Acute Onset Functional Tics

What are tics?

Tics are sudden, rapid, recurrent movements or sounds that are not rhythmic. They may be simple or complex. Tics are referred to as complex if they include more than one simple movement, or involve a combination of different movements or sounds.

Tics can be seen in different neurological conditions. Tourette disorder is characterized by the presence of at least two motor tics and one vocal tic present before the age of 18. Tics can also occur as part of a functional neurological disorder (FND), in which case they are referred to as ‘functional tics’.   

How are acute onset functional tics different from the typical tics seen in Tourette's disorder?

The tics that are seen in Tourette disorder often start in early childhood, between the ages of four and seven. Tics typically follow a waxing and waning pattern over the course of years, and start with simple motor and vocal tics such as eye blinking, nose twitching, or sniffing. Complex tics may develop several years later, and can involve hand gestures or repetition of words or sounds. Often the affected individual feels an urge to tic, and experiences relief after performing the tic. They are also able to suppress the tic for a short period of time.

The tics seen in acute onset functional tic disorder often start rapidly and increase in severity over a very brief period of time, commonly on the order of hours to days. Tic-like movements or sounds are often complex, without a prior history of simple motor or vocal tics. Tics may interfere with normal actions, which would be uncommon for tics seen in Tourette disorder. Affected individuals may or may not feel an urge to tic, and may not have an ability to temporarily suppress their tics. Functional tics are most commonly seen in teenagers and young adults, and are more common in females.

Can someone have functional tics and Tourette's disorder?

While many individuals impacted by acute-onset functional tics do not have prior history of Tourette's disorder, sometimes the situation is more complicated. It is in fact possible to have both Tourette's disorder as well as functional tics. In this case, it is important to work with your healthcare provider to determine the main issue, given that treatments may vary.

What causes functional tics?

Over the last several years, there has been an increasing number of individuals presenting with functional tics. There are a number of factors hypothesized to contribute to this “pandemic” of functional tics. The rise in functional tics appears to have begun around the time of the COVID-19 pandemic; the stress and social isolation of the COVID-19 pandemic may have served as potential risk factors or triggers. In addition, many individuals with acute-onset functional tics have had exposure to tic-like behaviors on social media platforms such as TikTok. The popularity of videos showing this tic-like behavior has grown significantly during the pandemic. The psychological and social stressors of the pandemic, combined with this exposure to tic-like behavior on social media, could potentially be contributing to the increasing number of individuals impacted by acute onset functional tics.

How are acute onset functional tics treated?

In general, behavioral therapy rather than medication is recommended for the treatment of functional tics. Personalized psychoeducation may be beneficial. As with treatment of Tourette's disorder, use of Comprehensive Behavioral Intervention for Tics (CBIT) may be used to treat functional tics. Individuals with acute onset functional tics should be encouraged to limit exposure to tic-related social media. Given that stress may make symptoms worse, learning to identify and modify stressors is recommended; working on stress management skills may also be helpful. If anxiety or depression are present, treating these symptoms can also be effective.

Other Recommended Resources:

For additional details, please see the following webpage on functional tics:

https://www.neurosymptoms.org/en_US/symptoms/fnd-symptoms/functional-tics/