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PubMed2005

Secondary tics and tourettism.

Motor and phonic tics are most frequently due to Tourette syndrome, but there are many other causes of tics. We analyzed data on 155 patients with tics and co-existent disorders (101M/54F; mean age 40.5 +/- 20.2 years). Fourteen (9.0%) patients had tics associated with an insult to the basal ganglia, such as head trauma (N = 4, 2.5%), stroke (N = 2, 1.2%), encephalitis (N = 3, 1.9%) and other causes. In addition, certain drugs, toxins, and post-infectious causes were associated with tics. Rarely, peripheral injury can cause movement disorders, including tics (N = 1, 0.6%). Pervasive developmental disorders, including Asperger's syndrome (N = 13, 8.3%), mental retardation (N = 4, 2.5%), autism (N = 3, 1.9%), and Savant's syndrome (N = 1, 0.6%), also may be associated with tics, as noted in 21 of the 155 patients (13.5%). Genetic and chromosomal disorders, such as Down's syndrome 5 (3.2%), neuroacanthocytosis (N = 2, 1.2%), and Huntington's disease (N = 1, 0.6%), were associated with tics in 16 patients (10.3%). We have also examined the co-existence of tics and other movement disorders such as dystonia (N = 31, 20.0%) and essential tremor (N = 17, 10.9%). Sixteen (10.3%) patients presented psychogenic tics, and one (0.6%) psychogenic tics and dystonia; conversely, Tourette syndrome preceded the onset of psychogenic dystonia (N = 1, 0.6%), and psychogenic tremor (N = 1, 0.6%) in two patients. Finally, 12 (7.7%) patients had tics in association with non-movement related neurological disorders, such as static encephalopathy (N = 2, 1.2%) and seizures (N = 3, 1.9%). To understand the physiopathology of tics and Tourette syndrome, it is important to recognize that these may be caused or associated with other disorders.

Adult↗
PubMed1998

The temporal dynamics of tics in Gilles de la Tourette syndrome.

BACKGROUND: Statistical characterization of tic behavior in Gilles de la Tourette syndrome (GTS) may provide insight into the dynamic functioning of the human central nervous system, as well as improve the quantitative assessment of tic symptom severity. METHODS: Twenty-two medication-free GTS subjects underwent videotaping of their tics. The intervals between temporally adjacent tics were measured, and the statistical properties of these intervals were assessed through graphical representation of frequency distributions, autoregressive integrated moving average (ARIMA) modeling, spectral analysis, and construction of first return maps. RESULTS: The frequency distribution of tic interval durations followed an inverse power law of temporal scaling. Spectral analyses similarly demonstrated that the spectral power density of tic interval duration scales inversely with frequency. ARIMA modeling suggested that the time series for tics are nonstationary as well as moving average processes. The first return maps demonstrated "burstlike" behavior and short-term periodicity in tics, and proved that successive tic intervals are not statistically independent. Graphic display of the time series confirmed shortterm periodicity, and in addition suggested the presence of period doubling. CONCLUSIONS: These findings are suggestive though not conclusive evidence for the presence of a fractal, deterministic, and possibly chaotic process in the tic time series. These analytic methods provide insight into the temporal features of tics that commonly are described clinically (such as short-term bouts or bursting, and longer term waxing and waning), and they reveal certain important temporal features of tics that have not been clinically described. The methods may also prove useful in the improved characterization of tic symptom severity.

Adolescent↗
PubMed1998

Course of tic severity in Tourette syndrome: the first two decades.

