The author of the article "Tic" in the Dictionary in Sixty Volumes of
1822 urges the necessity of care and perseverance in the correction of
the involuntary movements characteristic of the disease. In 1830 Jolly
recommended different exercises in the treatment of convulsions, as a
means of interrupting the sequence of certain spasmodic phenomena.
Blache's[220] adoption, in 1851, of medical gymnastics in cases of
"abnormal chorea" was attended with excellent results; and Trousseau, as
we have seen, extolled the value of exercises systematically applied to
the muscles involved in non-dolorous tic. The principle of the treatment
consisted in the regular execution of given movements by the muscular
groups affected, to the rhythmical accompaniment of a metronome or the
pendulum of a clock.
In these instances we have a forecast of the modern methods of
re-education, so successfully employed to combat tic.
Letulle advises an appeal to the intelligence, good sense, and will of
the patient in the endeavour to provoke an inverse effort at the moment
when the tic begins, or even before. It is the prerogative of the
physician to indicate suitable exercises and to encourage and aid the
patient in his attempts. Even the most inveterate of tics may thus be
controlled and made to disappear. On the other hand, the _Traité de
médecine_ ignores the subject, while Lannois' paper in the _Traité de
thérapeutique_ contains the statement that in the treatment of
myoclonus--under which term various indefinite convulsive movements are
comprehended--no method has hitherto been of any avail. Yet in another
section of the same book we discover some sound advice anent tics and
choreas of hysterical origin, emanating from the pen of Pierre Janet.
It is well to study the influence of the attention on these
conditions; some tics are contingent on the direction of the
patient's attention to them, others appear solely during times of
distraction.... Education of movements by some form of drill may be
of the greatest utility.
These general therapeutic indications are applicable to all kinds of
tic, independently of their form and localisation. Moreover, they
conform to the procedures advocated by Brissaud since 1893.
So long as tic is regarded as a purely external phenomenon, treatment is
bound to be insufficient; but recognition of the relations between the
convulsion and the mental state of the subject has made possible a
rational therapeusis. There can be no doubt, thanks to the laborious
work of Bourneville, that systematised mental discipline has sometimes a
surprising effect on congenital psychical imperfections; and where the
patients have attained a higher level of mental development,
re-education has shown itself to be the method _par excellence_.
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