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

BACKGROUND AND PURPOSE: Very little is known about the long-term prognosis of patients with functional tic-like behaviours (FTLBs). We sought to characterize the trajectory of symptom severity over a 12-month period. METHODS: Patients with FTLBs were included in our prospective longitudinal child and adult clinical tic disorder registries at the University of Calgary. Patients were prospectively evaluated 6 and 12 months after their first clinical visit. Tic inventories and severity were measured with the Yale Global Tic Severity Scale (YGTSS). RESULTS: Eighty-three youths and adults with FTLBs were evaluated prospectively until April 2023. Mean YGTSS total tic severity scores were high at baseline, with a mean score of 29.8 points (95% confidence interval [CI] = 27.6-32.1). Fifty-eight participants were reevaluated at 6 months, and 32 participants were reevaluated at 12 months. The YGTSS total tic severity score decreased significantly from the first clinical visit to 6 months (raw mean difference = 8.9 points, 95% CI = 5.1-12.7, p < 0.0001), and from 6 to 12 months (raw mean difference = 6.4 points, 95% CI = 0.8-12.0, p = 0.01). Multivariable linear regression demonstrated that tic severity at initial presentation and the presence of other functional neurological symptoms were associated with higher YGTSS total tic scores at 6 months, whereas younger age at baseline, receiving cognitive behavioural therapy for anxiety and/or depression, and prescription of selective serotonin reuptake inhibitors were associated with lower YGTSS total tic scores at 6 months. CONCLUSIONS: We observed a meaningful improvement in tic severity scores in youth and adults with FTLBs over a period of 6-12 months.

Tic disorder in allergic rhinitis children and adolescents: a case-control study.

BACKGROUND: Allergic rhinitis is the most common allergic disease. It can accompany psychological disorders such as tic disorders due to the prolonged course of the symptoms of allergic rhinitis. This pioneer case-control study aims to investigate tic disorders in children and adolescents under 18 years of age diagnosed with allergic rhinitis. METHOD: The case group in this study consisted of patients who had both allergic rhinitis and tic disorders. Patients with allergic rhinitis without tic disorders were also enrolled as the control group with matched gender and age. Demographic characteristics, tic classifications, and contributing factors for allergic rhinitis and tic disorders were studied among the cases. Tic disorders were evaluated using DSM-5 criteria for the classification of tic disorders. RESULTS: 47 patients in the case group and 47 patients in the control group were included in this study. 53.2% and 46.8% were males and females in the case group, respectively. The mean age of the patients was 10.46 ± 3.97 years old. Sound tics were more common among the patients compared to motor tics. Patients with concomitant AR and tic disorders had more days per week with AR symptoms (P-value ≤ 0.001; OR (every day vs. three days a week = 11.02(2.98, 40.76))). Most patients with sound tick were women (p: 0.026), and most patients with motion tic were in the Provisional tic disorder group (p: 0.001). The history of infantile eczema was seen more in patients without sound tic (p: 0.025), and otitis media was significantly less common among patients with sound tics (p: 0.026). Provisional tic disorder was the most common class among the patients. In the case group (coexistence between allergic rhinitis and tic) compared to the control group, patients had significantly more days with AR symptoms per week. CONCLUSION: This preliminary study indicates that Provisional tic disorder was the most common classification of tic among patients with allergic rhinitis, especially in patients with motor tics. Asthma in motor tics, a history of food allergy in infancy, and a history of infantile eczema were also common among patients with vocal tics. Also, patients with allergic rhinitis and tic had more severe disease (more symptoms per week) than those with rhinitis alone. These findings emphasize the association of tic disorders with immunological pathways.

Advancements in the phenomenology, assessment, and treatment of Tourette syndrome.

