The Semiology of Tics, Tourette's, and Their Associations

Abstract

Gilles de la Tourette syndrome (GTS) is a prototypical neuropsychiatric disorder breaking the boundary of disciplinary dualism between neurology and psychiatry. The diagnosis of GTS is clinical and, in most cases, straightforward. Tics as a hallmark of GTS are usually easy to recognize and distinguish from other movement disorders as fragmented, repetitive, exaggerated movements resembling normal motor behavior, but appearing out of context. In complex cases, knowledge on additional characteristics and signs as, for example, tic distribution, suggestibility, voluntary tic inhibition, and presence of echo‐ or paliphenomena might further aid clinical diagnosis. However, although defining GTS, tics are rarely the main issue. The presence of comorbidities and coexisting psychopathologies often hampers normal development and negatively affects quality of life. Their recognition and treatment is paramount. Here, we review existing literature and provide a comprehensive update on the multifarious aspects of the movement disorder and neuropsychiatry of GTS. We also provide a list of associated movement disorders known to occur in GTS patients and discuss differential diagnoses to be considered in atypical cases. We finally comment on available treatment options.

Clinical features and neuropsychiatric comorbidities in pediatric patients with tic disorders

“…The mean age of tic onset was 6.9 years (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14] and the mean age at diagnosis was 8 years (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. The mean lag between tic onset and diagnosis was 13.3 months (range, 0.25-132).…”

“…Severity of tics and tic-related impairment were assessed using the semi-structured interview Yale Global Tic Severity Scale (YGTSS) and categorized as follows: absence of tics (0), minimal tics (1-9), mild tics (10)(11)(12)(13)(14)(15)(16)(17)(18)(19), moderate tics (20-39), and severe tics (40-50). A high tic score was de ned as moderate or severe tics (20-50).…”

“…Tic disorders are usually associated with mental, behavioral, and developmental comorbidities, with previous studies demonstrating that approximately 80-90% of individuals with tic disorders also present other concurrent neuropsychiatric symptoms [5,8,9]. Attention-de cit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) are the most commonly reported comorbidities, followed by depression [5,[10][11][12]. O'Hare et al [13] noted that children with tic disorders and co-occurring neuropsychiatric comorbidities tend to have a lower global quality of life and more severe functional impairment.…”

Clinical features and neuropsychiatric comorbidities in pediatric patients with tic disorders: A retrospective chart review study from South Korea

“…Tic severity was assessed by summing the total scores of motor and vocal tics on a scale from 0 to 5, in 5 separate dimensions: number, frequency, intensity, complexity, and interference. Total scores were categorized as follows: absence of tics (0), minimal tics (1-9), mild tics (10)(11)(12)(13)(14)(15)(16)(17)(18)(19), moderate tics (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39), and severe tics (40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50). A high tic score was de ned as moderate or severe tics .…”

Tics and Tourette Syndrome

“…Tic-specific characteristics in GTS such as an anatomic rostrocaudal gradient in tic distribution, awareness of premonitory urges, tic suggestibility, the presence of echophenomena, paliphenomena, and in some instances coprophenomena, the capacity to inhibit tics on demand and personal or family history of aforementioned neuropsychiatric comorbidities are helpful diagnostic clues. 72 Finally, a long list of conditions may present with secondary tics, including neurodevelopmental disorders, acute brain lesions, neurodegenerative illnesses, immune-mediated conditions, and drugs or toxins. A later age at onset (eg, late adolescence or adulthood), abrupt onset, and association with other neurologic manifestations represent red flags that should prompt the exclusion of secondary causes of tics (Boxes 1 and 2 provide a comprehensive list of secondary causes of tics).…”