It should be said that the cases which Charcot, Tourette, and Guinon had more especially in mind were of a graver nature, such as the disease of generalised convulsive tics with echolalia and coprolalia, and peculiarly resistant to treatment. Patients suffering from these forms of tic present in the most advanced degree psychical instability and volitional fickleness, and betray an irresistible tendency to impulsion and obsession, calculated to render the institution of any methodical treatment futile. In their case patience and perseverance may be rewarded, but they never consent to undergo for a sufficiently long period the discipline indispensable for their cure.
Fortunately, these severer varieties are exceptional. The vast majority of cases are certainly more amenable to modern therapeutic measures, and the results obtained so far place the disease in a much more favourable light. Letulle had already remarked, in 1883, that the most tenacious of co-ordinated tics might be amended, mitigated, and even wholly inhibited.
MEDICINAL TREATMENT
All the ordinary medicinal agents in vogue in nervous and mental diseases have at one time or other been applied to the cure of tics; all have proved equally inefficacious.
Sedatives and hypnotics, such as the bromides, chloral, or the preparations of opium, sometimes effect a transient improvement, but they cannot permanently modify the psychasthenia which is the key to the situation. According to Grasset and Rauzier, the injection of morphia, atropine, curare, and the inhalation of chloroform or ether have been of some avail, as has the employment of zinc valerianate, and of gelsemium in large doses. Quinine, cannabis indica, and arsenic have also been tried.
Unexpected success has followed the administration of the bromides in some instances, and for the treatment of various neuroses, convulsive tics in particular, Flechsig's opium and bromide cure for epilepsy has been adopted by Dornbluth, with encouraging results. It is true some of the symptoms of epilepsy may be manifested in the guise of tics, while, on the other hand, the association of tic and epilepsy is not unknown; but however that may be, there is sufficient and reliable evidence to justify at least the empirical use of bromide as a last resource.
Every conceivable sedative and derivative have had their advocates, while local and counter-irritant medication has not been without support. Grasset and Rauzier obtained transitory improvement by means of strong mustard plasters; Busch applied the actual cautery to the vertebral column.
Cold, hot, and tepid douches, warm fomentations, simple, medicinal, and vapour baths, have all been prescribed. Resort has been made to rhythmic traction of the tongue, to thoracic compression, to phrenic electrisation, in all of which procedures, as Oppenheim observes, the principal effect must be a psychical one.
The predisposition of the subjects of tic to mental disturbance renders the administration of ether, morphia, or cocaine in their case inadvisable. For a similar reason it is better to avoid antipyrine, sulphonal, hypnotics generally, and above all opium in the form of laudanum or thebaic extract.
If a sedative be really indicated, we prefer the preparations of valerian, as their disagreeable odour is scarcely likely to encourage abuse of the drug. Stimulants such as kola, coca, caffeine, etc., are rather to be avoided. Hartemberg recommends the preliminary use of lecithin to improve the patient's general condition.