[In this connection reference may be made to certain conditions
occasionally noted among those who tic--viz. a curious tendency to
maintain abnormal positions of the limbs or trunks, and difficulty in or
impossibility of relaxing various muscles (_catatonic aptitudes_).
Patients are sometimes given to the exaggerated repetition of the
ordinary movements of their members (_echokinesis_), as well as to
imitation of the actions of others (_echomimia_). Such catatonic and
echopraxic phenomena[51] are not confined to sufferers from tic, for
they are encountered among psychopathic subjects generally, and indicate
defect of cortical control--what is called by Brissaud "passive
activity." These catatonic aptitudes may be discovered by resort to
clinical tests, such as letting the arm fall from the horizontal
position.[52]]
INTENSITY OF THE MOTOR REACTION
The muscular contraction varies considerably in intensity, in most cases
exceeding that of the corresponding normal movement, and, especially in
tonic tics, being often so powerful as to necessitate the exertion of
great force to overcome it. Even though one's effort prove unavailing,
however, it is only needful to distract the patient's attention to
perform any and every passive movement with consummate ease.
In the case of S., any attempt to budge the head from its torticollic
position on the left evokes strong muscular resistance; but engage him
in conversation or otherwise divert his mind, and the difficulty soon
vanishes. By similar means, the resistance awakened by sudden change of
the direction of passive rotation will rapidly die down.
Occasionally the muscles brought into play surpass their fellows of the
opposite side in size and power, this secondary hypertrophy being the
natural sequel of repeated exercise. It was noted by Charcot that in
rotatory tics the disused muscles atrophied, whereas the affected
muscles hypertrophied, but they may do so only in appearance. The tonus
of the muscles at the moment of examination may create differences
inappreciable during relaxation. Sometimes one comes across such
expressions as "paresis" or even "paralysis" of antagonistic muscles,
and "contracture" of those in which the tic is localised. To draw a
distinction between slight contracture of the latter and mild paresis of
the former is a problem practically always insoluble. Opinion has been
ever divided on this point; yet some, in their desire to harmonise the
two, take up an eclectic position and do not hesitate to speak[53] of
"paralytic contracture," or "mixed contracture, at once active and
passive," a terminology by no means calculated to simplify the question,
and one the discussion of which we do not care to pursue.
Public-domain text, read in full here on John Shaqi.
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