Shake, rattle and (eye) roll: Is it a tic? Seizure? Something else?
12/18/2023 by Erin Triplet, M.D., Ph.D.
As kids settle into the school year, it can be common to notice new behaviors. Perhaps a teacher notices that your child often seems to stare off into space. Maybe your child mentions a friend has started making odd, jerking movements every few minutes. This article will cover some common reasons that children may experience these symptoms and what you can do about it.
Tic disorders
A tic is a brief movement or sound that is repeated frequently in the same way. Common examples would include throat clearing, sniffing, eye blinking or shoulder shrugging. Sometimes people with a tic disorder can stop these movements for a brief time if they focus hard on preventing it, but for the most part, they can't stop the tics. They may not even be aware that they are happening, or they may feel an intense urge that only goes away after the tic.
As many as 1 in 10 grade school children will have tics at some point. For the vast majority of kids, these will go away on their own over time (termed a provisional tic disorder). Stress, anxiety, poor quality sleep and even some medications can make tics worse. Sometimes these tics can run in families. You may be able to find another close relative who had tics for a time. Less than 1% of children will be diagnosed with Tourette syndrome, a disorder that is characterized by multiple types of tics that do not go away over time. Fortunately, using rude or obscene gestures, called copropraxia, or words, called coprolalia, is quite rare.
How are tic disorders treated?
- Ignore it: Tics are not dangerous and should not impact school performance, development or socialization For the majority of kids, tics will go away after a year or so. However, if tics are causing distress — for example, bullying at school — therapy may be an option.
- Therapy: Habit reversal training is an effective treatment strategy for children with a tic disorder. This process involves training a child to recognize the urge to tic and then replace that with another behavior. Over time, the need to tic should decrease.
- Medications: There are prescription medications that can decrease the frequency and severity of tics. Like all medications, these can have side effects, so they are best used when tics are causing distress or impairing functioning. You should have a thorough discussion with your child's clinician before starting any medication.
Seizure disorders
A seizure is a temporary, uncontrolled burst of electrical activity between brain cells, or neurons. Though the term brings to mind the type of full-body shaking convulsions (called a generalized tonic-clonic seizure) we see depicted on television, seizures can take on a wide variety of forms. A common type of seizure in school-age children is called absence seizures. Like tics, absence seizures usually only last a few seconds and occur multiple times throughout the day. Children with these seizures will suddenly stare off into space and may have facial movements, like eye blinking or lip smacking, and then will go back to what they were doing before. Many will not even realize anything happened.
Although absence seizures are brief, they are important to recognize and treat because they can negatively impact learning and school performance. Since they tend to be frequent, kids end up missing out on a lot of teaching and are constantly trying to catch up with the information they miss. Children with seizures also need additional supervision around water or with activities like riding a bike where they might injure themselves if they were to lose consciousness.
How are absence seizures treated?
- Medications: Almost all seizure disorders, including absence seizures, need to be treated with specific anti-seizure medications. A pediatric neurologist manages these. About 2 out of 3 kids with absence seizures will eventually outgrow their seizures and may not need to be on medications long-term.
What to do if my child has abnormal movements?
It can be scary if your child is doing a new behavior that just seemed to appear one day. Fortunately, the vast majority of spells are not seizures. If you, your child's teacher or other caregiver is concerned, it's best to set up an appointment with your child's primary care clinician. They will help work through whether the episodes are tics, seizures, a mood disorder like anxiety or depression, a reflection of sleep problems, behaviors or something else entirely. In the meantime, here are a few things you can do to get the most out of that appointment:
- Find a quiet, private time to ask your child about the behavior. Have they noticed the movement or sound that they make? Can they tell when it is about to happen? Has anyone else commented on it? Are they feeling anxious or worried about something?
- Don't draw attention to the episodes. For tics, this is likely to make them worse. Scolding your child or instructing them to stop will not decrease seizures.
- Try to get a video of the movement/vocalization. This can be very helpful to show your child's primary care clinician.
- Ask around for family history — Did grandpa have tics as a kid? Is there a cousin with seizures? Beyond second-degree relatives (e.g., grandparents, aunts, uncles, cousins), family history is less relevant.
- If you haven't already, talk to your child's teacher. Has school performance declined this year? Are the episodes happening both at home and school?
Erin Triplet, M.D., Ph.D., is a resident in Community Pediatric and Adolescent Medicine in Rochester, Minn. Her interests include pediatric neurology, genetics and gene therapy research.