OBJECTIVE: Prevalence studies indicate a 10-fold higher rate of Tourette syndrome (TS) among children compared with adults. The purpose of this investigation was to examine the course of tic severity during the first 2 decades of life. METHOD: A birth-year cohort of 42 TS patients followed at the Yale Child Study Center was recontacted an average of 7.3 years after their initial clinical evaluation. Data concerning the onset and course of tic severity until 18 years of age were available on 36 TS patients. A variety of statistical techniques were used to model aspects of the temporal patterning of tic severity. RESULTS: Mean (SD) tic onset at 5.6 (2. 3) years of age was followed by a progressive pattern of tic worsening. On average, the most severe period of tic severity occurred at 10.0 (2.4) years of age. In eight cases (22%), the frequency and forcefulness of the tics reached a severe level during the worst-ever period such that functioning in school was impossible or in serious jeopardy. In almost every case this period was followed by a steady decline in tic severity. By 18 years of age nearly half of the cohort was virtually tic-free. The onset of puberty was not associated with either the timing or severity of tics. CONCLUSIONS: A majority of TS patients displayed a consistent time course of tic severity. This consistency can be accurately modeled mathematically and may reflect normal neurobiological processes. Determination of the model parameters that describe each patient's course of tic severity may be of prognostic value and assist in the identification of factors that differentially influence the course of tic severity.

Adolescent↗
PubMed1985

Recurrence of childhood multiple tic in late adult life.

In contrast to the lifelong persistence of symptoms characteristic of Gilles de la Tourette's syndrome, multiple tic of childhood is considered to be a self-limited disorder that remits by early adulthood. We describe four patients who had a history of multiple tic of childhood, complete absence of tics throughout most of their adult lives, and recurrence of tics in late adult life. All four had multiple tics that began before the age of 9 years and included both motor and vocal tics that changed in location and severity over time. None of the patients exhibited coprolalia. All tics subsided before the age of 20 years, only to recur after the age of 60 years, once again including both motor and vocal tics that changed in location and severity slowly over time. The one patient who was severely bothered by the recurrence of motor and vocal tics responded well to haloperidol. Although they do not fit into any accepted diagnostic category for multiple tic, these patients suggest that multiple tic of childhood can recur in adult life. This suggests that Gilles de la Tourette's syndrome may be a continuum for chronic multiple tic of childhood to full-blown classic Gilles de la Tourette's syndrome.

Age Factors↗
PubMed2001

Home alone: methods to maximize tic expression for objective videotape assessments in Gilles de la Tourette syndrome.

Our objective was to test whether at-home videotapes yield enhanced information on tics compared to office-based videotapes and a patient questionnaire on the current anatomical distribution of tics. Ten subjects with Gilles de la Tourette syndrome (age range 8-49 years) who were seen for initial evaluation completed a check list of anatomical areas currently affected with tics, and underwent a videotape examination according to the Rush Videotape Protocol. Each patient/family conducted the same protocol at home at the same time of day within 48 hours. We rated two tapes in random order using the modified published scoring method for the Rush Video-based Tic Rating Scale. Two environments were compared, the doctor's office and at home, with videotapes taken in three conditions: patient engaged in relaxed conversation, patient quietly seated with filmer in the room, and patient quietly seated alone in the room. Data were analyzed using a 2-factor repeated-measures analysis of variance (ANOVA), followed by Wilcoxon signed rank tests. All patients provided excellent quality videotapes that could be scored without difficulty. Environment (office vs. home) and Condition (conversation, quiet with observer, quiet and alone) were both highly significant (P < .0001) and did not interact (P = .54). The highest tic scores for total tic impairment occurred at home with the patient alone (mean score 14.5), and the lowest yield occurred in the office with an observer present (mean score 5.4), the setting closest to the clinical neurological examination. The Home/Alone video segments revealed tics not otherwise seen. Patient questionnaires on body regions recorded more areas than observed in the office videotape, but patients were unaware of several tics captured on the Home/Alone segment. Patients can produce videotapes for objective tic assessments. Because at-home videotapes consistently yield higher tic expressions than in-office films and capture tics that are not appreciated by patients, this methodology is well-suited for enhanced retrieval of objective data on tic expression.

Adolescent↗
PubMed2004

Tic disorders in children with frequent eye blinking.

