A's parents brought her to the local clinic due to sudden, repetitive movements and sounds that began six months ago. The symptoms started as brief eye blinking episodes, which they initially thought were related to dust exposure during farming. However, the symptoms have progressed to more noticeable and frequent head jerking and throat clearing noises.

A's symptoms began without any clear trigger. The eye blinking episodes gradually increased in frequency over the first few weeks. By the second month, she started making involuntary grunting sounds, which have since evolved into repetitive throat clearing and occasional clicking noises. She also developed a habit of shrugging her shoulders. The tics worsen when she is anxious, such as during exams or when she is reprimanded at school, and they decrease in frequency when she is relaxed, especially during prayer times.

The symptoms have become a source of embarrassment for A, particularly in school, where she has been teased by her peers. This has led to increased stress and occasional avoidance of school.

A’s family initially sought advice from a local herbalist, suspecting that she might be under a spiritual attack or curse, a belief common in their community. However, traditional remedies, including herbal concoctions and spiritual cleansing rituals, did not alleviate the symptoms.

The family was then advised by a teacher to visit the local health clinic, where A was seen by a general practitioner who recognized the symptoms as likely indicative of a tic disorder. There was a lack of awareness about tic disorders in the community, leading to delayed medical consultation.

Upon examination, A presented with both motor tics (frequent, involuntary blinking, head jerking, and shoulder shrugging) and vocal tics (throat clearing and clicking noises). These tics were more pronounced during the consultation due to anxiety but were absent during a brief period when she was distracted by a game on a smartphone.

A was diagnosed with a chronic tic disorder, likely Tourette Syndrome, given the presence of both motor and vocal tics for more than one year. The absence of other neurological symptoms and normal development otherwise supported this diagnosis.

The healthcare provider discussed the nature of tic disorders with A’s family, emphasizing that these are neurological, not spiritual, conditions. A referral was made to a specialist in a regional hospital for further evaluation and management, including the potential use of medication to reduce tic severity and psychological support to help A cope with the social challenges posed by her condition.

Given the limited access to specialists in the region, the local doctor also advised on simple behavioural interventions, such as stress management techniques and creating a supportive environment at school.

Amina and her family were encouraged to return for regular follow-ups to monitor her condition and adjust the management plan as needed. Education was provided to her teachers to foster a more understanding and inclusive school environment.