Tics are often preceded by a feeling or sensation that has been termed an urge. The urge that precedes the tics is felt to be completely involuntary and may be the driving force for the tic to occur. Interesting, medication used to treat tics often decreases the urge as well. This urge is a unique feature that distinguishes tics disorders from other movement disorders such as chorea, myoclonus or dystonia. The urge or warning, allows people to suppress or “hold in” the tics. However, not everyone reports the presence of this urge or warning.
What is the premonitory urge?
The warning or premonitory urge associated with tics disorders may take many forms. It is usually a sensation or feeling. Descriptions include an “urge to move”, an impulse, a feeling of “having to do it”, increased tension, anxiety, pressure, fullness, a feeling that something is not “just right”, an ache, itching, tingling, burning, numbness, and cold. The urge may be very brief (less than one second) or more prolonged. In many cases the feeling is very difficult to put into words.
Suppression of the tics usually makes the urge feeling worse and expression of the tic usually temporarily reduces the urge feeling. In younger children, they often do not describe the warning urge, but are still able to suppress the tic implying that they may have some sort of warning feeling that the tic is coming.
Does everyone get the urge to tic?
In studies of older children and adults with Tourette syndrome about 80 to 90% of people describe a premonitory urge occurring some of the time but not with every tic. Only 1/3 of people describe that every tic is associated with a preceding urge. Therefore, in most people the warning urge only occurs some of the time. There are many theories as to why this might occur. It may be that not all tics are associated with urge feelings; it may be that the urge is so brief that the person is not aware of it; or it may be related to attention.
In children less than 10 years of age, the rate of urge is much lower and very inconsistent. The typical age of onset of tics is 6 or 7 years of age and it has been found that children do not report having the urge feeling until 10 years of age. It is not known if that is because the urge develops as the disorder progresses or if the child becomes more aware of the urge feelings as they age. It is also postulated that young children may not have the vocabulary to describe the urge. Regardless, younger children generally are not aware of having the urge occur before the tic.
Are these movements still considered tics if there is no associated urge?
The short answer is YES! As stated above, not every person experiences a warning urge and most people do not experience a warning urge with each and every tic. If the movements behave otherwise like tics, then that is probably the best explanation. However, if the movements are never associated with an urge and are never suppressible, then other neurological disorders should be considered.