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Neuro Doctor
Neuro Doctor, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5040
Experience:  American Board Certified Neurologist, Internal Medicine
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I'm not completely sure when but i'de say roughly just

Customer Question

Hi, i'm not completely sure when but i'de say roughly just over a year ago i started to do tics but in the last 5 months or so they have got worse i think, when they first started it was mainly the usual head movements up and down but as times gone on they've become more frequent and involve different parts of the body now as well like shurgging shoulder, tensing one side of my back for one second, and hand movements and so on, at the moment i can control it very well i can resist any tic for about an hour and can also control it very well in public to if i have to but i'm concerned that it's going to get worse or i start getting the vocal tics as well as time goes on. Thought it be good to note that i had a full blown siezure when i was 12 also and they found that i had a benign brain tumor witch was removed successfully and haven't had one seizure since, i'm now 24. I'm on lamotrigine and two anti-depressants witch are citalopram (10mg) and mitzaripine (15mg) daily. I don't understand why i'm having these tics though, really concerned because my brain is obviously not functioning right if i'm having tics surely. look faward to your reply, thanks.
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Phil, MD replied 1 year ago.
do you take any other meds?
Customer: replied 1 year ago.
no just some oral antibiotics thats it
Expert:  Dr. Phil, MD replied 1 year ago.
did you change any meds when the tics started?
Customer: replied 1 year ago.
no their the only meds. i've been on the lamatrigine since i was 12, the mirtazipine since 2010 and the citalopram since 2011 or 2012 dont quite remember when i started the citalopram but was either 2011 or 2012 and the tics only started around over a year or year and half ago
Expert:  Dr. Phil, MD replied 1 year ago.
I think it could be an interaction between citalopram and mirtazapine. They do interact And sometimes it takes a while to develop a reaction
Customer: replied 1 year ago.
you reckon that interaction of anti-depressants could cause tics?
Expert:  Dr. Phil, MD replied 1 year ago.
Yes, I do
Customer: replied 1 year ago.
my dr decreased the dose from 20mg citalopram to 10mg three weeks ago so i've been on that but dont know if my tics have improved or not really it's hard to judge
Expert:  Dr. Phil, MD replied 1 year ago.
I would give it more time.
Customer: replied 1 year ago.
trouble is i think my mood has dropped since decreasing the citalopram, is it possible for my tics to develop in to torrettes syndrome because i'm worried about that i dont want to start having focal tics as well.
Expert:  Dr. Phil, MD replied 1 year ago.
Yes, anxiety can certainly trigger it
Customer: replied 1 year ago.
re:list i paid for medium infomation
Expert:  Dr. Phil, MD replied 1 year ago.
I'm here
What more questions do you have?
Customer: replied 1 year ago.
Is it possible to open my question to a neurologist please, i paid for medium information and all the responses you've given i haven't been happy with.
Expert:  Neuro Doctor replied 1 year ago.
Hi, I am an American Board Certified Neurologist and I am very glad to help you with your health concerns.
The symptoms you have described above indeed sound like tics.
Tics are uncommon in adults but rarely they can occur in adults too.
Most of the times tics are primary conditions (primary tick disorder), means there are no underlying abnormalities or pathologies that can be demonstrated by any laboratory investigations to explain the tics.
However rarely tics are secondary to some other conditions.
The following are the various secondary causes for tics;
Electrolyte abnormalities
Thyroid gland dysfunction
Parathyroid gland dysfunction
Stress disorder/anxiety disorder
Medication side effect etc
If the above conditions have not been ruled out then they need to be ruled out. Certain blood tests can help in ruling out electrolyte problems, thyroid, parathyroid problems etc. Stress and anxiety disorders are clinical diagnoses there are no laboratory tests to rule them in or rule them out. Regarding the medication side effect possibility; you are on 3 meds and actually none of them commonly cause tics although rarely they can cause tics. If you have not had any seizures all these years then the lamotrigine may not be needed for you so it may be slowly tapered off and stopped. If tics get better then we can consider it was lamotrigine induced. If this does not help then tapering off the other meds – one at a time can help in finding out whether these meds are the culprits. If needed they can be replaced with substitutes. And I agree with your points that you have been on these meds already for some time but the tics started only recently but human body is very complex and sometimes it is difficult to explain certain occurrences; in our clinical experience we have seen patients developing new side effects for the first time long after the introduction of certain meds, so there is a small possibility these tics could be due to the meds you are taking too. I am not telling this is definitely due to your meds, but there is a small possibility.
Now coming to the treatment of tics, if any obvious cause is identified then it needs to be treated and treating the underlying cause should help in getting rid of the tics, if no secondary cause is identified then the following are the various treatment options towards helping in controlling the tic disorder;
A) Non-medication treatment options for tics;
Counseling/ therapy (mainly habit-reversal CBT or cognitive behavioral therapy)
Biofeedback
Acupuncture
Relaxation therapy
Hypnotherapy etc
B) Medication treatment options for tics;
Clonidine
Guanfacine
Risperidone etc
Please let me know if you have any further questions; and if you feel you have received the answer to your question please rate me so that I can receive credit for the time and effort put by me in answering your question.
Best regards,
Customer
Customer: replied 1 year ago.
