Facial tics are uncontrollable spasms in the face, such as blinking of eyes or scrunching of the nose. They may also be called mimic spasms and can be caused by a number of different disorders. Although usually involuntary, tics may temporarily be voluntarily suppressed.
Children are more likely to experience facial tics than adults. Facial tics occur three to four times more often in boys than in girls.
Facial tics generally do not suggest a serious problem and most children outgrow the condition within a few months.
Facial tics are a symptom of a few different disorders. The severity of the tic and how long the behavior lasts can help determine which disorder is causing them.
Transient Tic Disorder
This is diagnosed when facial tics last for a short period of time (nearly every day for more than a month, but less than a year). This disorder is most common in children and is thought to be a mild form of Tourette’s syndrome.
Someone with transient tic disorder tends to experience an overwhelming urge to make a movement. The tics may include blinking the eyes, flaring the nostrils, raising the eyebrows, opening the mouth, and sticking out the tongue.
Transient tic disorders usually do not require any treatment.
Chronic Tic Disorder
One to two percent of the population has chronic tic disorder. This makes it more common than Tourette’s disorder, but less common than transient tic disorder.
Blinking and grimacing are common tics associated with chronic tic disorder. Unlike transient tic disorder, tics may occur during sleep. To be diagnosed with chronic tic disorder, an individual must have experienced tics for more than one year, with no tic-free periods longer than three months.
Children who are diagnosed between the ages of six and eight typically do not require treatment as the symptoms may be manageable or even subside on their own. Individuals who were diagnosed later in life may need treatment, depending on the severity of their symptoms and the impact on the individual’s daily life.
This may also be referred to as Tourette’s syndrome. This disorder usually begins in childhood with tics in the face, head, and arms. With Tourette’s disorder, tics tend to progress initially in intensity and affect many different areas of the body but usually decline in adulthood.
Tics with Tourette’s disorder tend to appear more purposeful than other tic disorders. Tics may include kissing, pinching, lip smacking, and inappropriate touching and gestures. In order for an individual to be diagnosed with Tourette’s disorder, he or she also needs to experience vocal tics. Tourette’s disorder can usually be managed with behavioral treatment but may require medication.
There are several factors that contribute to facial tic disorders. These factors tend to increase the frequency and severity of tics. Therefore, treating these problems may help alleviate facial tics. Contributing factors include:
- attention deficit/hyperactivity disorder (ADHD)
- stimulant medications
- obsessive compulsive disorder (OCD)
Your doctor can usually diagnose a facial tic disorder by discussing the symptoms with you. They may also refer you to a mental health professional for assessment of your psychological status.
It is important to rule out physical causes of facial tics. Your doctor may ask about other symptoms to decide if further testing in required. An electroencephalogram (EEG), a test that measures electricity in the brain, may be ordered to check for a seizure disorder.
An electromyography, a test that measures electricity in the muscles, may be ordered to check for conditions that cause muscle twitching.
Most facial tic disorders do not require treatment. However, if your child is affected, you should avoid drawing attention to their tics or scolding them for making these movements. Parents can help their child understand what the tics are, as well as how to explain them to their friends and classmates. Drug therapy may be prescribed if the tics interfere with social interactions, school or job performance.
Treatment options can include:
- stress reduction programs
- behavioral therapy
- dopamine blocker medications
- medications to treat underlying conditions, such as ADHD and OCD
- botulinum toxin (Botox) injections to temporarily paralyze facial muscles
Several studies have shown that deep brain stimulation may help treat Tourette’s syndrome. Deep brain stimulation is a surgical procedure that places an electrode in the brain to send electronic signals. According to Mayo Clinic Proceedings, these studies have shown that deep brain stimulation can improve symptoms (Lyons, 2011). However, more research is needed to determine the best area of the brain to stimulate for improvement of Tourette’s symptoms.