Twitch and Shout: Here’s One Box You Don’t Want to Tic

By Martha Michael

Imagine serving on a jury and being certain of the defendant’s guilt -- but not voting to convict because a prosecution witness had a facial twitch and you couldn’t shake your suspicion he was lying. You wouldn’t be the first to feel that way. It is not uncommon to have biases and presuppositions about people with muscle twitches or motor tic disorders.

Depending on your experience, you may not be aware there are many physical causes for behaviors such as facial spasms and jerking movements of the arms and legs.

Myoclonus

Some people suffer from involuntary muscle twitching, referred to as myoclonus, a condition that has a number of origins, according to the Cleveland Clinic website. Brief twitches or jerking movements in the face, arm, or leg result from muscles contracting and relaxing suddenly. Common forms of myoclonus include hiccups and the experience of feeling your body jerk as you drift off to sleep.

The classification of a patient’s myoclonus is based on its underlying cause, including:

• Epileptic - Common among people with epilepsy
• Sleep - Jerking movements that occur just before sleep, possibly caused by restless legs syndrome
• Action - Considered the most disabling classification, muscle spasms occur when moving or just considering movement
• Essential - May be genetic; twitching becomes worse over time
• Symptomatic - Sometimes called secondary myoclonus, it’s caused by Parkinson’s disease or another medical condition
• Stimulus-sensitive - Triggered by noise, activity, lights, or other stimuli

An involuntary jerking movement may be one of several symptoms resulting from a neurological disorder, says an online fact sheet by the National Institute of Neurological Disorders and Stroke. Though it’s rare, some patients have myoclonus due to an injury to peripheral nerves such as those connected to sensory organs and muscles, but most patients experience twitching because of a disturbance to the brain or spinal cord.

Myoclonus can be symptomatic of Parkinson’s disease, multiple sclerosis, epilepsy, or Tourette syndrome. People may experience twitching due to an infection or spinal cord injury, brain tumors, stroke, liver or kidney failure, intoxication, or the result of metabolic disorders. Oxygen deprivation can cause muscle spasms, as well.

Though specifics about the causes are unclear, studies show the two parts of the brain involved in myoclonus are the cerebral cortex and the brain stem. It may result from overexcitability of areas in the brain controlling movement or, in some cases, there’s a chemical imbalance among neurotransmitters affecting motor control.

Twitching in the Face

If you’ve ever had a twitch in your eyelid or another part of your face, it probably came and went without much drama. People experience hemifacial spasms when a blood vessel pulsates against a facial nerve, often without a known cause, according to the Mayo Clinic website.

As a nervous system disorder, these contractions can be the result of an injury or tumor, typically beginning in the eyelid and progressing to affect the cheek and mouth, always affecting one side of the face at a time. Facial twitching can be brought on by fatigue, stress, or anxiety, such as testifying during a trial.

Facial Tic Disorders

People with a facial tic disorder have involuntary spasms that usually involve blinking eyes or nose scrunches, and they can be temporarily suppressed, an article in Healthline says. It’s not uncommon for children to have facial tics -- particularly boys. Uncontrollable spasms in your face vary in severity and frequency based on their root cause.

Sometimes considered a mild form of Tourette syndrome, transient tic disorder refers to symptoms that become resolved in less than a year without intervention. They can take many forms, including:

• Throat clearing
• Grunting
• Mouth opening
• Tongue clicking
• Eyebrows raising
• Eyes blinking

When you experience facial twitching for more than a year, it is referred to as chronic motor tic disorder, which is less common than transient tic disorder. In this case, tics from blinking to grimacing can occur during sleep. Children between 6 and 8 years old are typically not given treatment, and many times symptoms disappear, but those who become symptomatic when they’re older often do need to be treated.

Tourette Syndrome

People who are managing life with one of the best-known conditions associated with tics, Tourette syndrome (or TS), are often targets for insensitive humor. The average age that individuals with Tourette syndrome begin showing symptoms is 7 years old. In most cases, tics become more prominent as the condition progresses but are less obvious in adulthood.

People with Tourette syndrome may display:

• Shrugging shoulders
• Flapping arms
• Inappropriate touching
• Sticking their tongue out
• Obscene gestures
• Uttering curse words

Treatment and Response

Appropriate treatment options depend on the cause of a person’s inability to control their body’s jerking movements, sounds, or behavior. Issues that arise can involve both psychological and physiological aspects, making an integrative treatment program preferable. Patients can be treated using:

• Behavioral therapies
• Psychotherapy
• Medications to treat underlying conditions
• Deep brain stimulation

The Tourette Association website has an article written by Jason Grant, a man who describes the discomfort of living with TS, including his inability to control his movements, sounds, and even his tendency to stare, which he also classifies as a tic.

“My tics are a strange and erratic phenomenon. It often starts with a thought or suggestion in my head telling me to do something and it won’t go away until I act on it; like a mosquito bite that needs to be scratched,” Grant says. “TS can obviously be very embarrassing because the movements and shouting are misunderstood and ripe for mockery and judgment.”

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