PURPOSE: To prospectively evaluate the significance of psychiatric consultation in children with frequent eye blinking. METHODS: Fifty children < 16 years of age with frequent eye blinking underwent a psychiatric examination after undergoing a detailed ophthalmologic examination and receiving appropriate treatment. Patients with squinting related to intermittent exotropia or uncorrected refractive errors were excluded. The severity of tic symptoms and the differences in mothering behavior and childhood behavioral problems between the children with tic and normal children were assessed. RESULTS: Tic disorders were diagnosed in 43 children: 39 had transient tic disorders, 2 had chronic tic disorders, and 2 had Tourette's syndrome. Ten patients had complex motor tics, and 4 had motor and vocal tics. Two children with Tourette's syndrome, and another 2 who returned to the clinic with aggravated symptoms after 6 months without any ophthalmologic abnormalities, were treated with psychiatric medication. There was no difference in mothering behavior or childhood behavior problems between the children with tic and normal children. The severity of tic was significantly correlated with the duration of tic symptoms, the score of somatic complaints, and attention problems. CONCLUSIONS: Most of the children with frequent eye blinking had a transient tic disorder. Tics become more severe with a longer duration of symptoms and may have influenced the somatic symptoms and the patient's level of attention. Psychiatric consultation may be necessary for children with long-standing and frequent eye blinking.

Attention↗
PubMed2001

Group A streptococcal infections and tic disorders in an Italian pediatric population.

BACKGROUND: The relationship between childhood tic disorders and group A streptococcal (GAS) infections has been recently investigated by several research groups, but no systematic evaluation of laboratory indicators of GAS infections has been provided. OBJECTIVE: The aim of our study was to seek clinical and laboratory evidence of GAS infections in a large population of children affected with tic disorders. STUDY DESIGN: This investigation was a case-control study: 150 consecutive children presenting with tics were investigated for clinical and laboratory signs of streptococcal infections on the occasion of their first neuropsychiatric consultation. To compare the rate of exposition to GAS in a similar population, a control group of 150 children without tic disorders was examined during the same period. RESULTS: In children with tics, mean antistreptolysin O (ASO) titer (434 +/- 338 IU) was significantly higher compared with that of control subjects (155 +/- 126 IU); 38% of the children with tics compared with 2% of the control subjects (P <.001) had ASO titers > or =500 IU. Twenty-six children with tics (17%) had throat cultures positive for GAS, but in all cases, only few colonies per plate were isolated. Among the strains isolated, no prevalent T pattern or M type was observed. In children with tics a positive correlation between ASO titers and severity of tic disorder (measured by the Yale Global Tic Severity Scale) was found. CONCLUSION: Our results suggest that children with tic disorder could be a unique population in which GAS infection, or at least the exposure to streptococcal antigens, is correlated to the neurobehavioral disorder. Moreover, our data indicate a relationship between the severity of tic disorder and the magnitude of the serologic response to GAS antigens.

Antistreptolysin↗
PubMedDate not supplied

Videotape tic counts in the assessment of Tourette's syndrome: stability, reliability, and validity.

OBJECTIVE: We examined the short- and long-term temporal stability of tic counts to estimate the minimum length of videotape needed for a reliable index of overall tic activity and determined the interrater reliability and validity of tic counts based on prolonged videotape segments (> 10 minutes). METHOD: Motor and phonic tic counts and clinician ratings were performed on 43 patients with Tourette's syndrome (TS), aged 7 to 50 years. Short-term stability was estimated by determining the mean interval-to-interval correlation of sequential equal-length segments from 30-minute videotape recordings of 20 subjects. Long-term stability was determined by correlating tic counts at 1-week (N = 14) and 2-week intervals (N = 11). In addition, tic counts were correlated with the most widely used clinical ratings of TS. RESULTS: The short-term stability data indicated that estimates of motor and phonic tic frequencies should be based on videotape counts of at least 5 minutes' duration. Tic counts also were highly reliable and were significantly correlated with clinical ratings with the Yale Global Tic Severity Scale and the Clinical Global Impression Scale for Tourette Syndrome. CONCLUSIONS: Standardized videotape tic counts can provide highly reliable, stable measures of tic frequencies that are moderately correlated with selected global ratings of tic severity.

