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Question 53: My daughter had a vocal tic that lasted for about a year and then "disappeared" again for about a year. After many months agonizing over whether or not to get her routine childhood immunizations we went ahead with them. Three weeks after her immunization the vocal tic came back (after being gone for one year). What are the chances that the immunization triggered the tic or that it was part of the waxing and waning of tics? I wasn't aware that someone could be totally tic-free for a year and then have the tic re-occur. I am very distressed and feel extremely guilty about this. I can't help but think that the tic would not have started if she didn't have the immunization. Do you have any information on this? Keep up the good work!! D.E., ON, Canada.

Good morning D.E:

If you haven't found it already you may be interested in reading a paper I wrote about the possible links between TS symptoms and strep throat -- the paper is called "Syndenham's Tourettic PANDAS" and can be found at However, any associations made between tics and infections tend to suggest that treatments that render that infection immune help rather than exacerbate tics. I did a medical database search and could not find any published papers, reports, or letters that have found any relationship between immunizations and tics.

I wrote the above response assuming that the vocal tic you spoke of was the ONLY tic that your daughter had ever had, which re-occurred following her immunization. Even if you were saying that your daughter has other tics and THIS PARTICULAR TIC re-occurred following the immunization, there is no evidence to suggest that certain triggers will lead to specific tics. Furthermore, with my knowledge of the neurology of TS I cannot even think of a rationale for why or how that might occur.

I wasn't aware that someone could be totally tic-free for a year and then have the tic re-occur.

This is absolutely possible -- for example I have a snorting tic right now that I have not had since 2nd year university (7 years ago). In a more global sense as well tics can decrease and increase again as a result of changed environment, growth, time of day, medications, etc.......... the timing of immunization and waxing of a tic could be entirely coincidental (in other words, seeing a re-occurance of a tic that causes distress to you could lead you to link this event with ANY other salient event that has just occurred in your daughter's life).

TS first begins to present around the ages of 5 to 7-- in the age range you say your daughter has been over the past year. While it might be more unusual for a person in their teens to have a sudden loss of all tics for a year, and then have them re-occur, manifesting such a pattern at your daughter's age is less surprising. Your daughter may be "working toward" an eventual diagnosis of TS, or she may simply be experiencing some transient tics as she develops (certainly on the TS spectrum, but "sub-clinical" -- below a diagnosable level of symptoms). Time will tell.

Finally, given that the immunization and the re-occurance of this tic were over 20 days apart from one another leads me to even reject the idea that the general physical and mental stress of an immunization may have indirectly led to a tic increase.

I am very distressed and feel extremely guilty about this.

Even if there were substantial evidence that irrevocably proved that immunizations always increase tics (which there most certainly is not!) I would plead with you to not feel guilty. The decisions a person makes in the absence of certain knowledge is not IN THE SLIGHTEST a reflection of who that person is, or how they feel. You said that you agonized over the decision to immunize or not -- that in itself tells me that you a.) were thinking, b.) care tremendously about the well-being of your daughter, and c.) wanted to do what was right. I see nothing worthy of regret in that.

Have an excellent day, D.E. It sounds like you deserve to allow yourself

Dr. Dunc.

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Last updated on March 25, 2022

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