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PubMed2005

Association of common cold with exacerbations in pediatric but not adult patients with tic disorder: a prospective longitudinal study.

Cross-sectional data and case studies suggest a temporal relationship between fluctuations in tic severity and preceding infections. In this study, we aimed to examine this possible relationship in a prospective longitudinal design. Two groups of tic disorder patients were included, a pediatric group between 7 and 15 years of age (n = 20), and an adult group over 15 years of age (n = 41). During a 24-week period, participants were asked to fill out weekly self questionnaires regarding the presence of tic exacerbations and the experience of the common cold. In addition, 6 throat swabs were taken at monthly intervals and cultured for streptococci; also, 3 serial serum assessments of streptococcal antibodies were performed at 8-week intervals. In the pediatric group, our results indicated a strong association between the self report of a common cold and a symptom exacerbation 4 weeks later (Odds ratio = 4.685; p = 0.001). In the adult group, we found no association between reports of common cold and tic exacerbations. Association with streptococcal infections could not be determined owing to the limited number of observed streptococcal infections. Thus, this study points to a hitherto unknown association of common viral infections with tic exacerbations in children, which may support the involvement of immune dysregulation in tic disorders.

Adolescent↗
PubMed1988

Transient tic disorder and the spectrum of Tourette's syndrome.

Transient tic disorder (TTD) has not generally been considered part of the spectrum of Tourette's syndrome (TS). We studied a large kindred affected by TS and identified two family members with TTD who are very likely obligate carriers of the TS gene. Our observations indicate that TTD is a possible expression of the TS gene and that individuals with TTD may transmit TS to their offspring.

Adult↗
PubMed1999

Deficient motor control in children with tic disorder: evidence from transcranial magnetic stimulation.

Decreased motor inhibition was reported in adult patients with tic disorder (TD) using the technique of transcranial magnetic stimulation. Since tics usually begin during childhood, motor threshold, cortical silent period (CSP) and intracortical inhibition/facilitation were measured in 21 TD children and 25 healthy children aged 10-16 years. In TD children motor threshold was normal. The CSP was significantly shortened compared to healthy controls but did not depend on tic localization. Intracortical inhibition and facilitation did not differ between the two groups. This study confirms that the finding of decreased motor control in adult patients also holds true for children wherever the tics in the latter group were located.

Adolescent↗
PubMed1997

Tic disorders.

The picture that emerges is one of complex behavioral phenotypes that alter over the course of CNS development. While many cases are mild and may not come to medical attention, others are chronic and disabling. The aim of this article is to provide an overview of recent progress in understanding phenomenology, epidemiology, genetics, neurobiology, and treatment of tic disorders.

Basal Ganglia↗
PubMed2005

Tourette syndrome and other tic disorders in a total population of children: clinical assessment and background.

AIM: To describe the symptoms, onset, heredity, pre-/perinatal events and socio-economic status in Tourette syndrome (TS) and other tic disorders. METHODS: From a total population of 4479 children, 25 (0.6%) with TS, 58 (1.3%) with chronic motor/vocal tics (CMVT) and 214 (4.8%) with transient tics (TT) in the last year were found. A three-stage procedure was used: tic screening, telephone interview and clinical assessment. The TS group was compared with 25 children with TT and 25 controls without tics. RESULTS: The mean age of the first symptoms of TS was significantly lower than the onset of CMVT. All except one with TS had contact with medical services. The tics of children with TS were significantly more severe than the tics of others. Younger age of onset of TS indicated more severe tics. Parents and siblings of children with TS had an increased prevalence of tic disorders, obsessive-compulsive behaviour (OCD), attention-deficit/hyperactivity disorder (ADHD) and depression. Eighty per cent had a first-degree relative with a psychiatric disorder. A non-significant increase with regards to reduced optimality score in the pre-, peri- or neonatal periods was found in children with TS compared to controls. No differences were found concerning socio-economic status. CONCLUSION: Almost all children from a total population with TS have sought help from medical services. An increased prevalence of tics, OCD, depression or ADHD was found in the parents/siblings of children with TS, which draws attention to the importance of thorough investigation of family members.

Adolescent↗
PubMed2004

Adult-onset tic disorder, motor stereotypies, and behavioural disturbance associated with antibasal ganglia antibodies.

