Clinical Features of Tourette Syndrome

Abstract

Tourette syndrome is a multifaceted disorder characterized by multiple motor and at least one vocal tics that start in childhood, persist for at least 1 year, and cannot be attributed to another medical condition or exposure to medications/drugs. Clinical diagnostic criteria are available, and identification of tics is typically straightforward based on characteristic appearance and features. Diagnostic uncertainty can rarely arise in cases of mild tics, atypical features, certain psychiatric comorbidities, and other non-tic movement disorders. Comorbid psychopathology, including attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive behaviors/obsessive-compulsive disorder, affects the majority of patients and is correlated with disease severity and the presence of additional psychiatric behaviors. The severity of tics often improves after adolescence, whereas psychiatric symptoms typically persist. The subset of patients in whom tics persist into adulthood experience higher rates of anxiety, and lower self-esteem, socioeconomic status, and quality of life; the relative contribution of motor tics and psychopathology is not fully understood. This article summarizes the clinical features of Tourette syndrome, including major diagnostic criteria, unique features of tics, and key aspects that differentiate tics from common mimics and chameleons. Comorbid psychiatric conditions and their impact on phenotype and quality of life are described. Finally, current understanding of the natural history is summarized, including limited research in adults with Tourette syndrome.

Current Status, Diagnosis, and Treatment Recommendation for Tic Disorders in China

“…First of all, tic symptoms should be differentiated from epileptic seizures, substance or medication-induced dyskinesia, chorea, dystonia, to name a few (32,64). The presence of a premonitory urge with relief following the tic movement, the ability to suppress the tic movement, as well as the waxing and waning pattern support the diagnosis of TD.…”

“…The presence of a premonitory urge with relief following the tic movement, the ability to suppress the tic movement, as well as the waxing and waning pattern support the diagnosis of TD. Furthermore, tics occur when the motor function of the involved muscle is normal; and tics are sudden, brief, and repetitive, and happen temporarily and episodically (32,64).…”

“…However, it is important to keep in mind that a variety of medical conditions and acquired factors could also cause tics or tic-like symptoms ( 8 , 29 , 46 , 64 ). According to the previous studies, the following medical conditions and disorders could present tics or tic-like movements as the main or part of the clinical manifestations ( 8 , 29 , 46 , 64 ): (1) genetic syndromes, in which tics or tic-like symptoms are only part of, but not the primary clinical manifestation, such as Down’s syndrome, Fragile X syndrome, tuberous sclerosis complex, and neuroacanthocytosis; (2) infectious diseases, such as streptococcal infection, encephalitis, neurosyphilis, Creutzfeldt-Jakob disease; (3) intoxicating factors, such as carbon monoxide, mercury, or bee poisoning; (4) medication side effects, such as methylphenidate, pemoline, amphetamine, cocaine, carbamazepine, phenobarbital, phenytoin, and lamotrigine; (5) other factors, such as stroke, and head trauma.…”

“…The presence of generalized anxiety disorder in subjects with TD/TS has been reported in the range from 19%–80%, with a high-risk period for anxiety issues starts at age 4, and a high-risk period for mood disorders begins at age 7 ( 47 , 75 ). The presence of depression in patients with TS has been positively correlated with an earlier onset, greater severity, and a longer duration of tics ( 31 , 45 , 64 , 75 ). Anxiety and depression should be routinely screened in children and youth with TD/TS by MINI Kid 5.0 ( 72 , 73 ), and properly assessed using the Multidimensional Anxiety Scale for Children (MASC) and the Children’s Depression Inventory (CDI) when the symptoms are prominent and intervention is needed ( 75 ).…”

Effect of Jian-Pi-Zhi-Dong Decoction on the Amino Acid Neurotransmitters in a Rat Model of Tourette Syndrome and Comorbid Anxiety Disorder

“…Normally, TS is diagnosed by the onset of multiple motor tics and vocal tics lasting at least 1 year in clinic. The different tics do not need to present concurrently, but manifest at some point throughout the course of the illness (1). The disorder is usually self-limiting, but may continue into adulthood.…”