Editing Tic (section)

==Diagnosis==
{{main|Tic disorder}}
Tic disorders occur along a spectrum, ranging from mild (transient or chronic tics) to more severe; Tourette syndrome is the more severe expression of a spectrum of tic disorders, which are thought to be due to the same genetic vulnerability.<ref name=Zinner2000/> Nevertheless, most cases of Tourette syndrome are not severe.<ref name=Zinner2000>{{cite journal | pmid = 11077021 | volume=21 | title=Tourette disorder | date=November 2000 | author=Zinner SH | journal=Pediatr Rev | issue=11 | pages=372–83 | doi=10.1542/pir.21-11-372 | s2cid=7774922 }}</ref> Management for the spectrum of tic disorders is similar to the [[management of Tourette syndrome]].

Tic disorders are defined based on symptoms and duration.<ref name="DSM307.2">American Psychiatric Association (2013). ''Diagnostic and Statistical Manual of Mental Disorders'', 5th ed., pp. 81–85 {{isbn|978-0-89042-555-8}} [https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm01] {{Webarchive|url=https://web.archive.org/web/20170630140438/http://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm01|date=2017-06-30}}</ref> The fifth edition of the ''Diagnostic and Statistical Manual of Mental Disorders'' ([[DSM-5]]), published in May 2013, reclassified Tourette's and tic disorders as [[motor disorder]]s listed in the neurodevelopmental disorder category, removed the word "stereotyped" from the definition of ''tic'' to better distinguish between [[stereotypy|stereotypies]] and tics, replaced transient tic disorder with provisional tic disorder, removed the criterion that tics must occur nearly every day, and removed the criterion that previously had excluded long tic-free periods (months) from counting towards the year needed to diagnose Tourette's or Persistent (Chronic) tic disorders.<ref name=DSM307.2/><ref name=DSMV>[https://web.archive.org/web/20110510131026/http://www.dsm5.org/proposedrevision/Pages/NeurodevelopmentalDisorders.aspx Neurodevelopmental disorders.] [[American Psychiatric Association]]. Retrieved on December 29, 2011.</ref><ref name=Moran>{{cite journal | author = Moran M | year = 2013 | title = DSM-5 provides new take on neurodevelopment disorders | url = https://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2013.1b11 | journal = Psychiatric News | volume = 48 | issue = 2| pages = 6–23 | doi = 10.1176/appi.pn.2013.1b11 | url-access = subscription }}</ref><ref name=Highlights>[http://www.psychiatry.org/File%20Library/Practice/DSM/DSM-5/Changes-from-DSM-IV-TR--to-DSM-5.pdf "Highlights of changes from DSM-IV-TR to DSM-5" (PDF).]  American Psychiatric Association. 2013. Retrieved on June 5, 2013. {{webarchive |url=https://web.archive.org/web/20130203165749/http://www.psychiatry.org/File%20Library/Practice/DSM/DSM-5/Changes-from-DSM-IV-TR--to-DSM-5.pdf |date=February 3, 2013 }}</ref>

===Differential diagnosis===
[[Dystonia]]s, paroxysmal dyskinesias, [[choreia (disease)|chorea]], other genetic conditions, and secondary causes of tics should be ruled out in the [[differential diagnosis]].<ref name=Bagheri/> Conditions besides Tourette syndrome that may manifest tics or stereotyped movements include [[developmental disorder]]s, [[autism spectrum disorder]]s,<ref>{{cite journal | author = Ringman JM, Jankovic J | date = Jun 2000 | title = Occurrence of tics in Asperger's syndrome and autistic disorder | journal = J Child Neurol | volume = 15 | issue = 6| pages = 394–400 | pmid = 10868783 | doi = 10.1177/088307380001500608 | s2cid = 8596251 }}</ref> and [[stereotypic movement disorder]];<ref>{{cite journal | author = Jankovic J, Mejia NI | year = 2006 | title = Tics associated with other disorders | journal = Adv Neurol | volume = 99 | pages = 61–8 | pmid = 16536352 }}</ref><ref name=FreemanBlog>Freeman, RD. [http://www.tourette-confusion.blogspot.com/ Tourette's Syndrome: minimizing confusion]. Roger Freeman, MD, blog. Retrieved on February 8, 2006.</ref> [[Sydenham's chorea]]; [[idiopathic]] dystonia; and genetic conditions such as [[Huntington's disease]], [[neuroacanthocytosis]], [[pantothenate kinase-associated neurodegeneration]], [[Duchenne muscular dystrophy]], Wilson's disease, and [[tuberous sclerosis]]. Other possibilities include chromosomal disorders such as [[Down syndrome]], [[Klinefelter syndrome]], [[XYY syndrome]], and [[fragile X syndrome]]. Acquired causes of tics include drug-induced tics, head trauma, [[encephalitis]], [[stroke]], and [[carbon monoxide poisoning]].<ref name=Bagheri/><ref name=Mejia>{{cite journal | author = Mejia NI, Jankovic J | year = 2005 | title = Secondary tics and tourettism| journal = Rev Bras Psiquiatr | volume = 27 | issue = 1| pages = 11–17 | pmid = 15867978 | doi = 10.1590/s1516-44462005000100006 | doi-access = free }}</ref> Most of these conditions are rarer than tic disorders, and a thorough history and examination may be enough to rule them out, without medical or screening tests.<ref name=Zinner2000/>

