Functional tic-like behaviours during the COVID-19 pandemic: Follow-up over 12 months

Abstract

BackgroundFunctional tics are included in the wide spectrum of functional movement disorders (FMDs). Their distinction from organic tics is challenging because they both phenomenologically present common features. During the COVID-19 pandemic, there has been an increase in functional tic-like behaviours in vulnerable children and adolescents after social media exposure. This study explores the phenomenology and course of a cohort of newly diagnosed functional tic-like behaviors.MethodsWe analysed clinical data of 243 patients affected by tic disorders collected at outpatient Tourette Clinic, Child and Adolescent Neurology and Psychiatry Unit, Catania University. Among the clinical cohort with functional tic-like behaviors, we evaluated the clinical course of symptoms at follow-up visits after 6 and 12 months.ResultsAmong the cohort of 243 patients referred for evaluation at our centre, 11 were diagnosed with functional tic–like behaviours. The majority of participants with functional tic–like behaviours were female with a mean age of 15 years old and presented an explosive symptom's onset. At follow-up visit after 12 months, patients with functional tic-like behaviors showed a significant variation in the severity of tics and anxiety symptoms. Conversely, depressive, and obsessive-compulsive symptoms did not significantly differ during the follow-up.ConclusionOur data suggest that several characteristics in clinical course and their phenomenology can help clinicians to distinguish functional tic–like behaviours from organic tics. Our results also suggest a better outcome for tics and anxiety symptoms respect on other comorbidities. A prompt diagnosis and management not only of tics but also comorbidities are recommended, as generally conventional pharmacotherapy for tics does not have positive effects on these patients.

Time is ticking for TikTok tics: A retrospective follow‐up study in the post‐COVID‐19 isolation era

“…More specifically, current theories postulate that FND is driven by impairments in self‐awareness and predictive coding, which are neurobiologically affected by stress, uncertainty, and neurally encoded beliefs, all of which are highly affected by mood and anxiety disorders (Milano et al., 2023). Our findings are similar to other studies of this population, which also demonstrated mean age of onset around 14–15, high rates of anxiety and depression, rapid progression of symptoms, and higher than expected prevalence of FND symptoms (Cavanna et al., 2023a; Prato et al., 2022; Pringsheim et al., 2023).…”

“…The CGI data gathered at follow‐up visits from August 2022 to January 2023 showed that approximately three‐fourths of patients had improvement in FTLBs, independent of comorbid diagnoses. This is in keeping with findings across other sites (Howlett et al., 2022 ; Nilles et al., 2023 ; Prato et al., 2022 ) and in contrast to tic disorders which tend to be more treatment‐resistant. The cessation of COVID‐19 isolation protocols likely reduced the burden of depression and anxiety.…”

Prospective follow‐up study of youth and adults with onset of functional tic‐like behaviours during the COVID‐19 pandemic

“…Two interventions that seem to have the best effect on symptoms prognosis were pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioural therapy (CBT) for anxiety and depression. In another study from Italy [22], the authors evaluated prognosis in 11 patients with FTLB. At 12‐month follow‐up, the authors observed a decrease in severity of tics and anxiety, but no improvement of obsessive–compulsive disorder (OCD) or depression.…”

“…Although a substantial number of studies have reported on the presentation of FTLBs at first onset and/or cross-sectionally, the long-term prognosis in these patients is still not clear. So far, only two studies have addressed this aspect [11,22]. In a prospective 6month follow-up conducted at our centre, we reported on course and treatment in an earlier case series of 20 adolescents and nine adults with FTLBs.…”

Functional Tic‐Like Behaviors: A Common Comorbidity in Patients with Tourette Syndrome

“…(3) worsening or no response to treatment compared to recent response to anti-tic therapies 18,24,46 ; (4) unusual or atypical descriptions of premonitory sensations, suppressibility, and influential factors with respect to increase, decrease, and remission of symptoms compared to descriptions related to preexisting tics 30,31,47 ; (5) occurrence of movements and vocalizations atypical for tics [19][20][21]24,[26][27][28][29]33,42,[44][45][46][48][49][50][51][52][53][54][55][56][57] ; (6) occurrence of SIB atypical of patients with TS 30,47 ; (7) secondary gain, for example, granting privileges at school or work 14,30,47 ; (8) atypical course or change in the course of symptoms in relation to the previous course of tics such as occurrence of "attacks," temporarily spontaneous remission for hours or days, and strong influence of specific activities or presence of other people [19][20][21][26][27][28][29][30][31]33,<...…”