How is the volition of tics characterized in Tourette syndrome (TS) and other tic disorders?

Updated: May 30, 2019
  • Author: William C Robertson, Jr, MD; Chief Editor: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP  more...
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Tics are nearly unique compared with other movement disorders in the perceived degree of volition. Although tics are clearly not voluntary in the usual sense (no one decides to have tics), the term involuntary is not strictly accurate.

Often in children and occasionally in adults, tics appear to be truly involuntary: The person tics without awareness or without a sense of voluntary movement. However, when pressed for details, adults describe most tics as a volitional response to an irresistible impulse, rather than an involuntary movement. [144] For example, patients often say, "I shake my head" rather than "my head shakes."

One of the authors' patients tried to describe his tics to people who have not experienced them: "Think of the last time you were at the symphony or at church and you had a tickle in your throat. Maybe you could hold it back until the end of the quiet movement or the end of the prayer, but then you just had to cough or clear your throat. This is something like what it feels like to have a tic, but with TS it is happening throughout the day, every day."

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