Correlation of Comorbidities and Variability of Tics in Children with Chronic Tic Disorder.

OBJECTIVE: Chronic tic disorder (CTD) is characterized by the presence of motor and/or phonic tics, and is often accompanied by comorbidities, where obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD) are the most predominant. The aim of this study was to investigate a correlation between comorbidities and variability of tics in children with CTD. METHOD: A cross-sectional study was completed on a clinical cohort recruited from the Danish National Tourette Clinic at Herlev Hospital. The cohort consisted of 167 children who were examined by the Yale Global Tic Severity Scale. Data regarding comorbidity were collected on 152 of these patients by using validated diagnostic instruments, and the patients were divided into four subgroups: CTD-only, CTD + ADHD, CTD + OCD, and CTD + ADHD + OCD. RESULTS: The comorbidity subgroups had significantly higher severity, impairment, and Total Tic Scores compared to the CTD-only group (p-value ≤ 0.001, 0.001, 0.003, respectively). The assessment of the association between variability of tics and comorbidities showed a significantly higher Simple Phonic Tic Score in the CTD + OCD group compared to the CTD-only group (p-value = 0.003). CONCLUSION: This study showed significantly higher Simple Phonic Tic Scores in the CTD + OCD group compared to the CTD-only group, which suggests that awareness of the variability of tics in patients with CTD and comorbidities is important.Total Tic Scores, severity of tics, and impairment were significantly higher in the comorbidity subgroups compared to the CTD-only group, which support findings from previous studies.

Increased Number of Functional Tics Seen in Danish Adolescents during the COVID-19 Pandemic.

BACKGROUND: Global increase in functional tics in adolescents has been observed. Differentiating functional from classic tics is important since pathophysiology and treatment differ. We investigated possible triggers for development of functional tics and discuss the possible role of the coronavirus disease 2019 (COVID-19) pandemic and social media exposure in cases of functional tics seen during this period. Moreover, the treatment, and its efficacy is discussed. METHODS: Medical records of 28 Danish adolescents diagnosed with functional tics at the National Tourette Clinic, Department of Pediatrics, Herlev University Hospital, Denmark, from May 2020 to June 2021 have been retrospectively reviewed. Descriptive statistical analyses were used to analyze the data. MAIN FINDINGS: A total of 28 patients diagnosed with functional tics were included, 96.4% girls and 3.6% boys, mean age 14.4 years. Tic phenomenology differed from classic tics with more complex tics and no rostrocaudal progression. Note that 69.2% reported harmful tics. Also, 78.6% had trauma/precipitating event and 40% denounced lockdown related to the COVID-19 pandemic as trigger, both prior to onset of functional tics. Note that 60.7% reported psychiatric symptoms/diagnoses, 42.9% had a first-degree family member with psychiatric symptoms/diagnoses, and 96.4% were exposed to tics on social media prior to onset. Treatment consisted of psychoeducation, elements from cognitive behavioral therapy, and focus on psychiatric symptoms. All patients responded to the treatment. CONCLUSION: The vulnerability of the adolescents is characteristic. Treatment strategy has shown immediate positive effect. Consequences of the COVID-19 pandemic in combination with exposure to tics on social media could be part of the cause for the increase in number of functional tics.

Headache in Children and Adolescents: The Association between Screen Time and Headache within a Clinical Headache Population.

BACKGROUND: More than half of children and adolescents have experienced headache within the last 3 months. Several risk factors for headache have been identified, including obesity and lack of sleep. The association between screen time and headache in children and adolescents is sparsely investigated. The aim of this study was to assess this association and evaluate if it varied according to headache diagnosis. METHOD: This cross-sectional study was performed at the tertiary pediatric outpatient clinic for headache at Herlev University Hospital. A total of 139 participants who answered a questionnaire on lifestyle factors and their daily living were included. Diagnoses of migraine and tension-type headache (TTH) were made according to the International Classification of Headache Disorders-3. Children with both migraine and TTH were allocated to a mixed headache group. We differentiated between total, leisure, and school-related screen time. RESULTS: The mean age was 13.20 ± 3.38 years and 53.2% were girls. Note that 25.2% were diagnosed with migraine without aura, 23.0% migraine with aura, 28.1% TTH, 15.8% mixed headache, and 7.9% had an unclassified headache diagnosis at the time of inclusion. There was no statistically significant difference in screen time across the five headache groups. An association between screen time and headache frequency was found in children with migraine with aura. CONCLUSION: In this study, we investigated the association between screen time and headache in children and adolescents. More screen time was associated with more frequent headaches in children with migraine with aura. Future prospective studies are needed to determine the causality of this association.

Long-term employment, education, and healthcare costs of childhood and adolescent onset of epilepsy.

