Gilles de la Tourette syndrome in pregnancy: a retrospective series

Abstract

Summary: Tourette syndrome is a neuropsychiatric syndrome characterized by motor and vocal tics with further co-morbidities, e.g. obsessive -compulsive disorder and attention deficit hyperactivity disorder. There is only a single prior case report in pregnancy in addition to a postal questionnaire study including 10 pregnancies. In a series of 11 pregnancies in patients assessed by the authors, there were no adverse effects on the pregnancy, although some obstetricians were unduly concerned. There was no consistent effect on the severity of the tics, although in some women there seemed to be a significant improvement during pregnancy. Keywords: Tourette, pregnancy, ticsTourette syndrome (TS) is defined by multiple motor and one or more vocal tics, lasting longer than a year, usually with onset in childhood. Apart from the involuntary twitch-like movements and noises, patients may have echolalia (copying what other people say), coprolalia (inappropriate and involuntary use of swear words) and self-injurious behaviours. Also, the majority of individuals seeking medical attention have additional co-morbid disorders, including attention deficit hyperactivity disorder, obsessive-compulsive behaviours/disorder and depression. The prevalence of TS is now recognized to be around 1% in school children, but the range of severity is very wide. 1Tics are characteristically situational and fluctuate in severity over time. The prognosis is better than previously thought with many individuals improving substantially by the age of 18 years so that the media stereotype of an adult with very severe TS applies to a small proportion of patients. The tics are often treated with neuroleptics or clonidine and co-morbidities generally need to be treated in their own right.There are well-known examples of an effect of the pregnant state on neurological disorders: for instance improvement of preexisting migraine, 2 or reduced relapse frequency in women with multiple sclerosis (with an increase in relapses after delivery), 3 and issues relating to anticonvulsant metabolism and teratogenesis in pregnancy. 4 There is no clinical link between TS and these examples, but its behaviour during pregnancy may be of interest as sex hormones have been implicated in the expression of TS, albeit only speculatively. 5 The prevalence of TS is 2-4 times greater in boys than in girls. 6 There has been a case report of the successful use of pimozide in a pregnant woman with TS with a normal pregnancy outcome.7 A postal questionnaire survey of 1000 TS Association (in the USA) members yielded 349 respondents, of whom 74 were women with medically diagnosed TS. Of those, 47 were of reproductive age and 26% experienced a premenstrual increase in tics, which in some cases was predicted by an increase in tics at menarche, a time when for most patients TS symptoms often decline. Menopause was not associated with a change in tics. Ten women recorded having had a pregnancy, with nine saying that there was no effect on their tics. 6 We investigated our own cohort of ...

Outcome of patients with early T1 and T2 squamous cell carcinoma of the base of tongue managed by conventional surgery with adjuvant postoperative radiation

“…In one study of hormonal effects on tics, 26% of women with Tourette's syndrome surveyed reported an increase in tic frequency premenstrually, but no consistent changes were associated with pregnancy 54. In a recent series of 8 women with 11 total pregnancies, five of the pregnancies were associated with symptomatic improvement, three with symptomatic worsening, and three with no change 55…”

Movement Disorders and Pregnancy

“…However, pregnancy was not associated with a change in tic frequency. In another retrospective study of 8 women with TS including 11 pregnancies, Stern et al [61] found no adverse impact on the pregnancies, and improvement of TS clinical manifestations were reported during five of the pregnancies. In three pregnancies, symptoms deteriorated; and in three pregnancies, there were no changes.…”

Movement Disorders in Women

“…96,97 There is neither consistent association between tic severity and estrogen levels during the menstrual cycle or pregnancy, nor does TS itself appear to have adverse effects on pregnancy. [98][99][100] In cases of pregnancy in women with TS where medication cannot be withdrawn prior to pregnancy, limited safety data necessitate an individualized discussion of risks and benefits.…”