HiCustomersorry for the late reply my internet connection went down for a couple of days. I do have a history of depression and anxiety but since i went on that comination of anti-depressants i felt ok for a long time and never got anxious and have felt generally well, it's only been since one month ago when i woke up randomly in the night and was in panic mode my legs were shaking and everything and i was like it for a good 10 minutes, my girlfreind rang an ambulance and i went in to the hospital for a little check up as pracaution it was very strange for me because as i've got older my anxiety has got way better and i never had a panic attack for years but since that episode a month ago i haven't quite felt right, while i was in the hospital for a few hours they did do a blood test and it came back normal. The tics didn't use to bother me that much but they are now and i think the anxiety and stress certainly does make them worse, i have actually decreased the dose of the one med citalopram to 10mg for a few weeks already but i dont think the tics improved really and my mood hasn't been right i've felt quite low lately, weather thats because i reduced the citalopram or because i'm wary the tics will get worse and develop in to vocal tics i dont know but i've gone back to my original 20mg dose of citalopram today, i haven't tried reducing the mitarzipine yet because it helps me sleep, i made an appointment with a neurologist yesterday for the 3rd of augast so i'll tell them whats all started happening, i went off the list because i missed a couple of appointments so haven't seen them for a couple of years so be good to see someone, i've been taking the lamatrigine since i was 12, what does lamatrigine induced mean could these tics be due to the lamatrigine?
Thamks
Expert:  Neuro Doctor replied 1 year ago.
Hi, sorry I couldn't reply earlier as I was away from the computer and just returned.
Yes going back on the original dose of citalopram looks like a correct decision because after reducing the dose of this med you did not see any improvement of tics, also you feel your overall mood is low recently and more anxious too.
Since mirtazapine is helping with sleep so not to try to taper it unless you have some other substitutes to help with sleep (for example an over the counter sleep aid like Valerian root extract can be substituted). Mirtazapine is an antidepressant too so make sure citalopram is helping you before you attempt to come off mirtazapine (if at all you decide to come off it to find out whether the tics have anything to do with mirtazapine).
Lamotrigine too rarely can induce or exacerbate tics. Since your seizure is very long ago so you may not need seizure med anymore, so when you see your neurologist you may discuss with them about possibly coming off lamotrigine. But remember lamotrigine is an antidepressant too so make sure your depression is under control before coming off lamotrigine (if at all decided to come off it).
This is an article on lamotrigine induced tics;
http://www.ncbi.nlm.nih.gov/pubmed/10897158
You are very welcome! Please let me know if you have any further questions; and if you feel you have received the answer to your question please rate me so that I can receive credit for the time and effort put by me in answering your question.
Customer: replied 1 year ago.
I think i'll want to decrease the mitarzipine or lamatrigine to see if my tics do improve, do u think their a good chance these tics could be because of the meds then even though i've been taking lamatrigine for example for 12 years and the tics only started 1 year and half ago?? ye a few years ago they gave me an option of coming off my meds but i wanted to stay on them because i wanted to start learning to drive and i would of had to prove i was seizure free for one year without the meds before starting. Even though i haven't had a seizure since i was 12 before i had the brain tumor removed doesn't the brain tumor kill some healthy brain cells after it's been removed giving the risk of a seizure without the meds and also because i've been on this anti-convulsant for so long my brains got use to it so if i come off haven't i got a risk of the slightest of seizure activity or doesn't it work like that? Thanks for the artical i will take a look at it
Expert:  Neuro Doctor replied 1 year ago.
Like I had mentioned earlier too the possibility of meds causing tics is very less, but since there is no other obvious cause we are looking at rare causes.
Yes it is likely the brain tumor has killed some brain cells or there may be surgical scar etc which also can act as a seizure focus but after so many years these may not act like an active seizure focus now. At least the chances are very low. So coming off seizure med is something to consider, but there is no 100% guarantee that you will not get any seizures after coming off the seizure med, however the possibility will be very low so if you are willing to take a very small risk then you can consider taking a chance by coming off seizure med. And if you ever decide to come off the seizure med it should be tapered off very slowly and this way you minimize any chances of withdrawal seizure due to being on seizure med for very long time.
You are very welcome! Please let me know if you have any further questions; and if you feel you have received the answer to your question please rate me so that I can receive credit for the time and effort put by me in answering your question.
Customer: replied 1 year ago.
ye i see what your saying, one last thing and i'll high credit you, like you said because theirs no obvious cause it maybe to do with the meds because is this quite rare then to develop tics at my age, because i'm thinking ye maybe to do with the meds or could this happen because the history/effects of having a major brain operation or it wouldn't it be to do with the tumor removal?
Also a thing i didn't mention witch i wanted to is since i've started to be bit concerned about these tics in this past week, witch may sound crazy is i've been saying certain sentences in my head but over and over again like this as an example " might just need to sort my medicines out" or what my GP said to me "he doesn't think i'll get the vocal tics as well"
Expert:  Neuro Doctor replied 1 year ago.
Yes it is correct, the tics are extremely rare in adults, and also there are no obvious cause for tics in you and due to these we need to look for rarer and rarer causes – and in this regard meds too are considered as possible culprits. But I do not think history or effects of having a major brain operation or history or effects of a tumor removal have anything to do with tics. I am not aware of these situations triggering tics. The other concern you are having – “saying a sentence again & again in your head” – to be honest with you this does hint that you are under excessive stress or under excessive anxiety recently due to your recent heightened health concerns. I am really not suspecting any pathological conditions to explain this new development (of repeating something in your mind again & again) and I can strongly reassure you in this regard. As your health anxiety subsides this new symptom should resolve.
You are very welcome! Please let me know if you have any further questions; and if you feel you have received the answer to your question please rate me so that I can receive credit for the time and effort put by me in answering your question.
Customer: replied 1 year ago.
ye i know what you mean and some of the possibilities like throid problems etc that you gave me can some of them be ruled out due to the blood test i had done a month ago was normal, thanks for the reasurrance on me saying things over and over again problem
Expert:  Neuro Doctor replied 1 year ago.
You are very welcome! Yes, the saying things over and over again in the head is certainly not anything pathological and I can strongly reassure you in this regard.
Please let me know if you have any further questions; and if you feel you have received the answer to your question please rate me so that I can receive credit for the time and effort put by me in answering your question.