Tics and Their Treatment

by Henry Meige; E. Feindel

We have also applied Brissaud's method to the treatment of variable chorea, with no less encouraging results. Its worth in cases of mental torticollis has been noted by several authors as well as by ourselves. A cure resulted in a peculiarly difficult instance recorded by Martin[230]:

A young man of twenty-six suffered from melancholia and hypochondriasis. He used to complain that his limbs were hopelessly rotten, that his hands, feet, legs, were gone, vanished; his head and neck had ceased to exist. So easily was he irritated that to most questions he vouchsafed no answer. His sentiments of affection were much blunted; a visit from his mother evoked no pleasurable sensation. All day long he used to lounge on a couch, his head sunk on his breast, and inclined somewhat to the right. The attitude was exaggerated if he was addressed, but while he could raise his head, by the help of his hand, to regard his interlocutor, it resumed its position of flexion as soon as he withdrew the support. Confined to the left side of his face was a tic which consisted in abrupt and jerky elevation of the corner of the mouth. On request, he would gain his feet laboriously and walk with abdomen protuberant, back arched, and legs apart. From time to time the neck musculature on the left side was the seat of convulsive movements. The left sternomastoid and trapezius were in a state of tonic contraction, and on any attempt being made to correct this vicious attitude, spasm occurred, and the patient resisted to his utmost.

On March 10, 1900, treatment was begun; an effort was made to gain the patient's confidence by explaining that a cure was within the bounds of possibility, and by demonstrating to him that his limbs, which were in a state of slight contracture, could be moved by his hand. The procedure was renewed three times a day, and followed by baths and massage.

By April 15 the contractures had disappeared, and he could perform any movement of relaxation himself. His attention was now drawn more particularly to his head, which was still in a faulty position, and annoyed him considerably. Advantage was taken of an improvement in his tractability to make him perform some movements of his neck. At first the mere effort produced a spasmodic contraction, but he was able to move his head very slightly up and down. After five months of such treatment, occupying on an average three hours a day, his mental torticollis was finally reduced to subjection, an interesting feature of the case being the parallelism between the physical and the psychical improvement.

On three occasions since we have noted a recurrence of the torticollis, but each time it has been both brief and easily overcome. The cure has been maintained now for upwards of a year, and four months ago the patient resumed his work.

We must impress ourselves with the importance of recognising the proneness of tics to relapse. Any triviality which may have a prejudicial effect on the patient's will-power is calculated to facilitate the reawakening of a bad habit. Such relapses are commonly transient, and are instructive in so far as their manifestation sometimes differs from the original tic and entails alterations in treatment.

L., for instance, whose condition was one of permanent rotation of the head to the right, had a fit of depression after eight days of treatment and noteworthy improvement, a depression so severe that she questioned the practicability of a cure, and forthwith her head began to turn to the right again. On this occasion, however, the tic was an intermittent one, consisting of clonic contractions of the cervical muscles chiefly, without antagonistic gesture. For five days the fit persisted, and was sufficiently acute to render omission of the exercises advisable.

After some days' rest a beginning was made with the treatment again, under the direction of one of us and in the presence of her father. We took care to place ourselves always in front and to the left of the patient, on the side opposed to her torticollis. The position allotted her at table was such that in order to converse with her parents she had to turn to the left.

Not long thereafter a second fit of depression occurred, but on this occasion her head began to rotate to the left. She had been under treatment for six weeks, when she made the remark one day that her head seemed once more to be drawn to the right. She hastened to add, moreover, that she had discovered a means of remedying the mischief—viz. by putting her left hand to her left cheek—a corrective proceeding nothing short of paradoxical.

It was about this time that the pains and dragging sensations in the muscles of the neck subsided. On the other hand, for days on end, then for gradually diminishing periods, there existed a slight trembling of the head, due to muscular exertion, and explicable by the contraction of small cervical muscles on one side and their antagonists on the other.