Persistent (Chronic) Motor Or Vocal Tic Disorder

The primary symptom of PMVT is the presence of either vocal or motor tics nearly every day for more than a year. These symptoms may be chronic, such as chronic motor tics. A motor tic impacts the body, whereas a vocal tic impacts the voice. Chronic tics are often considered life long. People with PMVT have either vocal tics or motor tics, but not both.

Vocal tics

Some examples of vocal tics that people with PMVT may experience include:

• Grunting
• Barking
• Snorting
• Coughing
• Sniffing
• Throat clearing
• Repeating others
• Repeating words
• Humming
• Uttering inappropriate words
• Hissing 
• Yelling

Motor tics

People with motor tics may perceive that their tics are a response to an inner urge and may have abnormal sensations in the area of the tic before it occurs. Motor ticks can also be simple or complex. 

Motor tics often involve only one muscle group or body part. In contrast, complex tics can involve a series of movements, including multiple muscle groups or a combination of many simple motor tics. Complex motor tics may appear to others as purposeful movements, but they can significantly interfere with everyday life. 

Motor tics that someone with PMVT can have include:

• Jerking
• Blinking
• Grimacing
• Head banging
• Shoulder shrugging
• Foot tapping
• Imitating someone else’s movements
• Lip biting
• Nose wrinkling
• Frowning
• Head turning
• Sticking out the tongue
• Squatting
• Kicking
• Jumping
• Hopping
• Rocking back and forth

Tics are not voluntary and may be more noticeable when the person is relaxing. Certain factors may worsen tics, including stress, excitement, sleep deprivation, caffeine, and heat. They rarely occur during sleep, though they can. Engaging in a task or activity can lessen the frequency or severity of tics. Some people can suppress their tics for a few seconds or minutes, while others may have the urge to perform them. 

Tics, like those that appear in PMVT, are likely caused by a combination of factors, including genes, the environment, and dysfunctional connections between the parts of the brain that control movement.

Recent studies have found that rates of PMVT were substantially higher in first-degree relatives compared to the general population. People with PMVT are also at risk for developing additional psychiatric comorbidities,² including obsessive-compulsive disorder (OCD),³ attention-deficit hyperactivity disorder (ADHD),⁴ general anxiety disorder (GAD),⁵ mood disorders, and disruptive behavior disorders.

There are multiple treatment options available for PMVT and comorbid conditions like obsessive-compulsive disorder and attention-deficit hyperactivity disorder, including the following.

Medication

Though there are no medications FDA approved to treat PMVT, there are medications that are used to treat some of the symptoms of PMVT such as tics.

Medication may be necessary if tics interfere with someone’s quality of life. Multiple medications can be effective at treating PMVT and other tic disorders. 

Only three medications have FDA approval for the suppression of Tourette syndrome-related tics; these are: haloperidol, pimozide, and aripiprazole.

However a healthcare professional may prescribe one of these other medications to treat tics: 

• Clonidine
• Guanfacine
• Botulinum toxin A: This injectable medication can relax or stop muscles from moving, which can reduce tics and tic-related issues. 

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis. 

Self-care

While tics cannot be cured, there are some ways to lessen their impact, including:

• Finding ways to forget about the urge 
• Avoiding stressful situations as much as possible
• Getting enough sleep
• Avoiding drawing attention to the tic 

Avoiding stress may not be possible in every situation, but some self-care techniques you can use to deal with stress include the following:

• Getting at least 30 minutes of exercise a day—Even 30 minutes of walking, broken into two 15-minute sessions may be helpful 
• Eating healthy, regular meals
• Staying hydrated 
• Setting goals and priorities—Decide what you can do now and what can wait, and learn to say “no” if you begin to sense you’re taking on heavy duties  
• Identifying negative or unhelpful thoughts and challenging them
• Doing a relaxing activity, like yoga, journaling, or breathing exercises
• Staying connected to friends and family and reaching out for help 

If you’re experiencing motor or vocal tics and want to learn more about HRT or CBIT, an online therapy platform like BetterHelp may be helpful. Some people with tics may be self-conscious about them, and attending in-person therapy may cause additional stress. With online therapy, you can talk to a therapist online and learn more about possible treatments from the comfort of your home via phone, video, or live chat sessions. 

The International Parkinson and Movement Disorder Society offers handouts about multiple movement disorders, including tic disorders. The Tourette Association of America offers in-person support groups around the country for people with Tourette and tic disorders. There are also online support groups available to people in the Tourette and Tic disorders community.

Some recent research proposes that PMVT is a milder form of Tourette syndrome. This study found that those with PMVT had strong family histories and lower tic severity, later age of onset, and lower or similar rates of psychiatric comorbidities than people with Tourette syndrome.

As noted above, OCD and ADHD are more prevalent in people with PMVT. Although the prevalence of these two conditions is lower in PMVT than with Tourette syndrome, they are still significantly higher than in the general population. Researchers believe this connection may show shared genetic ties between these conditions and concluded that PMVT and Tourette's syndrome are more similar than they are different. Some believe they may be the same condition, with Tourette being the most severe version.

Another recent study looked at the effectiveness of online support groups for people with tic disorders and Tourette syndrome and found that online communities had a positive impact on the well-being of people with these conditions and their families. Online communities provide a place where people with these conditions can belong to a community that reduces their social isolation and helps them find acceptance. 

Below are several statistics about persistent chronic motor or vocal tic disorder: 

• Although PMVT is believed to be more common than Tourette syndrome, its prevalence is unknown. The CDC estimates that persistent tic disorders like PMVT and Tourette syndrome affect about 1.4 million people in the US. 
• People with PMVT have high rates of psychiatric comorbidities. About 20% of people with PMVT also have OCD, and 60% also have ADHD. The rates of OCD and ADHD in people with PMVT are approximately ten times higher than in the general population.
• Tics generally increase in severity from childhood and peak between ages 10 and 12. Most tics disappear on their own, but in about 1% of children, tics persist into adulthood.
• Tics are more likely to affect boys than girls by as much as 4:1.
• According to the CDC, behavioral therapy may reduce the severity of tics.