THE COMPLICATIONS OF TIC
Following in the train of the tics may come a number of complications,
insignificant enough as a general rule, the dread of which may in some
cases actually be instrumental in stimulating the will's activity to rid
the patient of his tic.
Dislocations have in violent cases been known to occur. Incessant
repetition of a tic may lead alike to hypertrophy of certain muscles and
atrophy of their antagonists, conditions which in aggravated instances
may produce permanent malformation.
It is of course in cases of spasm and other convulsive phenomena
dependent on structural disease of nerve centres or conductors that such
trophic disturbances are most liable to occur. Gaupp[152] has described
a case of partial congenital myotonia localised in the muscles of the
forearm and hand, and associated with atrophy, in a patient presenting
certain stigmata of infantilism; but the condition can scarcely be
classed with the tics.
As for actual paralysis supervening on a tic, the case recorded by
Grasset[153] of a young girl in whom a tic of the right leg was
succeeded by a trailing movement of the same limb in walking can hardly
be considered conclusive, inasmuch as such incidents usually indicate
hysteria or functional disturbances akin to tonic tics.
Biting tics are more apt to be accompanied by various sequelæ, such as
mutilations, excoriations, ulcerations of all sorts. By constant
nibbling at his lip J. produced an erosion of the mucous membrane, which
became infected and developed into an ulcerative stomatitis. The
accident, however, had a salutary effect on his tic.
We may quote another illustration from the history of the same patient
to show how complications may sometimes be of curative value.
In January, 1901, in consequence of excessive cudgelling of one
fist by the other, the back of the left wrist became inflamed and
painful, but the bruise soon disappeared. In April of the same
year, however, a large reddish ecchymosis made its appearance in
the neighbourhood of the left elbow, with a painful swelling of the
whole arm on the proximal side, and a few days later the discovery
of a hard, cordlike mass along the border of the biceps made it
clear that phlebitis had set in. With proper treatment the symptoms
gradually diminished in intensity, but there can be no doubt of
their origin in the reiterated violence of J.'s onslaught on his
left arm.
The immediate outcome of the event was to put a brake on his
exuberant gestures, and although the impulse was still sometimes
urgent enough to tempt him to recommence, the thought of his
phlebitis and fear of the dangers of a relapse were sufficient to
recall him to his senses.
Apropos of complications the case of O. occurs to the mind, his biting
tics ending in the premature loss of all his teeth, while his habit of
rubbing his nose and his chin against the back of a chair led to the
development of callosities. Tonic tics of the neck may in cases of long
duration result in permanent deformities.
Apart from such complications, the vast majority of the accidents that
accompany tics are attributable to various concurrent affections. A case
reported by Féré[154] of rotatory movements of the head passing some
years later into the initial symptom of epileptiform convulsions ought
not, in all probability, to be placed among the tics.
As for the grave mental affections that sometimes are superadded to
long-standing tics, it is unjustifiable to class them as complications;
they are rather manifestations of psychical instability that have found
a suitable medium for their evolution; in many instances they occur
quite independently of the tics.
It may, however, be remarked that the persistence of a tic entails
ceaseless preoccupation on the part of the subject, and may thus pave
the way for obsessions or hypochondriacal ideas. The motor disturbance
reacts adversely on the mental state of which it is the outcome. Hence
an obsession may give rise to a motor display that has all the
appearance of a tic, while the motor act in its turn may become an
actual obsession.