Our lack of knowledge concerning the precise localisation of these
functional centres is paralleled by our ignorance as to the manner of
their involvement.
Noir has prudently observed that the manifestation of co-ordinated tics
in cases of widespread cerebral disease, and the frequent occurrence of
the most extensive and complex varieties in patients who have suffered
from meningeal affections, suggest their cerebral origin. On these
points, however, anatomo-pathological information is to seek, and for
that matter the direct dependence of such an habitual movement as a
co-ordinated tic upon one lesion is scarcely within the bounds of
probability. Tic pertains to a psychical rather than to a motor sphere,
and is to be regarded as a disease of the will.
With this statement, and with the expression of our hope that subsequent
work will aid in the elucidation of the question, we shall close the
chapter of the tic's pathological anatomy. It may not prove superfluous,
however, to indicate why and how the facts gleaned from pathology and
supposed to be in harmony with the clinical picture of tic should be
allocated to other morbid entities.
In several cases considered to be tics of the face, cortical lesions
have been discovered at the posterior end of the second frontal
convolution, in the centre for voluntary and co-ordinated movements of
the contra-lateral facial muscles. It has become classical to cite an
example described as long ago as 1864 by Debrou[41] under the title
"painless facial tic," but a glance at the observation suffices at once
to negative its classification as a tic, and to justify the diagnosis of
a spasm of a quite peculiar sort.
Public-domain text, read in full here on John Shaqi.
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