2008:chap 23.

Johnston MV. Movement disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 597.