The onset of tics in adulthood is rare and, unlike the childhood variety, there is commonly a secondary environmental cause. We present four cases (1 man, 3 women) with an adult onset tic disorder (mean age of onset, 36 years; range, 27-42 years) associated with the presence of serum antibasal ganglia antibodies (ABGA). One patient had motor tics and unusual motor stereotypies, 2 had multiple motor and vocal tics, and the remaining patient had motor tics only. Concomitant psychiatric disturbance was noted in 3 cases. In 2 cases, there was a close temporal relationship between upper respiratory tract infection and the subsequent onset of tics. Imaging was possible in three cases and was normal in two but revealed a lesion involving the right caudate and lentiform nuclei in the other. We suggest that there might be a causal relationship between ABGA and the clinical syndrome in these cases and that ABGA should be considered as a possible etiology for adult-onset tics.

Adult↗
PubMed2000

New-onset tic disorder following acute hemorrhage of an arteriovenous malformation.

The etiology of tic disorder includes idiopathic, postencephalitic, head injury, carbon monoxide poisoning, stroke, and developmental syndromes. We report a case of new-onset complex motor and vocal tics that began after hemorrhage of an arteriovenous malformation located in the left frontal lobe. We have found no reported cases of new-onset tics related to arteriovenous malformations or hemorrhage into the frontal lobes. The patient is a 16-year-old right-hand-dominant boy who presented with generalized tonic-clonic seizures. Evaluation, including magnetic resonance imaging, revealed a left frontal arteriovenous malformation, confirmed by angiogram. Following resection, there was an intraparenchymal hemorrhage of the left frontal lobe with intraventricular hemorrhage, noted most prominently in the left lateral and IIIrd ventricles, and a subdural hematoma caudal to the craniotomy. The postoperative course was complicated by hemiparesis and global aphasia. During recovery, the patient developed what was thought to be a complex partial seizure evidenced by head turning to the right with vocalization and left upper extremity clonic jerks. These were brief and occurred multiple times per day. A trial of carbamazepine was given with no improvement. It was noted that the spells occurred more frequently under stress, as when the patient was frustrated with communication. The diagnosis was changed to complex motor tics and the therapy changed to clonidine. The tics subsequently improved by 80%, although they were still present. We believe the development of complex motor tics due to frontal hemorrhage represents a unique etiology and could complicate postsurgical recovery in similar cases.

Acute Disease↗
PubMed2000

Asperger's syndrome, X-linked mental retardation (MRX23), and chronic vocal tic disorder.

Pervasive developmental disorders are severe disorders of development with no consistent neurobiologic etiology and most often an idiopathic etiology. We report a 12-year-old male who met criteria for a pervasive developmental disorder (Asperger's syndrome) and a chronic tic disorder. The child also has an X-linked cognitive impairment (MRX23). The presence of tic symptomatology, pervasive developmental disorder, and fragile X syndrome has previously been reported. Since no singular etiology for Asperger's syndrome has been found, the possibility of other cases of Asperger's syndrome occurring with concurrent abnormalities on the X chromosome should be considered by clinicians, especially if tic symptomatology is present.

Asperger Syndrome↗
PubMed1984

Fluphenazine and multifocal tic disorders.

In a five-year study, 21 patients with multiple tic disorder intolerant of haloperidol therapy were treated with fluphenazine hydrochloride. Sixteen of these patients had fewer side effects with fluphenazine and had either equivalent (five patients) or better (11 patients) tic control. Fluphenazine can be an effective treatment for multiple tics in patients with dose-limiting side effects related to haloperidol.

Adolescent↗
PubMed2004

Transient tic disorder following carbon monoxide poisoning.

We report a 12-year-old male patient who developed transient motor and vocal tics twelve days after carbon monoxide (CO) poisoning. Cranial magnetic resonance image (MRI) of the patient showed bilateral symmetric hyperintensity in the caudate nucleus and putamen. Tic disorder was successfully treated with haloperidol. Thirty-three months after CO poisoning, the patient was asymptomatic and MRI revealed atrophy in caudate nucleus and putamen. The mechanism of tic disorder in CO intoxication is discussed.

Atrophy↗
PubMed1997

Tourette syndrome. Secondary tic disorders.

The putative relationship between a variety of neurologic and neuropsychiatric disorders, which have been reported in association with tics, is reviewed. Tics also may be increased or exacerbated by drugs affecting a variety of neurotransmitter systems. Recognition and study of these secondary tic disorders may further our understanding of basal ganglia physiology and the pathogenesis of Tourette syndrome.

Adult↗
PubMed1989

Pain in Gilles de la Tourette syndrome and related tic disorders.

