DOCSLIB.ORG

Tics & Tourettes

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Tics & Tourettes Tics & Tourette’s Infomed Giles Elrington [email protected] Tic’s & Tourettes Infomed Giles Elrington [email protected] Definitions Cavanna AE, Sero S BMJ 2013;347:f4964 • Tics: involuntary, sudden, rapid, recurrent, non-rhythmic movements (motor tics) and vocalisations (vocal or phonic tics). • Tourette’s syndrome: the chronic presence of at least two motor tics and one vocal tic since childhood. Tourette’s prevalence • 0.3-1% of schoolchildren affected • 200 000-330 000 people affected in UK • Peak severity in early teens • 2/3 improve by adulthood • Not associated with intellectual disability • 10% no associated psychiatric comorbidity • 60% have OCD or ADHD • Personality disorder over-represented OCD symptoms GTS Primary OCD • Symmetry concerns • Cleaning rituals • “Evening –up” behaviours • Compulsive washing • Obsessional counting • Fears of contamination • “Just right” perceptions Coprolalia & copropraxia • 10% of GTS patients • 20-30% in specialist clinics • Not required for diagnosis • Cultural specificity Famous OCD, tic or TS sufferers • Dr Samuel Johnson • Howard Hughes • Dan Ackroyd • David Beckham • W A Mozart What was Gilles de la Tourette’s given name? • Gilles • Georges • Albert • Edouard • Brutus • All of the above Classification of tics 1 Type of tic Examples Simple motor tics Blinking; grimacing; shrugging; tongue protruding; contracting platysma, rectus abdominis or glutei Complex motor tics Head shaking; shoulder rolling; touching; jumping; squatting; spitting; echopraxia; copropraxia Simple vocal tics Sniffing; grunting; throat clearing; coughing; humming; yelping; barking Complex vocal tics Coprolalia; palilalia; echolalia Classification of tics 2 Type of tic Examples Sensory Sensation usually within body part, can be perceived as external, may be relieved by movement Mental Repetitive thoughts resembling echolalia, palilalia & coprolalia but not verbalised; may be described as mental images of the word or phrase Causes of tics 1: idiopathic • Transient – Motor or vocal (not both) – 1-12 month duration – Onset <21 years of age – No secondary cause • Chronic motor or vocal tic disorder – As above (transient) but >12 months – Adult variants can occur • Gilles de la Tourette’s syndrome – Multiple motor plus 1 or more vocal tic – Onset normally <21 years of age Causes of tics 2: secondary • Specific neurodegenerative – Huntington’s – Neuroacanthocytosis • Associated with neurodevelopmental disorders – Learning disability (including chromosomal), autism, schizophrenia • Following acute brain injury – Stroke – Encephalitis (lethargica) – Sydenhams chorea, TBI, CO poisoning, hypoglycaemia • Related to drug exposure – Stimulants (including amphetamine & cocaine) – Levodopa – Neuroleptics (“tardive Tourettism”) – Carbamazepine, phenytoin, barbiturates – Quiniolone antibiotics Diagnostic approach to a child with a single tic • Masterly inactivity – Common esp in boys – most resolve naturally • Chronic tic:- – Low threshold for Wilson’s disease screen – Motor & vocal: consider GDT syndrome Diagnostic approach motor & vocal tics • Differentiate tic from chorea or myoclonus • Consider – neuroleptic exposure – Brain injury – CO poisoning • Look for FH neurology other than GDT or OCD • Exclude – Huntington’s & neuroacanthocytosis – Encephalitis Brain imaging in Tourette’s • No clear consensus on abnormalities • Wide range incidental findings • Possible loss normal slight asymmetry caudate • PET & fMRI research tools only Lab studies in Tourette’s • Genetics – Twin & family studies suggest major genetic component – Genetic studies limited by phenotype definition • Immunology – Overlap with PANDAS & Sydenham’s chorea – Basal ganglia antibodies low specificity Management of GTS • Specialist referral for all patients • Behavioural • Medication – haloperidol pimozide – aripiprazole risperidone sulpiride tetrabenazine clonidine topiramate – SSRI for OCD – botulinum toxin for tic – not benzos • Surgery – deep brain stimulation .