Although tic disorders are commonly considered to be childhood syndromes, tics occasionally develop during adulthood; adult-onset tics often have a secondary cause.<ref>{{Cite web |url=http://cat.inist.fr/?aModele=afficheN&cpsidt=16202816 |title=Adult-onset tic disorder, motor stereotypies, and behavioural disturbance associated with antibasal ganglia antibodies |access-date=2008-06-05 |archive-url=https://web.archive.org/web/20090113115050/http://cat.inist.fr/?aModele=afficheN&cpsidt=16202816 |archive-date=2009-01-13 |url-status=dead }}</ref> Tics that begin after the age of 18 are not diagnosed as Tourette's syndrome, but may be diagnosed as an "other specified" or "unspecified" [[tic disorder]].<ref name=DSM307.2/>

Tests may be ordered as necessary to rule out other conditions: For example, when diagnostic confusion between tics and [[seizure]] activity exists, an [[Electroencephalography|EEG]] may be ordered, or symptoms may indicate that an [[MRI]] is needed to rule out brain abnormalities.<ref name=Assessment>{{cite journal | author = Scahill L, Erenberg G, Berlin CM Jr, Budman C, Coffey BJ, Jankovic J, Kiessling L, King RA, Kurlan R, Lang A, Mink J, Murphy T, Zinner S, Walkup J, Tourette | date = Apr 2006 | title = Contemporary assessment and pharmacotherapy of Tourette syndrome | journal = NeuroRx | volume = 3 | issue = 2| pages = 192–206 | doi = 10.1016/j.nurx.2006.01.009 | pmid = 16554257 | pmc = 3593444 }}</ref> [[Thyroid-stimulating hormone|TSH]] levels can be measured to rule out [[hypothyroidism]], which can be a cause of tics. [[Brain imaging]] studies are not usually warranted.<ref name=Assessment/> In teenagers and adults presenting with a sudden onset of tics and other behavioral symptoms, a [[urine drug screen]] for [[cocaine]] and [[stimulants]] might be necessary. If a family history of [[liver disease]] is present, serum copper and [[ceruloplasmin]] levels can rule out [[Wilson's disease]].<ref name=Bagheri>Bagheri, Kerbeshian & Burd (1999).</ref>

Individuals with [[obsessive–compulsive disorder]] (OCD) may present with features typically associated with a tic disorder, such as compulsions that may resemble motor tics. "Tic-related OCD" is hypothesized to be a subgroup of OCD, distinguished from non-tic-related OCD by the content and type of obsessions and compulsions; individuals with tic-related OCD have more [[intrusive thoughts]], and exhibit more hoarding and counting rituals than individuals with non-tic-related OCD.<ref name=Hounie>{{cite journal | author = Hounie AG, do Rosario-Campos MC, Diniz JB | display-authors = etal | year = 2006 | title = Obsessive-compulsive disorder in Tourette syndrome | journal = Adv Neurol | volume = 99 | pages = 22–38 | pmid = 16536350 }}</ref>

Tics must also be distinguished from [[fasciculation]]s. Small twitches of the upper or lower eyelid, for example, are not tics, because they do not involve a whole muscle, rather are twitches of a few muscle fibre bundles, that are not suppressible.<ref>
{{cite journal|url= https://d1wqtxts1xzle7.cloudfront.net/62154985/22._TIC_10.1920200220-73731-xvf2fo.pdf?1582237254=&response-content-disposition=inline%3B+filename%3DTic_disorder_definition_clinical_context.pdf&Expires=1594852037&Signature=M5jspfaapRSdO3HtflIOLfUA1LTFzYnhBpyq5WKoNWvzokN-ZBxxGQupdgroalVSF7iBch5mBOygBYllUqPrCV1KRaVVUd-MWHovSHFFjnEGVdW-2sdHUQXejhXVx-0DfMZVufscBG7Dvl~4dR8u50E0KAECaP69SxN2aaA3Q3Vpf3ivoOCU9fj8WqxUsqJgelEnq6smwiXU5zujC90xyDvetTTfJYZweNEobMH-cqY0sTMjWXmH~-mCX8O6SKa0Lf1RdvDgXO-FLPml36Zf20sD6RR8IO1poxgtPsIrZ632qJL23ELOQTnDwUUNDkNBnz0YJU6hyxFLTGYBy0mz1w__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA |archive-url= https://web.archive.org/web/20200715213358/https://d1wqtxts1xzle7.cloudfront.net/62154985/22._TIC_10.1920200220-73731-xvf2fo.pdf?1582237254=&response-content-disposition=inline%3B+filename%3DTic_disorder_definition_clinical_context.pdf&Expires=1594852037&Signature=M5jspfaapRSdO3HtflIOLfUA1LTFzYnhBpyq5WKoNWvzokN-ZBxxGQupdgroalVSF7iBch5mBOygBYllUqPrCV1KRaVVUd-MWHovSHFFjnEGVdW-2sdHUQXejhXVx-0DfMZVufscBG7Dvl~4dR8u50E0KAECaP69SxN2aaA3Q3Vpf3ivoOCU9fj8WqxUsqJgelEnq6smwiXU5zujC90xyDvetTTfJYZweNEobMH-cqY0sTMjWXmH~-mCX8O6SKa0Lf1RdvDgXO-FLPml36Zf20sD6RR8IO1poxgtPsIrZ632qJL23ELOQTnDwUUNDkNBnz0YJU6hyxFLTGYBy0mz1w__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA |url-status= dead |archive-date= 2020-07-15 |title= Tic disorder: definition, clinical contexts, differential diagnosis, neural correlates and therapeutic approaches |publisher= MeDOA Publications |journal= Journal of Neuroscience and Rehabilitation |date= 2019 |volume= 2019 |issue= 1 |vauthors= Perrotta G |quote= Tics must also be distinguished from fasciculations. Small contractions of the upper or lower eyelid, for example, are not tics, because they do not involve an entire muscle. They are contractions of some bundles of muscle fibres, which can be felt but just seen. These contractions of the eyelids also differ from tics in that they are not suppressible, are strictly involuntary and tend to fade after a day or two.}}</ref>