Adolescent↗
PubMed1997

A controlled study of sensory tics in Gilles de 1a Tourette syndrome and obsessive-compulsive disorder using a structured interview.

OBJECTIVE: To determine the prevalence and characteristics of sensory tics in the Gilles de la Tourette syndrome (GTS), and a matched population of patients with obsessive-compulsive disorder (OCD) using a structured assessment. METHODS: 50 subjects each of GTS, OCD, and healthy controls were studied to determine the prevalence and phenomenology of sensory tics, and diagnose tic disorders, OCD, and affective disorders according to DSM-III-R criteria. The severity of tics and obsessive-compulsive symptoms were quantified using the Tourette syndrome global scale (TSGS) and Yale-Brown obsessive-compulsive scale (Y-BOCS) respectively. RESULTS: The GTS group (28%) had significantly-greater life-time prevalence of sensory tics than the OCD (10%) and healthy (8%) groups (P < 0.05). The sensory tics in both the GTS and OCD groups were predominantly located in rostral anatomical sites. Multiple sensory tics occurred in some patients with GTS or OCD, but not in healthy subjects. Within the OCD group, those who had sensory tics had significantly higher TSGS scores (P < 0.0001), and a higher prevalence of GTS (P < 0.005). CONCLUSIONS: Sensory tics seem to be a common and distinctive feature of GTS and that subpopulation of patients with OCD predisposed to tic disorders. Neurophysiologically, a possible explanation for sensory tics is that they represent the subjectively experienced component of neural dysfunction below the threshold for motor and vocal tic production.

Adolescent↗
PubMed2002

[Comorbid disorders associated with tics].

INTRODUCTION: Tics are the most frequent abnormal movements in children. This is one reason for their importance. Another reason is their relationship to fascinating disturbances of human behaviour such as compulsion and obsessions. Several 'behavioural disorders', mainly attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD), are more frequent in patients with tics than in the general population. These associated disorders (named 'comorbid') are probably of more consequence than the tics. Relationship between tics and comorbid disorders is not well known. This review considers data, consequences, hypothesis and management of comorbid disorders associated to tics. DEVELOPMENT: From the personal series of children with tics, data of comorbid disorders associated to tics was analysed. Of 340 cases of tics, 132 (39%) cases have ADHD, 135 (40%) cases have OCD, obsessive compulsive symptoms (OCS) or obsessive-compulsive behaviour (OCB). 68 (20%) cases have both ADHD and OCD. Considering only Tourette cases (219) the figures are only slight higher: ADHD (42%), OCD (45%) and ADHD plus OCD (24%) suggesting that all the spectrum of tics has a common basis. CONCLUSIONS: Familial studies shows that 44 percent of the patients with tics have a positive familial history of tics and 30 percent positive familial history of obsessive compulsive signs. The data of the literature on the tics and comorbid disorders relationship is also revised.

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

Prevalence of tic disorders among primary school students in the city of Pavia, Italy.

BACKGROUND: The prevalence of tic disorders in children varies from 1% to 29% depending on the characteristics of the study population, the diagnostic criteria, and the study design and methods. AIMS: To calculate the prevalence of tic disorders among primary school children in Italy. METHODS: The study population comprised 2347 primary school children from the city of Pavia (pop. 80 073), Northern Italy. Using trained school teachers as the source of cases, all children with motor or vocal tics occurring intermittently and unpredictably out of a background of normal motor activity were accepted. The type, frequency, and circumstances of tic disorders were noted. School performance was correlated to the presence of tics. RESULTS: A total of 68 children (56 boys, 12 girls) aged 6-11 years were identified with tic disorders. The period prevalence was 2.9% (95% CI 2.3 to 3.7). The prevalence was 4.4% in boys and 1.1% in girls, with no detectable trends at age 6-11. Motor tics were present in 46 cases, vocal tics in 6, and motor and vocal tics in 16. Situation related tics were noted in 37 cases. A significant correlation was found between the presence of tic disorders and impaired school performance. DISCUSSIONS: Tic disorders are a fairly uncommon but disabling clinical disorder among primary school children from an urban community. The fairly low prevalence of this clinical condition, as compared to other reports, can be explained by the choice of stringent diagnostic criteria and the exclusion of patients with other movement disorders.