Load more

Recommended publications
  • Tourette Syndrome: Training for Law Enforcement
    Tourette Syndrome: Training for Law Enforcement 42-40 Bell Blvd., Suite 205, Bayside, NY 11361 tourette.org 888-4TOURET Understanding Tourette Syndrome & Tic Disorders: The Basics Tourette Syndrome (TS) is a type of Tic Disorder. Tics are involuntary, sudden, rapid repetitive movements and vocalizations. Tics are the defining feature of a group of childhood-onset, neurodevelopmental conditions. There are two types of tics— motor (movements) and vocal (sounds). As seen in the chart below, tics range from head shaking to throat clearing. You may see someone doing more than one tic at a time. It is important to note that you might encounter someone uttering obscenities, racial statements, or socially inappropriate phrases (corprolalia). However, only 1 in 10 individuals present this type of tic. It is also possible that you might encounter someone acting out obscene gestures (copropraxia). These tics, like all others, are involuntary. Types of Tics TYPES SIMPLE COMPLEX Motor Tics SUDDEN, BRIEF MOVEMENTS: MOVEMENTS ARE OFTEN Some Examples: Eye blinking, head shaking, face SLOWER AND MAY SEEM grimacing, shoulder shrugging, PURPOSEFUL IN APPEARANCE: abdominal tensing, or arm jerking Touching, tapping, hopping, squatting, skipping, jumping, or copropraxia (obscene gestures) Vocal Tics SUDDEN SOUNDS OR NOISES: WORDS OR PHRASES THAT Some Examples: Sniffing, coughing, spitting, OFTEN OCCUR OUT OF grunting, throat clearing, CONTEXT: Syllables, words or snorting, animal noises, phrases (“shut up”, “stop that”), squeaking, or shouting coprolalia (uttering of obscen- ities), palilalia (repeating own words), echolalia (repeating others’ words) Tic Challenges in Social Situations Tics can increase in high stress situations, such as being stopped by law enforcement.
    [Show full text]
  • Tic Disorders
    No. 35 May 2012 Tic Disorders A tic is a problem in which a part of the body moves repeatedly, quickly, suddenly and uncontrollably. Tics can occur in any body part, such as the face, shoulders, hands or legs. They can be stopped voluntarily for brief periods. Sounds that are made involuntarily (such as throat clearing, sniffing) are called vocal tics. Most tics are mild and hardly noticeable. However, in some cases they are frequent and severe, and can affect many areas of a child's life. The most common tic disorder is called "transient tic disorder" and may affect up to 10 percent of children during the early school years. Teachers or others may notice the tics and wonder if the child is under stress or "nervous." Transient tics go away by themselves. Some may get worse with anxiety, tiredness, and some medications. Some tics do not go away. Tics which last one year or more are called "chronic tics." Chronic tics affect less than one percent of children and may be related to a special, more unusual tic disorder called Tourette's Disorder. Children with Tourette's Disorder have both body and vocal tics (throat clearing). Some tics disappear by early adulthood, and some continue. Children with Tourette's Disorder may also have problems with attention, and learning disabilities. They may act impulsively, and/or develop obsessions and compulsions. Sometimes people with Tourette's Disorder may blurt out obscene words, insult others, or make obscene gestures or movements. They cannot control these sounds and movements and should not be blamed for them.