OBJECTIVE: Childhood- and adolescent-onset epilepsy may have a significant impact on long-term educational and vocational status, which in turn has consequences for individuals' socioeconomic status. We estimated the factual long-term socioeconomic consequences and healthcare costs of individuals with diagnosed epilepsy. METHODS: The prospective cohort study included Danish individuals with epilepsy onset before the age of 18 years, diagnosed between 2002 and 2016. Healthcare costs and socioeconomic data were obtained from nationwide administrative and health registers. The prediction was made with a general estimating equation (GEE). A total of 15,329 individuals were found with the diagnosis during this period and were followed until the age of 30 years. These were compared with 31,414 controls. We used 30 years as this represent an age where most has finalized their education, and as such represent the final educational level. Patients and their controls were subdivided into debut age groups of 0-5 and 6-18 years. Individuals were matched for age, gender, and residential location. RESULTS: Compared with control groups, patients with epilepsy at the age of 30 years tended to have the following: 1) parents with lower educational attainment; 2) a significantly lower educational level when controlling for parental education attainment; 3) lower grade-point averages; 4) a lower probability of being in employment and lower income, even when transfer payments were considered; and 5) elevated healthcare costs, including those for psychiatric care. It was also noted that the long-term educational consequences for patients with epilepsy were associated with parental educational level. Differences were more pronounced for those with early (0-5 years) rather than later (6-18 years) onset epilepsy. CONCLUSIONS: Epilepsy is associated with severe long-term socioeconomic consequences: lower educational level, school grades, employment status, and earned income. The presence of epilepsy is associated with parental educational level. LIMITATIONS: SIGNIFICANT OUTCOMES.

Clinical guidance for diagnosis and management of suspected Pediatric Acute-onset Neuropsychiatric Syndrome in the Nordic countries.

Pediatric acute-onset neuropsychiatric syndrome is a clinical concept used to describe a subgroup of children with sudden onset of psychiatric and somatic symptoms. The diagnostic term and especially management of children differs depending on the clinical setting to which they present, and the diagnosis and management is controversial. The aim of this paper is to propose a clinical guidance including homogenous diagnostic work-up and management of paediatric acute onset neuropsychiatric syndrome within the Nordic countries. The guidance is authored by a Nordic-UK working group consisting of paediatric neurologist, child psychiatrists and psychologists from Denmark, Norway, Sweden and Great Britain, and is the result of broad consensus. CONCLUSION: Consensus was achieved in the collaboration on work-up and treatment of patients with paediatric acute-onset neuropsychiatric syndrome, which we hope will improve and homogenise patient care and enable future collaborative research in the field.

Nonpharmacologic Treatment Options in Pediatric Tension-Type Headache Patients: A Systematic Review.

Objective: This systematic review aims to examine effects of nonpharmacologic treatment options for pediatric tension-type headache patients as well as evaluate current results from these treatment options. Background: Headache is a worldwide problem among both adults and children, with tension-type headache among the most common. Methods: Eighteen relevant studies were found using PubMed and evaluated in this review. These include therapy programs, biofeedback, alternative medicine, strength exercise, physical therapy, mindfulness therapy, and psychotherapy. Results: Several nonpharmacologic treatment methods showed improvement in pediatric headache patients, with few reported adverse effects. This suggests that nonpharmacologic treatment is safe for use and might have an effect in most cases. Conclusion: No single intervention has been proven superior to another, and some studies would need replication with a control group to confirm the findings. This study illustrates the variety of nonpharmacologic treatment options and the importance of future research on this topic.

Fine Motor Skills in Children with Tourette Syndrome and their Unaffected First-degree Siblings.

Background: The exact etiology of Tourette Syndrome (TS) remains unclear, making the search for impaired neuropsychological functions possibly connected to the underlying cause of TS as important as it is challenging. One neuropsychological domain of interest is fine motor skills. Method: This study compared fine motor skill performance on the Purdue Pegboard Task (PPT) in 18 children with TS, 24 unaffected first-degree siblings and 20 controls. A set of screening questionnaires was administered to determine comorbid psychiatric illness. Results: Children with TS, their siblings and controls did not differ significantly in fine motor skills as measured with the PPT. Performance on the PPT was not correlated with tic severity; however, we found an inverse correlation with severity of attention-deficit/hyperactivity disorder (ADHD) symptoms, as assessed by parent reported ADHD symptoms. Children with TS were found to have significantly higher parent reported ADHD symptoms compared to controls, yet only two out of the 18 participants had been diagnosed with ADHD. Conclusion: This study suggests that fine motor skill impairment in children with TS may be more strongly correlated with comorbid ADHD than to TS and tics.

Tourette syndrome research highlights from 2022.

This is the ninth yearly article in the Tourette Syndrome Research Highlights series, summarizing selected research reports from 2022 relevant to Tourette syndrome. The authors briefly summarize reports they consider most important or interesting.

Tourette syndrome research highlights from 2021.

We summarize selected research reports from 2021 relevant to Tourette syndrome that the authors consider most important or interesting. The authors welcome article suggestions and thoughtful feedback from readers.

[Melatonin for children with insomnia].

Treatment for insomnia with melatonin (MT) in children and adolescents aged 0-17 years has doubled since 2011. The efficacy and safety profile for MT in children has not been determined. Recent clinical trials indicate, that MT only has a clinical effect on sleep latency, not on total sleep time. Furthermore, it has emerged, that proper sleep hygiene can cure the sleep problem in 50% of the children. Typically, the safety evaluation only entails an unclassified report of adverse events. Two long-term studies investigate and dispel the potential influence of MT on puberty.