Tics of childhood are curable: we draw attention to the fact afresh. Their spontaneous dissolution is not unknown, but parents must not consider the question merely one of time. They must impress on their children the sobering effect of good behaviour and decorum. Discipline of this kind may be a long and delicate task, but to condone indulgence in untimely movements, on the pretext that they are merely quaint, is a mistake fraught with the gravest consequences.
When a child holds its knife or fork incorrectly, or puts its elbows on the table, or its finger in its nose, we feel that the habit is displeasing; but how much more serious the outlook if the trick consists in biting the lips, or tossing the head, or blinking the eyes! The former is an offence against good taste; the latter is a tic in embryo.
It may be said, as a general rule, that the chances of spontaneous cure are in inverse proportion to the age of the patient and the duration of his tic.
Tics of adult life may also be cured, less often, it is true, than in the case of children. Oppenheim gives the history of a woman with a rebellious facial tic of twelve years' duration, which ceased on the occasion of a certain happy event in the family life. Of course one wants to know whether it ever returned, for many so-called cures are simply remissions.
T. had suffered from torticollis for a whole year, but on the eve of her son's marriage it stopped entirely for three days, and she deemed the cure permanent; it was not long, unfortunately, ere she underwent a relapse.
Brissaud[192] quotes an instructive case of temporary cessation of tic. A patient afflicted with mental torticollis of three years' standing learned that his son had been injured and had been removed to hospital to undergo an operation. In an instant his torticollis disappeared, but a reassuring report from the surgeon a few days later was followed by a recrudescence of the condition.
It is true a hardened tiqueur may be relieved of his tic, but the potentiality remains. He is still at the mercy of the impulse to tic, should it arise. Cruchet gives the history of a young man who suffered in succession from convulsive movements of negation, facial tic, blinking of the eyes, abrupt yawning, and twitches of the shoulder—all in the space of two years. Each disappeared in its turn, independently of treatment, without leaving any trace behind. In cases of this description a new tic is ever imminent. The facility with which one tic replaces another is a matter of common observation. We have often had occasion to observe relapses, or partial relapses, in which an altogether new tic suddenly makes its appearance on the top of one which has either been improving or has actually been checked.
Apart, however, from obdurate forms of long standing, especially such as are accompanied by signs of grave mental defect, we maintain that the subjection of patients to appropriate treatment for an adequate period has a favourable influence on prognosis. The curability of tic was denied by Oddo, but he has recently seen fit to change his opinion, and to confine his pessimistic views to Gilles de la Tourette's disease.
The prognosis of the mental state of victims to tic is outwith our province: it is a topic long since handled by psychiatrists. We may ask, however, whether any particular prognostic import is to be attached to the tics themselves.
In cases of Gilles de la Tourette's disease the progressive unfolding of motor disorders suggests a corresponding evolution of psychical derangements which may end in dementia. Brissaud warns us that in cases of mental torticollis we must be on our guard against the apparition of some much more redoubtable affection than the torticollis, for that, sometimes, is an incident in the prodromal stage of general paralysis of the insane. Séglas has had a case of ærophagic tic which eventually became one of general paralysis, and a similar instance occurred in the practice of one of us.