    [Show full text]
  • Final Program
    FINAL PROGRAM 2nd Pan American Parkinson’s Disease and Movement Disorders Congress JUNE 22-24, 2018 MIAMI, FLORIDA, USA www.pascongress2018.org Table of Contents About MDS ...............................................................................................................................................................................................................................................2 About MDS-PAS Section ...........................................................................................................................................................................................................................3 Continuing Medical Education (CME) Information ....................................................................................................................................................................................4 Hilton Miami Downtown Floor Plan .........................................................................................................................................................................................................4 Schedule-At-A-Glance .............................................................................................................................................................................................................................5 Session Definitions ...................................................................................................................................................................................................................................6
    [Show full text]
  • Mozart's Scatological Disorder
    loss in this study, previous work has been descriptive Our study shows that there is a potential for hearing in nature, presenting the numbers of cases of hearing damage in classical musicians and that some form of loss, presumed to have been noise induced orcomparing protection from excessive sound may occasionally be hearing levels with reference populations.'7-8 Both needed. these descriptive methods have shortcomings: the former depends on the definition of noise induced 1 Health and safety at work act 1974. London: HMSO, 1974. 2 Noise at work regulations 1989. London: HMSO, 1989. hearing loss, and the latter depends on identifying a 3 Sataloff RT. Hearing loss in musicians. AmJ Otol 1991;12:122-7. well matched reference population. Neither method of 4 Axelsson A, Lindgren F. Hearing in classical musicians. Acta Otolaryngol 1981; 377(suppl):3-74. presentation is amenable to the necessary statistical 5Burns W, Robinson DW. Audiometry in industry. J7 Soc Occup Med 1973;23: testing. We believe that our method is suitable for 86-91. estimating the risk ofhearing loss in classical musicians 6 Santucci M. Musicians can protect their hearing. Medical Problems ofPerforming Artists 1990;5:136-8. as it does not depend on identifying cases but uses 7 Rabinowitz J, Hausler R, Bristow G, Rey P. Study of the effects of very loud internal comparisons. Unfortunately, the numbers music on musicians in the Orchestra de la Suisse Romande. Medecine et Hygiene 1982;40:1-9. available limited the statistical power, but other 8 Royster JD. Sound exposures and hearing thresholds of symphony orchestra orchestras might be recruited to an extended study.
    [Show full text]
  • Tourrete-Syndrome.Pdf
    ISSN : 2376-0249 International Journal of Volume 2 • Issue 8• 1000360 Clinical & Medical Imaging August, 2015 http://dx.doi.org/10.4172/2376-0249.1000360 Case Blog Title: Tourrete Syndrome Rajarshi Sannigrahi1, Ajay Manickam1*, Shaswati Sengupta1, Jayanta saha1, SK Basu1 and Sunetra Mondal2 1Department of ENT and Head Neck Surgery, RG Kar Medical College and Hospital, Kolkata, India 2Vivekananda institute of medical science. Kolkata India Introduction Tourette syndrome is an inherited neuropsychiatric disorder with onset in childhood; it is characterized by multiple motor tics and at least one vocal tic. The occurrence of tics wax and wane with time can be suppressed voluntarily and are frequently preceded by a premonitory urge. Tourette is defined as a part of spectrum of tic disorders which include provisional, transient or persistent tics. The prevalence of tourrete is 0.4% to 3.8% among children between 5 to 18 years [1]. The tourette syndrome can be associated with use of obscene words and derogatory remarks but this is present in only a few cases [2]. Eye blinking, coughing, throat clearing, sniffing and facial movements are the common type of tics. Tourrete does not affect intelligence or life expectancy. To urrete is often associated with comorbid condition such as attention deficit hyperactivity disorder (ADHD) and obsessive compulsive disorder(OCD). These conditions often cause more functional impairment than the tics. Case Study 6 year old female patient presented in the ENT opd with recurrent sore throat. On examination bilateral tonsillitis was seen. During examination frequent blinking of eyes, grimacing, frowning and frequent protrusion of tongue was observed.
