Editing Tourette syndrome (section)

=== Tics ===
[[File:Tourette's tic long medium 192kbps.OGG|thumb|thumbtime=3|Examples of tics]]
[[Tic]]s are movements or sounds that take place "intermittently and unpredictably out of a background of normal motor activity",<ref name=TSADef>{{cite journal |title=Definitions and classification of tic disorders. The Tourette Syndrome Classification Study Group |journal=Arch. Neurol. |volume=50 |issue=10 |pages=1013–1016 |date=October 1993 |pmid=8215958 |doi=10.1001/archneur.1993.00540100012008 | type= Research support |url= http://www.tsa-usa.org/research/definitions.html |archive-url=https://web.archive.org/web/20060426232033/http://www.tsa-usa.org/research/definitions.html |archive-date=April 26, 2006 }}</ref> having the appearance of "normal behaviors gone wrong".<ref name=Dure>{{cite journal |vauthors=Dure LS, DeWolfe J |title=Treatment of tics |journal=Adv Neurol |volume=99 |pages=191–196 |date=2006 |pmid=16536366 |type= Review}}</ref> The tics associated with Tourette's [[wikt:wax and wane|wax and wane]]; they change in number, frequency, severity, anatomical location, and complexity;<ref name=EuropeanPartI>{{cite journal |vauthors=Szejko N, Robinson S, Hartmann A, et al |title=European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part I: assessment |journal=Eur Child Adolesc Psychiatry |date=October 2021 |volume=31 |issue=3 |pages=383–402 |pmid=34661764 |pmc=8521086 |doi=10.1007/s00787-021-01842-2}}</ref> each person experiences a unique pattern of fluctuation in their severity and frequency. Tics may also occur in "bouts of bouts", which also vary among people.<ref name= Hash2017>{{cite journal |vauthors=Hashemiyoon R, Kuhn J, Visser-Vandewalle V |title=Putting the pieces together in Gilles de la Tourette Syndrome: exploring the link between clinical observations and the biological basis of dysfunction |journal=Brain Topogr |volume=30 |issue=1 |pages=3–29 |date=January 2017 |pmid=27783238 |pmc=5219042 |doi=10.1007/s10548-016-0525-z |type= Review}}</ref> The variation in tic severity may occur over hours, days, or weeks.<ref name= Dale2017 /> Tics may increase when someone is experiencing stress, fatigue, anxiety, or illness,<ref name= Fernandez>{{cite book |vauthors=Fernandez TV, State MW, Pittenger C |title=Neurogenetics, Part I |chapter=Tourette disorder and other tic disorders |series=Handbook of Clinical Neurology |volume=147 |pages=343–354 |date=2018 |pmid=29325623 |doi=10.1016/B978-0-444-63233-3.00023-3 |type= Review |isbn=978-0-444-63233-3 }}</ref><ref name= Ludlow2018 /> or when engaged in relaxing activities like watching TV. They sometimes decrease when an individual is engrossed in or focused on an activity like playing a musical instrument.<ref name= Fernandez />{{sfnp|Sukhodolsky|Gladstone|Kaushal|Piasecka|2017|p= 243}}

In contrast to the abnormal movements associated with other [[movement disorder]]s, the tics of Tourette's are nonrhythmic, often preceded by an unwanted urge, and temporarily suppressible.<ref name= Hash2017 /><ref name=Jankovic2001>{{cite journal |vauthors=Jankovic J |title=Differential diagnosis and etiology of tics |journal=Adv Neurol |volume=85 |pages=15–29 |date=2001 |pmid=11530424 |type= Review}}</ref> Over time, about 90% of individuals with Tourette's feel an urge preceding the tic,<ref name= Dale2017>{{cite journal |vauthors=Dale RC |title=Tics and Tourette: a clinical, pathophysiological and etiological review |journal=Curr. Opin. Pediatr. |volume=29 |issue=6 |pages=665–673 |date=December 2017 |pmid=28915150 |doi=10.1097/MOP.0000000000000546 |s2cid=13654194 |type= Review}}</ref> similar to the urge to sneeze or scratch an itch. The urges and sensations that precede the expression of a tic are referred to as premonitory [[sensory phenomena]] or [[premonitory urge]]s. People describe the urge to express the tic as a buildup of tension, pressure, or energy<ref name=Prado>{{cite journal |vauthors=Prado HS, Rosário MC, Lee J, Hounie AG, Shavitt RG, Miguel EC |title=Sensory phenomena in obsessive-compulsive disorder and tic disorders: a review of the literature |journal=CNS Spectr |volume=13 |issue=5 |pages=425–432 |date=May 2008 |pmid=18496480 |doi=10.1017/s1092852900016606 |s2cid=5694160 |type= Review and meta-anlysis |url=http://www.cnsspectrums.com/aspx/article_pf.aspx?articleid=1540 |archive-url=https://web.archive.org/web/20120210003420/http://www.cnsspectrums.com/aspx/article_pf.aspx?articleid=1540 |url-status=dead |archive-date=February 10, 2012 }}</ref><ref>{{cite journal |vauthors=Bliss J |title=Sensory experiences of Gilles de la Tourette syndrome |journal=Arch. Gen. Psychiatry |volume=37 |issue=12 |pages=1343–1347 |date=December 1980 |pmid=6934713 |doi=10.1001/archpsyc.1980.01780250029002 }}</ref> which they ultimately choose consciously to release, as if they "had to do it"<ref name=Kwak>{{cite journal |vauthors=Kwak C, Dat Vuong K, Jankovic J |title=Premonitory sensory phenomenon in Tourette's syndrome |journal=Mov. Disord. |volume=18 |issue=12 |pages=1530–1533 |date=December 2003 |pmid=14673893 |doi=10.1002/mds.10618 |s2cid=8152205 }}</ref> to relieve the sensation<ref name=Prado /> or until it feels "just right".<ref name=Kwak /><ref name=Swain /> The urge may cause a distressing sensation in the part of the body associated with the resulting tic; the tic is a response that relieves the urge in the anatomical location of the tic.<ref name=Stern2018 /><ref name= Hash2017 /> Examples of this urge are the feeling of having something in one's throat, leading to a tic to clear one's throat, or a localized discomfort in the shoulders leading to shrugging the shoulders. The actual tic may be felt as relieving this tension or sensation, similar to scratching an itch or blinking to relieve an uncomfortable feeling in the eye.<ref name= Stern2018 /><ref name= TSADef /> Some people with Tourette's may not be aware of the premonitory urge associated with tics. Children may be less aware of it than are adults,<ref name=Dale2017 /> but their awareness tends to increase with maturity;<ref name=TSADef /> by the age of ten, most children recognize the premonitory urge.{{sfnp|Sukhodolsky|Gladstone|Kaushal|Piasecka|2017|p= 243}}