Although pain is not generally recognized as a symptom of tic disorders, we have seen a number of patients in whom this was a prominent feature, at times even the symptom of greatest concern. The commonest pain complaints are those arising from the actual performance of a tic. Most often this follows directly from the discomfort produced by sudden or repeated extreme exertion. Here the origin of the pain is usually musculoskeletal, though rare examples of neuropathic pain may occur. Pain also may arise from striking or being struck by a moving body part involved in large amplitude tics. Other related painful acts include deliberate self-injury and pain inflicted upon others. A second major category is represented by a smaller number of patients who complain of pain during voluntary efforts to suppress their tics. Finally, there are patients who obtain relief from tics while experiencing pain, to such an extent that they will deliberately provoke pain to obtain its benefit. We feel that pain should be recognized as a common complaint, and occasionally a source of significant disability, in patients with tics.

Adolescent↗
PubMed1988

Clonazepam, haloperidol, and clonidine in tic disorders.

We reviewed the treatment outcomes of 81 patients with multifocal tic disorders followed in our movement disorders clinic. From the three drugs used, rank orders of effectiveness were haloperidol, clonazepam, and clonidine. Because of the risk of tardive dyskinesia, we suggest first a trial with clonazepam, later combined with clonidine if clonazepam alone is not effective. Haloperidol should be reserved for the most disabling cases, and given only after trials with both clonazepam and clonidine have failed.

Child↗
PubMed1993

Tic disorders.

This article has provided an approach to patients who present with Tourette's syndrome or other tic disorders. The goals are to clarify each of the problems, to determine whether the major source of distress is related to tics or associated behaviors, and to develop an individualized multimodal treatment program. A valuable source of additional information for physicians, parents, and patients is the voluntary nonprofit Tourette Syndrome Association, 42-40 Bell Blvd, Bayside, NY 11361-9596.

Antipsychotic Agents↗
PubMed2004

Functional brain imaging in Sydenham's chorea and streptococcal tic disorders.

Group A streptococcal infections cause a wide range of neuropsychiatric disorders, such as Sydenham's chorea, tics, obsessive-compulsive disorders, and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Structural (computed tomography and magnetic resonance imaging) and functional (positron emission tomography, single-photon emission computed tomography) imaging studies in patients with Sydenham's chorea have suggested reversible striatal abnormalities. The objective of this study was to investigate the cerebral perfusion patterns of the subcortical structures by using hexamethylpropylenamine oxime single-photon emission computed tomography (HMPAO-SPECT) in seven cases of Sydenham's chorea and two cases of streptococcal tic disorder. HMPAO-SPECT studies revealed a hyperperfusion pattern in two and a hypoperfusion pattern in five of the chorea patients and in two patients with tic disorder. The results are discussed in relation to the duration and severity of the symptoms and the response to therapy. Functional imaging findings can be variable in Sydenham's chorea, and hyperperfusion of the striatum and thalamus could be an indicator of the response to therapy and the severity of symptoms. However, the number of cases so far investigated by either SPECT or positron emission tomography is still too limited to draw any firm conclusions.

Adolescent↗
PubMed1995

Competing responses for the treatment of Tourette syndrome and tic disorders.

A brief history of the competing response practice treatment for motor and phonic tic reduction is presented, as well as a basic explanation of the procedure. A table defining the competing responses of various tics that have been systematically studied over the past twenty years is also presented. This table is designed to be a reference tool for clinicians and researchers in the treatment of Tourette syndrome and tic disorders.

Awareness↗
PubMedDate not supplied

Adjunctive clonazepam treatment of tic symptoms in children with comorbid tic disorders and ADHD.

The treatment of seven children and adolescents with a tic disorder and concomitant attention-deficit hyperactivity disorder (ADHD) is reviewed. Symptoms of ADHD were treated successfully with clonidine; however, patients experienced persistent tics. The patients were treated with the adjunctive use of clonazepam. The addition of clonazepam resulted in a further decrease in tic frequency and severity without affecting the coexisting ADHD symptoms. These cases suggest that clonazepam may be a useful adjunctive pharmacological intervention in treating tics in children with comorbid ADHD.

Adolescent↗
PubMed1994

Self-reporting of behavior problems in patients with tic disorders.

Self-awareness of behavioral or emotional problems was examined in 25 children and adolescents with tic disorders by comparing the Youth, Parent, and Teacher forms of the Child Behavior Checklist. In general, their parents reported a significant number of deviant behaviors which were denied by the patients.

Adult↗