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Tics, Shakes & Tremors

This article is posted in: patients wuth abnormal (hyperkinetic) movements, tics, or tremors:....

The initial "Clinical and Compasionate Approach to Managing Tics and Twitches"

In my office was (yesterday) was a 5 year old and her Mommy who who rather insightful; here's how she dealt with her child's tics including the eyes sqinching, shoulders moving, head bobbing ans so forth--by purposefully ignoring all of it. She says, despite it hurting her, the parent, this is whst must happen--totally ignore the matter and only discuss it as s/he begins controlling it.  Mom also feels she had to relax on the cleaning, etc. (as in the child feels the anxiety and the discomfiture implied in strictness, rules and attempts to exert control).

From a reader:  I hadn't got a chance to read this [below] fascinating Delancey Place article about how habits are formed. Reminds me of behavior modification class I took in college.  Hopefully ____'s tics are just transient.  She definitely has that habit forming loop (cue, routine, reward) established although it sort of evolves.  For example her hard blink is now a flutter but she definitely has a 3 tic routine- eye, neck thrust back/then tuck, followed by a thumping jump.  I just wonder what the reward is.  I'm hoping it is some relief from symptoms of enlarged adenoids which come out weds.  I hope her habit isn't too entrenched."

From: 3/16/12 - habits are controlled by your basal ganglia cells; 

[W]hen a habit is formed, that activity is governed by your basal ganglia cells, in a region completely separate from the primary cognitive areas of your brain. That's why you can brush your teeth or give someone your phone number without giving it the slightest thought, and while thinking intensely about something completely different....

Habits, scientists say, emerge because the brain is constantly look­ing for ways to save effort. Left to its own devices, the brain will try to make almost any routine into a habit, because habits allow our minds to ramp down more often.

"This process within our brains is a three-step loop. First, there is a cue, a trigger that tells your brain to go into automatic mode and which habit to use. Then there is the routine, which can be physical or mental or emotional. Finally, there is a reward, which helps your brain figure out if this particular loop is worth remembering for the future. Over time, this loop-cue, routine, reward; cue, routine, reward-becomes more and more automatic. The cue and reward become intertwined until a powerful sense of anticipation and crav­ing emerges. Eventually a habit is born.      

"Habits aren't destiny. [They] can be ignored, changed, or replaced. But the reason the discovery of the habit loop is so important is that it reveals a basic truth: When a habit emerges, the brain stops fully participating in decision mak­ing. It stops working so hard, or diverts focus to other tasks. So un­less you deliberately fight a habit - unless you find new routines - the pattern will unfold automatically. However, simply understanding how habits work - learning the structure of the habit loop - makes them easier to control. Once you break a habit into its components, you can fiddle with the gears."

Author: Charles Duhigg    Title: The Power of Habit   Publisher: Random House
Date: Copyright 2012 by Charles Duhigg  Pages: 17-20

Of those with tics [they can't be distracted from them] between 0.4% and 3.8% of 5-18 year old children may have Tourette's Syndrome, however, the prevalence of transient and chronic tics in school-age children is higher, with the more common tics of eye blinking, coughing, throat clearing, sniffing, and facial movements. Also, extreme Tourette's in adulthood is a rarity, and Tourette's does not adversely affect intelligence or life expectancy. [See Wikipedia]

Habit reversal (HR) is worth considering, early.  I'm referring to a form of behavioral treatment that can be used to reduce repetitive behaviors that are bothersome and serve no adaptive function--examples: tics, hair-pulling, and nervous habits. HR was first developed in the 1970s, and has since been used in the treatment of several repetitive behavior disorders, particularly tic disorders. 

  • Many drugs such as neuroleptics used in the management of ADD, ADHD and distractibility-hyperkinesis syndromes, tamoxifen, amiodarone, and valproate, to name a few, can cause tremor, facial grimaces, etc.
  • The most effective drugs to use when attempting to treat intention tremor are propranolol or primidone.
  • Many abnormal movements can be helped by specific drug treatment or botox.
  • Tremor or dystonia may be due to Wilson's disease [where you cannot properly metabolize copper].
  • Restless leg syndrome may be due to low ferritin (iron storage) concentrations, and improve with iron therapy.

Source: Fuller G. "The Bare Essentials; Hyperkinetic Movement Disorders: Shakes, Jumps and Jolts." Practical Neurology 2010;10:114-123

Click here to learn more about Tics and Tourette's Disorders from the NYU Child Study Center.  

For more general information on Tics & Tourette Syndrome

Information is also available from the following organizations:

Tourette Syndrome Association
42-40 Bell Boulevard; Suite 205
Bayside, NY  11361-2820
Tel: 718-224-2999 888-4-TOURET (486-8738);  Fax: 718-279-9596

Publicaciones en Español

Prepared by: Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute's Brain Resources and Information Network (BRAIN) at:

P.O. Box 5801
Bethesda, MD 20824
(800) 352-9424 

<https:"" "="" style="color: rgb(0, 39, 130); font-family: inherit; font-size: inherit; font-weight: bold; ">"Tourette Syndrome Fact Sheet,"  Pub. Sept. 2011. (NIH Pub. No. 11-2163)

     See also other NINDS Disorders