PURPOSE OF REVIEW: Tourette syndrome (TS) and chronic tic disorders, collectively referred to as TS, are relatively common childhood onset neuropsychiatric conditions associated with functional impairment and distress. Over the past several years, clinical research has contributed to the advancement of the field's understanding of mechanisms and clinical correlates of TS. This progress has led to the development of key assessment tools and the implementation of novel interventions for individuals with TS. RECENT FINDINGS: This article provides a review of innovative TS research focusing on four key themes: investigation of clinical phenomenology of TS; validation of assessment tools for TS; dissemination of current evidence-based treatments for TS; and exploration of new intervention programs. SUMMARY: Cumulatively, this growing body of work presents considerable progress and provides a path forward to improve the assessment and treatment of TS.

Neuroacantocitosis, una nueva mutación / Neuroacanthocytosis: a new mutation

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Acidemia metilmalónica / Methylmalonic acidemia

Presentamos el caso de una mujer de 20 años que acude a nuestra consulta por tics motores y fónicos que empeoran con el nerviosismo y desaparecen con el sueño y maniobras de distracción. Se deriva al hospital y se decide su ingreso. Al revisar sus antecedentes observamos que había sido ingresada en varias ocasiones durante su infancia antes de ser diagnosticada a los cuatro años de edad de acidemia metilmalónica. La sintomatología de esa patología comenzó durante su primera semana de vida, manifestando vómitos, hipotonía y fallo de medro. La acidemia metilmalónica es una enfermedad congénita que provoca un defecto a nivel de la enzima metilmalonil CoA-mutasa, ocasionando como consecuencia un acúmulo del ácido metilmalónico. Se diagnostica por aumento de ácido metilmalónico en orina y se confirma mediante análisis molecular genético. Durante este último ingreso la paciente fue diagnosticada de un tourettismo, sin determinar si fue secundario al tratamiento o si se trata de una manifestación crónica de su patología. La acidemia metilmalónica es una enfermedad rara de difícil diagnóstico tanto por su clínica inespecífica como por el escaso conocimiento sobre la misma por parte del personal sanitario (AU)

The following is the case of a 20-year-old woman in seek of professional help because of chronic motor and phonic tics which worsened when nervous and disappeared when sleeping or when distraction manoeuvres were employed. She was referred to a hospital where she was hospitalized. In examining her medical history, we found that she required hospitalization on a number of occasions during childhood before being diagnosed with methylmalonic acidemia at the age of four. Her symptoms began within the first week of life, suffering from vomiting, hypotonia, failure to thrive and asthenia. Methylmalonic acidemia is a congenital disease which provokes a defect in the enzyme methylmalonyl-CoA mutase therefore causing a build-up of methylmalonic acid. It is diagnosed by an increase of methylmalonic acid in urine samples and it is confirmed with a molecular genetic analysis. In addition to this rare illness, the patient was also diagnosed with tourettism, without determining if it was due to treatment or a chronic presentation of her pathology. Methylmalonic acidemia is a rare disease, and consequently difficult to diagnose because of its unspecific clinical manifestations and because of healthcare workers' limited awareness of it (AU)

Trastorno obsesivo compulsivo con tics motores y verbales, trastorno de acumulación y síndrome del acento extranjero sin afasia: comunicación de un caso y revisión bibliográfica / Obsessive compulsive disorder with motor and vocal tics, hoarding behaviour and foreign accent syndrome without aphasia: a case report and literature review

Informamos sobre un caso de trastorno obsesivo compulsivo (TOC), con tics motores y verbales, conducta acumuladora y síndrome del acento extranjero (dialecto regional) sin afasia, en un nativo español diestro que presentó una hemorragia en ganglios basales izquierdos. Su TOC y conducta acumuladora, que precedieron a la hemorragia cerebral, se diagnosticaron a raíz de un ingreso hospitalario, ya que previamente no había estado en contacto con ningún servicio psiquiátrico. Una lesión limitada al núcleo estriado izquierdo le provocó una variante regional del síndrome del acento extranjero (SAE). El paciente respondió adecuadamente al tratamiento. En nuestro conocimiento, éste es el primer caso de SAE en un hispanoparlante y también en un individuo que presentaba previamente TOC, tics y conducta acumuladora. Revisamos la literatura científica de estos trastornos (AU)

