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Blepharospasm in adults - NICE guidance - suspected neurological conditions - recognition and referral

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Tics and involuntary movements in adults

Summary points from NICE guidance relating to tics and involuntary movements in adults are:


  • do not routinely refer adults with tics (involuntary movements that can be temporarily suppressed at the expense of mounting inner tension) unless the tics are troublesome or accompanied by additional progressive neurological symptoms

  • consider referring adults with a tic disorder for psychological therapy if the disorder distresses them

  • consider referring adults who have completed psychological therapy for a tic disorder to have a neurological assessment if their symptoms are severe and the disorder continues to distress them
    • however inform the person that: there are not many medicines available to treat a tic disorder the medicines that are available don't always work well and can have serious side effects.

Involuntary movements

Do not routinely refer adults with isolated involuntary movements of the eyelid unless the movements:

  • cause involuntary tight eye closure of both eyes (blepharospasm) or
  • have persisted for more than 3 months.

In adults with involuntary movements of the face, neck, limbs or trunk that cannot be temporarily suppressed by mental concentration:

  • refer for neurological assessment or

  • refer to neurology or an eye clinic, according to local provision, if the person has involuntary tight eye closure of both eyes (blepharospasm).

Do not routinely refer adults with small involuntary muscular twitches (fasciculations) unless these are associated with muscle wasting and weakness or muscle rigidity.


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