The spectrum of functional tic‐like behaviours: Data from an international registry

Martino, Davide; Hedderly, Tammy; Murphy, Tara; Müller‐Vahl, Kirsten; Dale, Russell C.; Gilbert, Donald L.; Rizzo, Renata; Hartmann, Andreas; Nagy, Péter; Anheim, Mathieu; Owen, Tamsin; Malik, Osman; Duncan, Morvwen; Heyman, Isobel; Liang, Holan; McWilliams, Andrew; O’Dwyer, Shauna; Fremer, Carolin; Szejko, Natalia; Han, Velda X.; Kozlowska, Kasia; Pringsheim, Tamara

doi:10.1111/ene.15611

Cited by 35 publications

(67 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The profile of affected students in our investigation showed some consistencies with other reports of FTLBs (1,3,5,8,23,28), and differed from the usual presentation of tic disorders in female preponderance, adolescent onset, elaborate tic symptoms on initial presentation, and no premonitory sensation. Notably, we observed all students to have simple tic-like behaviors, which differs somewhat from prior reports that emphasize the presence of highly complex tics.…”

Section: Discussionsupporting

confidence: 70%

“…There is some evidence that tics associated with tic disorders in females might be more complex, begin later in life, and co-occur with mood and anxiety disorders ( 39 ). FTLBs appear to occur more frequently among females ( 1 , 4 , 6 , 23 ) however, the recognition that tic presentation might be different among females highlights an area where more research is needed to understand how tic disorders might vary among females. Our findings highlight the need for a better understanding of FTLBs and mental health in adolescents, especially in the context of the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, persons with TDs typically have a premonitory sensation—a feeling or sensation that precedes the tics and that is usually relieved by experiencing a tic. Reports suggest people with FTLBs do not experience this sensation ( 5 , 6 , 22 , 23 ), although this characteristic has not been systematically studied. Like tics associated with TS, FTLBs are not purposeful or voluntary.…”

Section: Introductionmentioning

confidence: 99%

“…Although echo phenomena—repeating movement or words of others ( 24 )—occur frequently among TS patients, they might be more common or pronounced among FTLBs patients ( 6 ). Furthermore, FTLBs and tics associated with TS are typically similar in appearance, suggestibility and distractibility, and are exacerbated during periods of stress ( 5 , 23 ).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Rapid onset of functional tic-like behaviors among adolescent girls—Minnesota, September–November 2021

Firestone

Holzbauer²,

Conelea³

et al. 2023

Front. Neurol.

View full text Add to dashboard Cite

BackgroundOn October 15, 2021, the Minnesota Department of Health began investigating a school cluster of students experiencing tic-like behaviors thought to be related to recent COVID-19. The objective of this report is to describe the investigation, key findings, and public health recommendations.MethodsAffected students and proxies were interviewed with a standardized questionnaire including validated depression and anxiety screens.ResultsEight students had tic-like behaviors lasting >24 h after initial report with onset during September 26–October 30, 2021. All eight students were females aged 15–17 years. All students either had a history of depression or anxiety or scored as having more than minimal anxiety or depression on validated screens. Four students previously had confirmed COVID-19: the interval between prior COVID-19 and tic symptom onset varied from more than a year prior to tic symptom onset to at the time of tic symptom onset.ConclusionThe onset of tic-like behaviors at one school in Minnesota appeared to be related more to underlying mental health conditions than recent COVID-19. These findings highlight the need to better understand functional tic-like behaviors and adolescent mental health.

show abstract

Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Rapid onset of functional tic-like behaviors among adolescent girls—Minnesota, September–November 2021

Firestone

Holzbauer²,

Conelea³

et al. 2023

Front. Neurol.

View full text Add to dashboard Cite

show abstract

“…The authors reported at 6-month follow-up visit in the adolescent group a mean total decrease of YGTSS total tic score of 15.3, and described that the most used treatment approaches were selective serotonin reuptake inhibitors (SSRIs) and CBT ( 28 ). Finally, a recent multicentre international study confirmed substantial clinical differences between primary tic disorders and FTLBs ( 29 ).…”

Section: Discussionmentioning

confidence: 81%

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

Prato

Saia²,

Milana³

et al. 2023

Front. Pediatr.

Self Cite

View full text Add to dashboard Cite

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.

show abstract

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

Tomczak,

Worhach,

Rich

et al. 2024

Brain and Behavior

View full text Add to dashboard Cite

IntroductionDuring the COVID‐19 pandemic, an influx of adolescents presented worldwide with acute onset of functional tic‐like behaviors (FTLBs). Our goal was to evaluate psychosocial factors around onset, to elucidate outcomes after pandemic isolation protocols were lifted, and to examine therapy and medication management.MethodsA retrospective review was performed of 56 patients ages 10–18 years with new‐onset FTLBs seen at Boston Children's Hospital beginning in March 2020. Demographic factors, medical history, and treatment were evaluated. Patient outcomes were determined retrospectively based on the Clinical Global Impression Improvement (CGI‐I) and Severity (CGI‐S) scales from follow‐up visits. CGI‐I scores assessed the progression of FTLBs; CGI‐S assessed overall function.ResultsNinety‐six percent of patients were female‐assigned at birth with high rates of comorbid anxiety (93%) and depression (71%). Forty‐five percent were gender‐diverse. Based on scales that assessed FTLBs (CGI‐I) and overall functioning (CGI‐S), up to 79% of patients improved independent of comorbid diagnosis or treatment. Evidence‐based tic‐specific treatments were not more effective than other treatments. A subset of patients had improvement in their FTLBs but not in their general functioning and continued to have other psychosomatic presentations.ConclusionWhile many patients’ FTLBs improved, it is critical to remain alert to patients’ overall function and to assess for other functional neurological disorders and mental health concerns. The tendency of FTLBs to improve in this population, independent of treatment, highlights the unique pathophysiology of FTLBs. Future research on contributing psychosocial factors and specific treatment protocols will allow optimal support for these patients.

show abstract

The spectrum of functional tic‐like behaviours: Data from an international registry

Cited by 35 publications

References 32 publications

Rapid onset of functional tic-like behaviors among adolescent girls—Minnesota, September–November 2021

Rapid onset of functional tic-like behaviors among adolescent girls—Minnesota, September–November 2021

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

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

Contact Info

Product

Resources

About