Premonitory urges which precede the tic make suppression of the impending tic possible.<ref name= Hash2017 /> Because of the urges that precede them, tics are described as semi-voluntary or "''unvoluntary''",<!-- Please do NOT CHANGE "UNVOLUNTARY" to "INVOLUNTARY"; it is not a typo, it is the correct term, please read the text and the references. --><ref name=Stern2018 /><ref name=TSADef /> rather than specifically ''involuntary''; they may be experienced as a ''voluntary'', suppressible response to the unwanted premonitory urge.<ref name= Hash2017 />{{sfnp|Sukhodolsky|Gladstone|Kaushal|Piasecka|2017|p= 243}} The ability to suppress tics varies among individuals, and may be more developed in adults than children.<ref name= Ludolph2012 /> People with tics are sometimes able to suppress them for limited periods of time, but doing so often results in tension or mental exhaustion.<ref name=Stern2018 />{{sfnp|Müller-Vahl|2013|p=629}} People with Tourette's may seek a secluded spot to release the suppressed urge, or there may be a marked increase in tics after a period of suppression at school or work.<ref name= Dale2017 /><ref name=Dure /> Children may suppress tics while in the doctor's office, so they may need to be observed when not aware of being watched.<ref name=emed>{{cite web | vauthors = Black KJ |url= http://emedicine.medscape.com/article/1182258-overview |title= Tourette syndrome and other tic disorders |archive-url=https://web.archive.org/web/20090822025931/http://emedicine.medscape.com/article/1182258-overview |archive-date=August 22, 2009 |publisher= eMedicine |date= March 30, 2007 |access-date= August 10, 2009}}</ref>

Complex tics related to speech include [[coprolalia]], [[echolalia]] and [[palilalia]]. Coprolalia is the spontaneous utterance of socially objectionable or taboo words or phrases. Although it is the most publicized symptom of Tourette's, only about 10% of people with Tourette's exhibit it, and it is not required for a diagnosis.<ref name=Stern2018 /><ref name=Singer2011>{{cite book |vauthors=Singer HS |volume=100 |pages=641–657 |date=2011 |pmid=21496613 |doi=10.1016/B978-0-444-52014-2.00046-X |type= Historical review |series=Handbook of Clinical Neurology |isbn=978-0-444-52014-2 |chapter=Tourette syndrome and other tic disorders |title=Hyperkinetic Movement Disorders |publisher=Elsevier }} Also see {{cite journal |vauthors=Singer HS |title=Tourette's syndrome: from behaviour to biology |journal=Lancet Neurol |volume=4 |issue=3 |pages=149–59 |date=March 2005 |pmid=15721825 |doi=10.1016/S1474-4422(05)01012-4 |s2cid=20181150 |type= Review}}</ref> Echolalia (repeating the words of others) and palilalia (repeating one's own words) occur in a minority of cases.<ref name=phenomenology>{{cite journal |vauthors=Leckman JF, Bloch MH, King RA, Scahill L |title=Phenomenology of tics and natural history of tic disorders |journal=Adv Neurol |volume=99 |pages=1–16 |date=2006 |pmid=16536348 |type= Historical review}}</ref> Complex motor tics include [[copropraxia]] ([[obscene gestures|obscene or forbidden gestures]], or inappropriate touching), [[echopraxia]] (repetition or imitation of another person's actions) and [[palipraxia]] (repeating one's own movements).<ref name=Ludolph2012>{{cite journal |vauthors=Ludolph AG, Roessner V, Münchau A, Müller-Vahl K |title=Tourette syndrome and other tic disorders in childhood, adolescence and adulthood |journal=Dtsch Ärztebl Int |volume=109 |issue=48 |date=November 2012 |pages=821–828 |pmid=23248712 |pmc=3523260 |doi=10.3238/arztebl.2012.0821 |type=Review}}</ref>