Chi-Square Distribution↗
PubMed1996

Role of hydrophobic substituents in the interaction of opioid Tyr-Tic dipeptide analogs with dodecylphosphocholine micelles. Molecular partitioning in model membrane systems.

The conformational properties of three Tyr-Tic-NH-R dipeptide analogs [where R = (CH2)2-Ph, (CH2)3-Ph or (CH2)2-cHx; Ph = phenyl; cHx = cyclohexyl and Tic = tetrahydroisoquinoline-3-carboxylic acid] have been investigated in purely aqueous solution and in the presence of fully deuterated dodecylphosphocholine micelles. H-Tyr-Tic-NH-(CH2)2-Ph is an opioid delta-agonist, whereas H-Tyr-Tic-NH-(CH2)3-Ph is a fairly potent delta-antagonist. H-Tyr-Tic-NH-(CH2)2-cHx is a less potent delta-antagonist. 1H-NMR spectra revealed that conformers containing cis and trans configurations of the Tyr-Tic peptide bond were present in all compounds in H2O and the H2O/lipid solvent. Analyses of the NMR data for the compounds in H2O indicate that in all three dipeptides the C-terminal substituent is flexible and the Tyr-side-chain adopts a trans orientation in most of the conformations. This promotes a compact Tyr-Tic structure. NOE patterns observed for the compounds in the micelle solution indicate that Tyr has an even greater tendency to assume a trans side chain configuration in the biphasic-solvent system. This feature was more pronounced in the trans conformers than in the cis conformers. Specific lipid-peptide interactions were indicated by NOESY spectra acquired for micelle samples incorporating 20% (by mass) protonated lipid. According to the obtained NOE data, Tyr and Tic form an aromatic cluster which preferentially inserts into the lipid interior of the micelle for the trans conformers of all three dipeptides and for the cis conformer of H-Tyr-Tic-NH-(CH2)2-Ph. For the cis isomers, partitioning of the C-terminal substituents into the lipid phase exhibited more diverse behaviour. The cis conformers of H-Tyr-Tic-NH-(CH2)3-Ph and H-Tyr-Tic-NH-(CH2)2-cHx preferentially anchor to the micelle via their C-terminal substituent, while the corresponding region in H-Tyr-Tic-NH-(CH2)2-Ph remains flexible and immersed in the aqueous phase. The inconsistent mode of peptide-micelle interaction observed for cis conformers of the three compounds studied is explained in terms of differences in their dipeptide-substituent hydrophobicities. The more apolar the substituent, the greater its tendency to preferentially insert into the lipid core of the micelle. Amide-proton temperature coefficients measured for the three peptides revealed differences amongst the cis and trans isomers. The amide proton in the trans conformer of each compound is highly exposed to the aqueous phase in both solvent systems studied, whereas the cis NH proton of each peptide is only partially exposed. These results demonstrate that a subtle structural modification of an active peptide analog can result in dramatic changes of its biological activity and its mode of partitioning at a membrane surface.

Amides↗
PubMed2006

Adulthood outcome of tic and obsessive-compulsive symptom severity in children with Tourette syndrome.