    [Show full text]
  • Tourette Syndrome; Is It an Annoying Disorder Or an Inspiring
    nd Ado a les ld c i e h n C t f B o e l Journal of Child & Adolescent h a a n v r i Zaky, J Child Adolesc Behav 2017, 5:4 u o o r J Behavior DOI: 10.4172/2375-4494.1000353 ISSN: 2375-4494 Review Article Open Acces Tourette Syndrome; Is It an Annoying Disorder or an Inspiring Companion??!!! Eman Ahmed Zaky* Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt *Corresponding author: Eman Ahmed Zaky, Professor of Pediatrics and Head of Child Psychiatry Unit, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt, Tel :+ 201062978734; E-mail: [email protected] Received date: Jul 10, 2017; Accepted date: Jul 10, 2017; Published date: Jul 17, 2017 Copyright: 2017 © Zaky EA. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Tourette syndrome (TS) is a hereditary neurobehavioral disorder which starts early during childhood and manifests with a group of motor and one or more vocal tics for a duration of a year at least. It tends to be a lifelong chronic disorder with many remissions and exacerbations but in general, it is not a degenerative disease and has no negative percussions on intelligence or life span. Cases with TS need proper professional evaluation to exclude any differential diagnoses and detect any comorbidities. Cognitive Behavior Therapy (CBT), medications, and supportive intervention are indicated for cases with significant functional impairment.
    [Show full text]
  • Tourette's Syndrome
    Tourette’s Syndrome CHRISTOPHER KENNEY, MD; SHENG-HAN KUO, MD; and JOOHI JIMENEZ-SHAHED, MD Baylor College of Medicine, Houston, Texas Tourette’s syndrome is a movement disorder most commonly seen in school-age children. The incidence peaks around preadolescence with one half of cases resolving in early adult- hood. Tourette’s syndrome is the most common cause of tics, which are involuntary or semi- voluntary, sudden, brief, intermittent, repetitive movements (motor tics) or sounds (phonic tics). It is often associated with psychiatric comorbidities, mainly attention-deficit/hyperac- tivity disorder and obsessive-compulsive disorder. Given its diverse presentation, Tourette’s syndrome can mimic many hyperkinetic disorders, making the diagnosis challenging at times. The etiology of this syndrome is thought to be related to basal ganglia dysfunction. Treatment can be behavioral, pharmacologic, or surgical, and is dictated by the most incapacitating symp- toms. Alpha2-adrenergic agonists are the first line of pharmacologic therapy, but dopamine- receptor–blocking drugs are required for multiple, complex tics. Dopamine-receptor–blocking drugs are associated with potential side effects including sedation, weight gain, acute dystonic reactions, and tardive dyskinesia. Appropriate diagnosis and treatment can substantially improve quality of life and psychosocial functioning in affected children. (Am Fam Physician. 2008;77(5):651-658, 659-660. Copyright © 2008 American Academy of Family Physicians.) ▲ Patient information: n 1885, Georges Gilles de la Tourette normal context or in inappropriate situa- A handout on Tourette’s described the major clinical features tions, thus calling attention to the person syndrome, written by the authors of this article, is of the syndrome that now carries his because of their exaggerated, forceful, and provided on p.
    [Show full text]
  • Did Mozart Suffer from Gilles De La Tourette Syndrome?ଝ
    r e v c o l o m b p s i q u i a t . 2 0 1 7;4 6(2):110–115 www.elsevier.es/rcp Epistemology, philosophy of the mind and bioethics Did Mozart suffer from Gilles de la Tourette syndrome?ଝ a,∗ b Leonardo Palacios-Sánchez , Juan Sebastián Botero-Meneses , c d d Laura Daniela Vergara-Méndez , Natalia Pachón , Arianna Martínez , d Santiago Ramírez a Departamento de Neurología, Universidad del Rosario, Bogotá, Colombia b Grupo de Investigación en Neurociencia (NEUROS), Universidad del Rosario, Bogotá, Colombia c Departamento de Pediatría, Universidad del Rosario, Bogotá, Colombia d Semillero de Investigación en Neurociencia, Bogotá, Colombia a r t i c l e i n f o a b s t r a c t Article history: The personal and private lives of great men and women in history, like writers, painters Received 1 April 2016 and musicians, have been the subject of great interest for many years. A clear example Accepted 4 May 2016 of this is the vast scrutiny is cast over the famous composer, Wolfgang Amadeus Mozart. Available online 3 June 2017 What may have started as curiosity, rapidly evolved into extensive research, as the answers about the musician’s legendary talent may lie in the details of his life (his childhood, his Keywords: relationships, his quirks and his mannerisms). It is usually up to historians, anthropologists or philosophers to delve into the pages of old books, trying to grasp answers and clues. Tourette syndrome Movement disorders However, for some time, physicians have sought their own part in solving the puzzle.
