The localisation of the motor reaction in cases of tic is essentially
physiological. In rare instances its sphere may be limited to a single
muscle, if one muscle only be requisitioned for the performance of a
functional act; but it is very much more usual to find several muscles
contributing, whose synergic contractions fashion the movement of which
the tic is a caricature. If the same effect is yielded by the action of
either of two different muscles or groups of muscles, as in rotation of
the head, and if one be hindered from fulfilling its function, the
incidence of a tic originally located in it will promptly be transferred
to the other. This is the explanation of the persistence of rotatory
tics after exclusion of the sternomastoids by surgical means.
Two symmetrical muscles may be affected, as in tics of blinking and of
affirmation, or a median muscle, such as the orbicularis oris. Much more
frequently the tic is unilateral in its distribution, as, for instance,
when it involves the face; in this respect its figuration as a
functional disturbance is well exemplified, for expressional movements
of the face are normally bilateral. A tic may settle itself on two
mutually antagonistic muscles, and manifest its presence in the
immobilisation of a limb or segment of a limb; or only a portion of a
muscle may contract, as in the case of the deltoid or trapezius, which
are composed of bundles anatomically associated but physiologically
independent, and so capable of being functionally differentiated by
voluntary education. Fibrillary contraction and tic have nothing in
common.
Inasmuch as the muscles concerned are under voluntary control, and their
contractions such as the will can effect, it follows that with adequate
practice the movement of a tic can always be imitated, and in
predisposed soil imitation tics may thus take root; it is not always
feasible, on the other hand, to counterfeit a spasm.
Several functional muscular territories may be simultaneously affected,
and several tics may follow one another in quick succession, the
duration of any one tic on any one site being a more or less varying
quantity.
We have already noted the occurrence of variable tics. They appear one
day to disappear a few days later, and reappear again after another
space. Weeks or months may elapse without any vestige of them, until
they suddenly break forth again unheralded. As a general though not
absolute rule, the younger the patient, the less stable his tics.
Occasionally they are isolated, limited, and stationary, one of the most
frequent of this kind being a tic of blinking, but the intimate alliance
between the motor troubles and the mental level of the subject helps to
explain why these tics of children are so changeable.
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