We report a case of obsessive-compulsive disorder (OCD), with motor and vocal tics, hoarding behaviour and foreign accent syndrome (FAS) (regional dialect) without aphasia in a right handed native Spaniard who presented with a left basal ganglia haemorrhage. His OCD and hoarding behaviour, which predated the brain haemorrhage, were diagnosed as a result of his admission to hospital as he had never been in contact with psychiatric services. Limited damage to the left striatum caused a regional variant of foreign accent syndrome. The patient responded well to treatment. To our knowledge this is the first case of a regional dialect of FAS in a Spanish speaker and also in a subject that presented OCD, tics and hoarding behaviour. We review the literature of these disorders (AU)

Phenomenology and natural history of Tourette syndrome: brief summary or research / Fenomenologia e história natural da síndrome de Tourette: breve resumo da pesquisa

The phenomenology of Tourette syndrome is complex. Although overt motor and vocal tics are the defining features of Tourette syndrome, many individuals report experiencing sensory "urges," which are often difficult to describe. The natural history of this condition is also variable, with some individuals experiencing a marked reduction in tics by the end of the second decade of life while others go on to have a lifelong condition. The aim of this thesis was three-fold: (1) to develop a valid and reliable clinical rating instrument; (2) to investigate the sensory phenomena associated with Tourette syndrome; and (3) to document the course of tic severity over the course of the first two decades of life. Each of these three studies involved groups of patients with Tourette syndrome or a chronic tic disorder and each of these studies has been published in a peer-reviewed journal. The Yale Global Tic Severity Scale (YGTSS) has excellent psychometric properties that have been independently replicated. It has also emerged as the most widely used clinician-rated tic severity scale in randomized clinical trials around the world. Sensory phenomena, particularly premonitory urges, are commonly reported among individuals with Tourette syndrome by the age of 10 years. There is considerable overlap with the sensory phenomena described by individuals with Obsessive-Compulsive Disorder. Tics usually have their onset in the first decade of life. They then follow a waxing and waning course and a changing repertoire of tics. As documented in the third study, for a majority of patients the period of worst tic severity usually falls between the ages of 7 and 15 years of age, after which tic severity gradually declines. This falloff in tic symptoms is consistent with available epidemiological data that indicate a much lower prevalence of Tourette syndrome among adults than children. This decline in tic severity has been confirmed in subsequent studies...

A fenomenologia da síndrome de Tourette (ST) é complexa. Apesar de tiques motores e vocais serem as características definidoras da síndrome, muitas pessoas relatam ter urgências premonitórias (fenômenos sensoriais) de difícil descrição. A história natural da ST também é variável, com alguns indivíduos que experimentam uma redução acentuada nos tiques até o final da segunda década de vida, enquanto outros permanecem com sintomas ao longo de toda a vida adulta. Os objetivos principais desta tese são três: (1) desenvolver um instrumento de avaliação clínica com boa validade e confiabilidade para ST; (2) investigar os fenômenos sensoriais (FS) associados a ST; e (3) documentar o curso da gravidade dos tiques durante as duas primeiras décadas de vida. Para atingir esses objetivos incluíram-se grupos de pacientes clinicamente bem caracterizados e de artigos científicos publicados em periódicos internacionais de alto impacto. A Escala de Gravidade Global de tiques de Yale (YGTSS) apresentou excelentes propriedades psicométricas, o que foi replicado em estudos independentes. Também emergiu como a escala de gravidade mais utilizada em ensaios clínicos randomizados para ST em todo o mundo. Os FS, particularmente urgências premonitórias, são comumente relatados entre os indivíduos com ST com a partir da idade de 10 anos. Há uma sobreposição considerável com os FS descritos por indivíduos com Transtorno Obsessivo- Compulsivo (TOC). Os tiques costumam ter seu início na primeira década de vida e, então, seguem um curso flutuante com mudança do seu repertório. Conforme documentado no terceiro estudo, para a maioria dos pacientes, o período de pior gravidade dos tiques ocorre geralmente entre 7 e 15 anos de idade, após o qual a gravidade declina gradualmente. Esta queda dos sintomas de tiques é consistente com os dados epidemiológicos disponíveis que indicam uma prevalência muito menor de ST entre adultos do que crianças. Em resumo, há um esforço para incremento...

