We have studiously avoided the designation of a tic by the muscle or
muscles that determine it. To specify the precise muscle involved is
sometimes attended with no little difficulty, while if several, as is
customary, are concerned, their association is rarely anatomical;
indeed, this is one of the chief aids to diagnosis between tics and
spasms. Should the convulsion chance to follow an anatomical
distribution, neighbouring muscles are apt to participate as well. Hence
it is advisable to name a tic after its morphological situation, or,
better still, from the functional act of which it is, in Charcot's
phrase, the caricature.
This is the plan we shall pursue in our successive examination of the
different parts of the body disposed to be the seat of tics.
FACIAL TICS--TICS OF MIMICRY
Of all tics, those of the face are the most frequent, and the most easy
to see. No other part is as rich in muscles whose functions are so
diversified--nictitation, mastication, suction, respiration,
articulation, etc. Moreover, the face is the abode of the mimic
expressions, each one of which is the revelation, by muscular play, of
some sentiment, or passion, or emotion. Hence the idea has been
entertained of adopting a physiological classification. In the smiling
tic of Bechterew, for an instance, the muscular contractions are framed
into a smile in the absence of any provocative to mirth; in a similar
fashion, the sniffing tic brings to mind the inhaling performances of
snuff-takers.
Facial tic is frequently unilateral. It is rare to find the whole
muscular distribution of one facial nerve involved, however, this being
a property rather of spasm, as is also the restriction to a particular
branch. A common event is the simultaneous abstention of some facial
muscles and implication of others belonging to a different nerve supply.
If the condition is bilateral, as a general rule only those muscles on
each side co-operate that are wont to act in concert for the
accomplishment of some function. In a case reported as bilateral facial
spasm by Claus and Sano,[61] in which both sides of the face and neck
were affected, the exaggeration of the convulsions by emotion, their
curtailment daring rest and disappearance in sleep, coupled with the
fact of their temporary arrest by recourse to subterfuge, suggest that
the condition is really one of tic.
The contractions of the facial muscles are usually associated to produce
a more or less complex grimace. Movements of forehead, eye, nose, or
mouth, may succeed each other or be superimposed one on the other
without any preconceived order, or the tic may consist in the
synchronous activity of two or more muscles.
Of course any and every facial tic may occur by itself, but careful
investigation will often reveal concomitant reactions of other muscular
groups. The sniff that accompanies puckering of the nose indicates the
engagement of the muscles of inspiration.
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