What doctor can talk with me about tics?
October 17, 2010 12:31 PM   Subscribe

What kind of doctor, other than a psychiatrist, should I go see about tics? Onset age 18 or so.

I have what I think are vocal/motor tics that have been persistent since around age 17-19. As far as I'm aware, there is no history of tourette's in my family. I've seen a psychiatrist, but felt like this symptom was very downplayed by her, possibly because 1) I had other more pressing issues going on and 2) the only way to treat it is with some serious meds that I'm not interested in taking.

However, I AM interested in ruling out other potential medical causes for these tics beyond just tourette's or OCD. Would it be beneficial to see some other type of doctor about this, and if so, what kind?

If you can recommend a type of doctor, and possibly where I can look to find such a doctor (a hospital? a private practice? etc.), that would be very helpful.
posted by Tulip to Health & Fitness (9 answers total) 1 user marked this as a favorite
Neurologist. You can ask your psychiatrist if she has any recommendations.
posted by corey flood at 12:32 PM on October 17, 2010 [2 favorites]

I've had a tic from time to time (a Dreyfus eye twitch which I didn't even know people could see until I caught it in the mirror one day, to my great retrospective embarassment), but only when living in high-stress situations, which from your "other more pressing issues going on" sounds like a possible trigger on your side also.
posted by L'Estrange Fruit at 12:48 PM on October 17, 2010

Regarding other possible causes: it may be stress and nerves. When I was a child, all the way up to my mid-teens, I had tics. Mostly facial twitches - rapid blinking, head-jerking, weird mouth movements, that kind of thing. It was nerves. I was racked with nightmares, fear, worry, terror of other people, all sorts of stuff. As I got older and stronger the tics waned and disappeared. This may have no relation to your situation, but do consider that some form of stress may be causing your tics. Are you stressed? Try relaxation techniques of various kinds. Massage, yoga, TM, vigorous exercise, booze... don't rule anything out.

If none of that helps, see a neurologist.
posted by Decani at 1:05 PM on October 17, 2010

I was diagnosed with Tourette's at age 7. Was on meds during my teen years, but not anymore.

TS tics will come and go (often referred to as "waxing and waning"). Meaning, a particular tic (or set of tics) will appear for a few months or longer, then fade away, usually to be replaced by something else.

Stress exacerbates tics. Intense focus tends to minimize them.

I have met quite a few adults who went their lives to that point undiagnosed. TS was not a well known disorder until sometime in the 70s. I was fortunate enough to have a grade school teacher who noticed my tics and notified my mother. We went through a series of doctors, being misdiagnosed with epilepsy, until we found Arthur Shapiro in NY. At the time, he was one of the most pre-eminent doctors for TS. When we met with him, I tried to hide my tics for over an hour, out of embarassment. I later found out that he recognized my TS in the first few minutes.

See a neurologist for a workup. Try to find a neuro with a lot of experience with TS and tic disorders. This is why I related the story of my meeting with Shapiro. A less experienced neuro may miss the subtleties. When you are meeting with the Dr., let them see your tics naturally. Don't try to hide them or disguise them. Pay attention to the buildup before letting the tic "out". Keep a journal to see if there are patterns to tic behavior and triggers. Buildup for me was very much like a sneeze - I could not stop it, but I did learn to hide it, or turn it into something "acceptable", like a throat clearing or an arm movement.

Some tics are bizarre, believe me. Some are compound, as in multiple tics that come at the same time, in the same order. Of course, the most well-known tic is coprolalia (saying obscenities). Unfortunately, that is the one everyone focuses on. In the 37 years I've had TS, I never experienced coprolalia.

Feel free to mail me if you need more info, or have questions.
posted by sundrop at 3:06 PM on October 17, 2010 [1 favorite]

Thanks for the responses so far. These tics did noticeably kick in around a time of great stress for me. However, they do fit more along the descriptions of what sundrop drescribes (bizarre, build-up, adaptable, etc.). So, it's not just an eye twitch or something.

I did not even think to ask my psychiatrist for a referral to a neurologist. I suppose that's a good idea; perhaps she will know someone with my same insurance plan. Though, I have no idea if neurologist appointments are covered by insurance. Hm.
posted by Tulip at 4:55 PM on October 17, 2010

It's still a very new area of research, but there appears to be a link between childhood sudden-onset OCD and/or Tourette's syndrome and streptococcal infection. Check out Wikipedia on PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections). Although 17 is a little late for their typical age of onset, it's still worth checking out as a possibility, because a course of heavy duty antibiotics may help alleviate some of your symptoms.
posted by Asparagirl at 5:04 PM on October 17, 2010

A neurologist can do a more detailed exam and figure out if what you have is something they can treat. A clued GP might be able to treat, too.
posted by zippy at 5:59 PM on October 17, 2010

nthing suggestion of a neurologist with a specialty in movement disorders, from similar personal experience. You can get a referral from the psych or just a general practice doctor to someone in your area that's on your insurance plan. They may want to do an MRI to rule out other issues, especially given the relatively late onset (been there, done that), but they just as well might not.

There are a lot of different prescriptions out there that might help Tourette's/tics. I get that you're not particularly interested in them, but you might ask about tetrabenazine, a treatment for Huntington's Disease that shows some promise in TS patients, without all the side effects of a lot of the other meds. Very expensive because so few people use the drug, but the pharmaceutical company will work with you on it and may give drastic reductions in price that bring it down to insurable levels.

Feel free to MeMail me about my experiences.
posted by SuperNova at 7:07 PM on October 17, 2010

I have no idea if neurologist appointments are covered by insurance. Hm.

I can't speak for your specific plan, but I have epilepsy, and my visits to a neurologist are covered by insurance.
posted by virago at 8:04 PM on October 17, 2010

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