BACKGROUND: Tourette syndrome (TS) is a childhood-onset neuropsychiatric disorder that is characterized by both motor and phonic tics. One half to two thirds of children with TS experience a reduction or complete resolution of tic symptoms during adolescence. At least one third of adults with TS have comorbid obsessive-compulsive disorder (OCD). OBJECTIVES: To clarify the clinical course of tic and OCD symptoms in children with TS and determine if baseline clinical measurements in childhood are associated with future symptom severity in late adolescence and early adulthood. DESIGN: Prospective cohort study. SETTING: Yale Child Study Center tic and OCD outpatient specialty clinic. PARTICIPANTS: Forty-six children with TS who received a structured clinical evaluation prior to age 14 years. MAIN OUTCOME MEASURES: Expert-rated tic and OCD symptom severity at follow-up interview an average of 7.6 years later (range, 3.8-12.8 years). RESULTS: Eighty-five percent of subjects reported a reduction in tic symptoms during adolescence. Only increased tic severity in childhood was associated with increased tic severity at follow-up. The average age at worst-ever tic severity was 10.6 years. Forty-one percent of patients with TS reported at one time experiencing at least moderate OCD symptoms. Worst-ever OCD symptoms occurred approximately 2 years later than worst-ever tic symptoms. Increased childhood IQ was strongly associated with increased OCD severity at follow-up. CONCLUSION: Obsessive-compulsive disorder symptoms in children with TS became more severe at a later age and were more likely to persist than tic symptoms.

Adolescent↗
PubMed1999

The 4-year course of tic disorders in boys with attention-deficit/hyperactivity disorder.

BACKGROUND: Despite long-standing clinical concerns, relatively little is known about the comorbidity between attention-deficit/hyperactivity disorder (ADHD) and tic disorders. Therefore, we examined tic disorders in an ongoing prospective follow-up study of male subjects with ADHD, a sample unselected for any comorbid disorder. METHODS: One hundred twenty-eight male children and adolescents with ADHD and 110 male controls were comprehensively evaluated at baseline and 4 years later. We characterized tic disorders along with a wide range of neuropsychiatric correlates, including other comorbid disorders and indices of psychosocial function in multiple domains (school, cognitive, social, and family). RESULTS: Compared with controls, subjects with ADHD showed more tic disorders at baseline and more new onsets were reported at follow-up. Attention-deficit/hyperactivity disorder and tic disorders appeared to be independent in course: in contrast to low rates of ADHD remission, tic disorders mostly remitted. The age-adjusted rate of ADHD remission was 20% and that of tic remission, 65%. Tic disorders had little effect on the psychosocial functioning of subjects with ADHD. CONCLUSIONS: These findings suggest that comorbidity with a tic disorder has a limited effect on ADHD outcome. However, because of the relatively small sample of subjects with tic disorders, our conclusions should be considered preliminary until confirmed in larger studies of medicated and unmedicated children with ADHD with and without tic disorders.

Adolescent↗
PubMed2001

Comparative study of the behavioral and neuropsychologic characteristics of tic disorder with or without attention-deficit hyperactivity disorder (ADHD).

To study the nature of the comorbidity of tic disorder and attention-deficit hyperactivity disorder (ADHD), patients with tic disorder with or without ADHD were compared on the basis of clinical ratings and neuropsychologic tests. Seventy-eight children were involved in this study: 16 with tic disorder, 19 with comorbid tic disorder and ADHD, 21 with ADHD, and 22 normal controls. Rating scales for ADHD, the Child Behavior Checklist and the Yale Global Tic Severity Scale, were completed in clinical groups. To identify differences in neuropsychologic function among the four groups, the results of seven neuropsychologic tests of global cognitive abilities, attention, information-processing capacity, and fine motor skill were compared. On most behavioral and neuropsychologic tests, the tic disorder with ADHD and the ADHD groups demonstrated similar performance patterns and marked deficits compared with the tic disorder and the control groups, whereas in most of the attention tests, the ADHD group made more commission errors than the tic disorder with ADHD group. These findings suggest that the tic disorder with ADHD group has marked cognitive deficits and behavioral disturbance similar to the ADHD group, whereas the tic disorder group is more similar to the controls. The tic disorder with ADHD group might represent a true comorbidity of the two disorders.