Tratamiento exitoso con penicilina benzatina de dos pacientes con sospecha de PANDAS / Successful treatment with benzathine penicillin of two patients suspected of suffering from PANDAS

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Síndrome de ClusterTic. A propósito de um caso / No disponible

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Síndrome de Gilles de la Tourette conversivo. A propósito de un caso / Conversive Gilles de la Tourette syndrome. A case report

Introducción. El síndrome de Tourette es un trastorno neurológico de orden genético que se inicia en la infancia, caracterizándose por la presencia de múltiples tics motores y fónicos. Caso clínico. Se expone el caso de un varón, con antecedentes psicopatológicos disociativos y conversivos, que inició en la adultez un cuadro de tics motores y fónicos en el contexto de diversos conflictos interpersonales e intrapersonales de evolución desde la infancia. Con la instauración del tratamiento farmacológico no se apreció mejoría alguna, obteniéndose una respuesta parcial a la psicoterapia centrada en el afrontamiento de las situaciones amenazantes. Conclusiones. La psicopatología del espectro obsesivo compulsivo que presenta naturaleza conversiva y disociativa es un fenómeno inusual, observable en sujetos predispuestos constitucionalmente. Los tics conversivos constituyen un reto nosológico, dadas las fluctuaciones y exacerbaciones ante el estrés que manifiestan también sus homónimos neurológicos. Se hacen necesarios unos criterios operativos más específicos para optimizar la validez diagnóstica de este® trastorno del movimiento psicógeno» (AU)

Introduction. Tourette's syndrome is a neurological disorder of genetic order that begins in childhood, being characterized by the presence of multiple phonic and motor tics. Clinical case. A male with previous dissociative and conversion psychopathology initiated motor and phonictics in the adulthood in the context of several inter and intrapersonal conflicts beginning in childhood. No improvement was observed when drug treatment was established, there being partial response with psychotherapy oriented to coping with threatening situations. Conclusions. The psychopathology of the obsessive compulsive spectrum having a conversion and dissociative origin is an unusual phenomenon, this being observed in constitutionally predisposed subjects. Conversion tics are a nosologic challenge, given the fluctuations and exacerbations due to stress also manifested by their neurological homonyms. More specific criteria are necessary in order to optimize the diagnosis of this ®psychogenic movement disorder» (AU)

Síndrome de Gilles de la Tourette: estudo clínico de 58 casos / Gilles de la Tourette syndrome: a clinical study on 58 cases

A síndrome de Gilles de la Tourette (SGT) é um transtorno neuropsiquiátrico, de início na infância, caracterizado pela presença de tiques motores e vocais. Cinquenta e oito pacientes com SGT foram acompanhados clinicamente durante período de três anos. Trinta e seis pacientes eram do sexo masculino e 22 do feminino, a proporçäo entre os sexos foi 1,6:1. A idade dos pacientes variou de 7 a 50 anos, média 20,33 anos. A idade de início dos sintomas variou de 3 a 15 anos, sendo a média 7,81 anos. O tique motor foi o sintoma inaugural em 79 por cento dos pacientes. Quanto aos tiques complexos, a coprolalia estava presente em 27,6 por cento; a copropraxia em 20,1 por cento; a palilalia em 20,1 por cento; a ecolalia em 27,6 por cento; e a ecopraxia em 27,6 por cento. Em relaçäo a manifestaçöes associadas, 25,8 por cento apresentavam déficit de atençäo/ hiperatividade e 39,6 por cento transtorno obsessivo-compulsivo. O fenômeno sensitivo estava presente em 54,8 por cento dos pacientes

El papel del sistema dopaminérgico en el trastorno obsesivo-compulsivo atípico / role of the dopaminergic system in atypical obsessive-compulsive disorder

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