Tics and Their Treatment

by Henry Meige; E. Feindel

Tics confined exclusively to the tongue are of rare occurrence. Moreover, they must be strictly differentiated from the tonic or clonic contractions of the tongue muscles met with in hysteria, epilepsy, and Sydenham's chorea, from the varying tremors that accompany organic disease of cerebral or bulbo-pontine origin, as well as from those "glosso-spasms" that may or may not be associated with twitches of the facial musculature.

Functional polymorphism is no less marked in the case of the tongue than in that of the lips; it participates in suction, mastication, deglutition, as well as in respiration, phonation, and articulation, while to "put out the tongue" at any one is equivalent to an expression of contempt. It is, accordingly, no surprise to find the number of tongue tics very considerable. Such, for instance, is the licking tic, where the tongue is constantly being passed over the free border of the lips, moistening them to excess; or the chewing tic, in which its perpetual motion inside the mouth in every direction conveys the impression that the subject is chewing something. Further, its contact with the palate or the upper lip may yield different clucking, whistling, or crowing sounds. Letulle remarks that the trick of producing a little inspiratory whistle by the passage of a column of air through an incompletely closed labial commissure—a common habit among people suffering from dental caries—is not slow in developing into an actual tic.

It has not fallen to our lot to observe the tonic variety of tongue tics, none the less must we believe in the possibility of their occurrence. Convulsive lingual movements, consecutive to disease of mouth or teeth, or to lesions of corresponding nerves, are in all probability spasms properly so called, to which disturbances of sensation and of nutrition are often superadded. The tonic contractions of tongue, lips, and masseters, which have been described in cases of hypochondriasis and puerperal psychosis, are much more nearly allied to the tonic type of tic, if, indeed, they are not to be identified with it. A case has been put on record by Lange of tonic contraction of the tongue during speaking and eating, each time that it touched the dental arches. No doubt the condition was a sort of tonic tic. Sometimes players of wind instruments are afflicted with a "professional cramp" of the tongue, as Strümpell has reported.

Generally speaking, however, it is particularly in tics of language, and in the various kinds of stammering, that the tongue muscles are concerned.

TICS OF THE JAWS—BITING TICS—TICS OF MASTICATION

When the muscles of mastication are the site of tics, a medley of nibbling and mumbling results, from which convulsive movements of the same muscles consequent on cerebro-spinal mischief must be scrupulously separated. A. von Sarbo's[74] case of clonic maxillary spasm secondary to worry, depression, and an accident to the head, in a woman thirty-four years old, and otherwise free from stigmata—analogous cases are quoted by Strümpell and Ranschburg—was referred by him to a "spasm diathesis," akin to the "diathesis of contracture," but its etiology and evolution, together with a striking exaggeration of the knee jerks, negative the hypothesis of tic.

The masseters are chiefly but not exclusively affected. Unilateral implication of the pterygoids has been noted by Leube in a young girl who was also an hysteric and a choreic. A patient of ours prefaces every conversation by rapidly raising or lowering his inferior maxilla four or five times, and blinking at the same time; the performance has its variants, moreover, with the occasional addition of several nasal expirations.

Chattering or grinding of the teeth is a frequent accompaniment of the tics we are considering, and may have a disastrous issue in the loosening, cracking, or breaking of these structures, as in the case of O.

A still more common incident is injury to the buccal mucous membrane, a significant instance of which is furnished by an episode in the history of young J.

One day in June, 1900, J. experienced a feeling of discomfort in the articulation of the lower jaw—the sequel, as a matter of fact, to a slight alveolo-dental periostitis in the neighbourhood of a bad tooth—and, interpreting the sensation as a new and grave symptom in the march of his malady, forthwith proceeded to investigate its development by playing with his maxilla. Then ensued a perfect debauch of masticatory movements, in which agreeable repetition of every conceivable grimace was joined to protrusion and retraction of the jaw in the search after articular cracks. He became so wholly preoccupied with this tic of mastication that ere long he had begun to pinch the mucous membrane on the inside of the right cheek between the hindmost molars, and this fresh object of absorbing attention in its turn led quickly to some excoriation of the mucosa on both sides. No halt was called by the lower jaw to give the abrasions time for repair, with the natural outcome that they suppurated and paved the way for an attack of infective stomatitis with pain, fever, and malaise, which necessitated the application of the thermo-cautery to the ulcerated areas for its relief.