Adolescent↗
PubMed2001

Botulinum toxin for simple motor tics: a randomized, double-blind, controlled clinical trial.

OBJECTIVE: To determine the effect of injections of botulinum toxin on simple motor tics. BACKGROUND: Case series with unblinded assessments have reported improvement in tic frequency and associated urge with botulinum toxin. METHODS: Patients with suitable simple motor tics were randomized to receive botulinum toxin and placebo in a double blind, crossover design. All outcomes compared week 2 to baseline measurements. The primary outcome measure was the number of treated tics per minute on a videotape segment. Secondary outcome measures were number of untreated tics per minute, the Shapiro Tourette Syndrome Severity Scale score, a numerical assessment of the urge to perform the treated tic (0 to 4), the premonitory sensation associated with the treated tic (0 to 4), and the patient's global impression of change. RESULTS: Eighteen patients completed the study. The median relative change in treated tics per minute with botulinum toxin was -0.39 (or a 39% reduction) versus 0.058 (or a 5.8% increase) with placebo (net effect -0.37, p = 0.0007). The average change in urge scores (score range 0 to 4) was -0.46 in the treatment phase and +0.49 in the placebo phase (net effect 0.94, p = 0.02). Other secondary outcome measures were not significantly different between the two groups. CONCLUSION: Botulinum toxin reduced treated tic frequency and the urge associated with the treated tic. Despite these changes, patients did not report an overall benefit from the treatment. Careful consideration of the contribution of the target tic to the patient's disability is needed before making treatment decisions.

Adolescent↗
PubMed1997

Eye signs and tic disorders: Gilles de la Tourette's syndrome.

BACKGROUND: Eye tics are among the most common manifested symptoms of tic disorders, including Gilles de la Tourette's syndrome (GTS). METHODS: A review of medical literature or ocular signs and symptoms of tic disorders was conducted. RESULTS: Tic disorders are characterized by repetitive and often disabling movements that primarily involve the eyes, face, neck, and voice apparatus. In addition, patients with tics may have eye problems related to medications used to control tics. Some eye signs are atypical in tic disorders and their presence may suggest alternate diagnoses. CONCLUSION: Eye tics can be disabling and a optometrist should be familiar with ocular manifestations of tics and ocular dysfunction related to tic treatment, and also be aware of other neurologic conditions confused with tics.

Disability Evaluation↗
PubMedDate not supplied

[Dopamine D2 and D4 receptor genes distinguish the clinical presence of tics in obsessive-compulsive disorder].

An allelic association study between dopamine receptor gene polymorphisms D2 (DRD2) and D4 (DRD4), in obsessive-compulsive patients (OCD) with or without chronic motor or vocal tics (OCD+ or OCD-) was performed. Molecular genotypes were obtained using the polymerase chain reaction method (PCR) in 66 patients diagnosed according DSMIV criteria, 12/66 OCD patients presented tics, 54 Control subjects were also typed. OCD patients with tics compared to control had a higher frequency of TaqI A2 allele (p = 0.014); and an excess of homozygous individuals A2A2 (p = 0.001). In DRD4 genes polymorphisms, allele 7 showed a higher prevalence and frequency in those OCD+ tics compared to OCD- tics (91% vs. 48%). Most of the OCD patients with tics compared to those without tics showed an increased frequency of the DRD2-A2 (58% vs 27% respectively, p = 0.048) as well as an increased frequency of the DRD4-7-fold variant (48% in OCD with tics vs 9% in OCD without tics, p = 0.018). Similarly, when both alleles were combined (at least one copy of DRD2-A2 and DRD4-R7), patients with tics showed a higher frequency of this haplotype (83.3% vs. 40%, p = 0.016). OCD patients with tics may represent a different clinical and genetic subtype of the disorder.

Adolescent↗