It is true a hardened _tiqueur_ may be relieved of his tic, but the
potentiality remains. He is still at the mercy of the impulse to tic,
should it arise. Cruchet gives the history of a young man who suffered
in succession from convulsive movements of negation, facial tic,
blinking of the eyes, abrupt yawning, and twitches of the shoulder--all
in the space of two years. Each disappeared in its turn, independently
of treatment, without leaving any trace behind. In cases of this
description a new tic is ever imminent. The facility with which one tic
replaces another is a matter of common observation. We have often had
occasion to observe relapses, or partial relapses, in which an
altogether new tic suddenly makes its appearance on the top of one which
has either been improving or has actually been checked.
Apart, however, from obdurate forms of long standing, especially such as
are accompanied by signs of grave mental defect, we maintain that the
subjection of patients to appropriate treatment for an adequate period
has a favourable influence on prognosis. The curability of tic was
denied by Oddo, but he has recently seen fit to change his opinion, and
to confine his pessimistic views to Gilles de la Tourette's disease.
The prognosis of the mental state of victims to tic is outwith our
province: it is a topic long since handled by psychiatrists. We may ask,
however, whether any particular prognostic import is to be attached to
the tics themselves.
In cases of Gilles de la Tourette's disease the progressive unfolding of
motor disorders suggests a corresponding evolution of psychical
derangements which may end in dementia. Brissaud warns us that in cases
of mental torticollis we must be on our guard against the apparition of
some much more redoubtable affection than the torticollis, for that,
sometimes, is an incident in the prodromal stage of general paralysis of
the insane. Séglas has had a case of ærophagic tic which eventually
became one of general paralysis, and a similar instance occurred in the
practice of one of us.
Not long ago Dufour[193] advanced the opinion that the occurrence of a
motor syndrome consisting of the automatic movements of tic, in a case
of delusional insanity, heightens the gravity of the prognosis as
regards chronicity. It had been already remarked by Morel that such of
the insane as contract tics usually degenerate into dements. Most of the
contributors to the study of idiocy have noted the relation between the
degree of intellectual debility and the extent of the automatic and
rhythmical movements.
In this connection Joffroy has made some interesting statements.
Public-domain text, read in full here on John Shaqi.
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