Tics and Their Treatment

by Henry Meige; E. Feindel

Respiratory drill is an admirable method of procuring this result; it acts in the same way as any of the other exercises. Its use is not confined to tics of speech or of respiration, for thoracic muscles are involved in tic much more frequently than is commonly supposed. By resort to this technique Madet cured an expiratory hiccough[228] in a man of forty-six, who was afflicted in addition with twitches of head, trunk, and hands.

Systematized exercises have of course the advantages of exercise in general; motor, sensory, and psychical functions alike are stimulated and regulated, and tend to become normal. In particular, muscular exercise is a striking way of disciplining volition. Accordingly, we never fail to prescribe such pastimes as gymnastics, in any of its forms, rowing, fencing, cycling, lawn tennis, etc.; games which demand attention, skill, and decision are useful auxiliaries, and manual occupations of a more delicate nature ought not to be forgotten, provided they require of the patient a certain amount of immobility. Every case, needless to say, must be treated on its merits, but the general indications we have supplied can easily be modified to suit the individual.

The various procedures directed, under different names, to the suppression of tic by re-education, are all modelled on the same plan. Köster attributes the disease to exhaustion of higher co-ordinating centres, and counsels their reinforcement by appropriate exercise. Oppenheim, in his Lehrbuch der Nervenkrankheiten, adduces evidence of the value of what he calls Hemmungstherapie, which is merely an application of the principles and therapeutic rules laid down by Brissaud in 1893, and described by one of us in 1897, apropos of mental torticollis. The same may be said of the line of treatment pursued by Dubois, which appears to be based on the pathogenic interpretation given by Oettinger,[229] according to whom the brain of tic patients is incapable of conserving the image of sustained immobility, and thereby loses the habit of voluntary immobilisation. The essence of treatment, therefore, consists in habituating the subject to rest motionless like a statue in a position conducive to repose, and for a given time.

As has been already remarked, the polymorphism of tics is such that the plan of treatment selected must be necessarily elastic if it is to be altered to suit individual cases. What is the point in enjoining absolute immobility on a patient whose blepharotic is never in evidence unless he is walking about?

We may now proceed to narrate the details of various cases of tic treated by the combined method of disciplinary movements and immobility, taking the history of O. as our first example.

October 15, 1901.—Séance of absolute immobility in the upright position, with the head straight, for five seconds; to be repeated in front of a mirror for five minutes, with intervals for rest of fifteen seconds. Movements of rotation of the head to left and right, with progressively lengthening pauses in each of the extreme positions. Respiratory exercises with elevation and depression of the arms eight times a minute, decreasing steadily to four a minute. These exercises are to occupy a quarter of an hour morning and evening. Explain to the patient the action of the sternomastoids and how they combine to fix the head. Make the patient lie on his back and move his head antero-posteriorly.

October 19.—O. has still his tics, but he can already remain motionless on command, and is conscious of satisfaction in so doing. Just as his exercises come to an end there is always a momentary recrudescence of the tics, but a very appreciable calm follows.

October 21.—Immobility is maintained well for half a minute. The patient is to resume his cycling and fencing, physical exercises which he has abandoned for more than a year.

October 25.—O. considers himself greatly improved. He has gained insight into the way of combating his tics, and his self-confidence is on the up grade. For several days he has devoted his attention to his tic of blinking, with the result that he can open his eyes longer and more easily.

October 28.—He evinces a preference for certain of the exercises: if they please him, he performs them accurately; if they do not, they are neglected.