OBJECTIVE: Tourette's syndrome traditionally has been viewed as a
hyperkinetic movement disorder characterized by involuntary motor and
phonic tics. Many patients, however, describe their tics as a voluntary
response to premonitory urges. This cross-sectional study evaluated
premonitory urges and related phenomena in subjects with tic disorders.
METHOD: A total of 135 subjects with tic disorders, aged 8 to 71 years,
completed a questionnaire concerning their current and past tic symptoms.
Subjects were asked to describe and, if possible, localize their
premonitory urges. The Yale Global Tic Severity Scale was used to assess
current tic severity. The method of case finding does not provide
prevalence data for premonitory urges. RESULTS: Ninety-three percent of the
subjects reported premonitory urges. Anatomical regions with the greatest
density of urges were the palms, shoulders, midline abdomen, and throat.
Eighty-four percent of the subjects reported that tics were associated with
a feeling of relief. A substantial majority (92%) also indicated that their
tics were either fully or partially a voluntary response to the premonitory
urges. CONCLUSIONS: While epidemiological studies of tic disorders have yet
to incorporate questions concerning premonitory urges, these results
suggest that such urges may be commonplace in adolescent and adult subjects
with tic disorders. These results challenge the conventional wisdom that
tic behaviors are wholly involuntary in character. They also implicate
brain regions involved in the processing of sensorimotor information in the
pathobiology of tic disorders.