    [Show full text]
  • The ICD-10 Classification of Mental and Behavioural Disorders : Clinical Descriptions and Diagnostic Guidelines
    ICD-10 ThelCD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines | World Health Organization I Geneva I 1992 Reprinted 1993, 1994, 1995, 1998, 2000, 2002, 2004 WHO Library Cataloguing in Publication Data The ICD-10 classification of mental and behavioural disorders : clinical descriptions and diagnostic guidelines. 1.Mental disorders — classification 2.Mental disorders — diagnosis ISBN 92 4 154422 8 (NLM Classification: WM 15) © World Health Organization 1992 All rights reserved. Publications of the World Health Organization can be obtained from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications — whether for sale or for noncommercial distribution — should be addressed to Publications, at the above address (fax: +41 22 791 4806; email: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
    [Show full text]
  • 2018 Celebration of Research
    UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE 2018 Celebration of Research Welcome from the Dean The annual University of Florida College of Medicine Celebration of Research affords me the opportunity to say Thank You. Thank you for the late nights, the papers written and reviewed, the grant proposals that have been funded and those that will be resubmitted, the patience that you have shown with the varied hurdles placed in the pathway of research. But most importantly, thank you for the passion that you employ to move the boundary of science knowledge forward. Your research vision and the work of your research teams are appreciated and valued. The discoveries and inventions that result from the basic, translational, population and clinical research at our university are transforming medicine. Thank you for your dedication to creating a healthier future for all. The College of Medicine stands proudly behind your efforts. Michael L. Good, MD Dean, UF College of Medicine Celebration of Research 3 POSTER SESSION & RECEPTION Monday, February 19, 2018 5:30pm – 8:30pm Stephen C. O’Connell Center Slow down and smell the roses The 2018 Celebration is already here. Where did the year go? 2017 was indeed another remarkable year of continued growth and progress for research within the College of Medicine, and 2018 is already off to a great start. We have all been running and seem a bit out of breath. Now it is time to slow down and appreciate the breadth and depth of the College of Medicine’s research endeavors and recognize how our research is directed at fundamental, timely, and significant areas of human health.
    [Show full text]
  • Tourette Syndrome in Children
    Focus | Clinical Tourette syndrome in children Valsamma Eapen, Tim Usherwood UP TO 20% OF CHILDREN exhibit rapid jerky peak severity at the age of approximately movements (motor tics) that are made 10–12 years, and typically improve by without conscious intention as part of a adolescence or thereafter.6 Background Gilles de la Tourette syndrome (GTS), developmental phase that often lasts a few 1 characterised by motor and vocal tics, weeks to months. Similarly, involuntary has a prevalence of approximately 1% sounds, vocalisations or noises (vocal or Clinical features in school-aged children. Commonly phonic tics) such as coughing and even In addition to simple motor and vocal/ encountered comorbidities of GTS brief screams or shouts may be observed in phonic tics, complex tics may be present include attention deficit hyperactivity some children for brief periods of time. Tics (Table 1). Some complex tics – such as disorder (ADHD) and obsessive- lasting for a few weeks to months are known spitting, licking, kissing, etc – may be compulsive behaviour/disorder (OCB/ OCD). Genetic factors play an important as ‘transient tic disorder’. When single misunderstood or misinterpreted and part in the aetiology of GTS, and family or multiple motor or vocal tics – but not a may result in the young person getting members may exhibit tics or related combination of both – have been present in trouble, especially if these tics include disorders such as ADHD, OCB or OCD. for more than one year, the term ‘chronic involuntary and inappropriate obscene tic disorder’ is used. When both (multiple) gesturing (copropraxia) or copying the Objective The aim of this article is to present a motor and (one or more) vocal tics have been movements of other people (echopraxia).
    [Show full text]
  • Sensory Phenomena Related to Tics, Obsessive-Compulsive Symptoms
    Available online at www.sciencedirect.com ScienceDirect Comprehensive Psychiatry 62 (2015) 141–146 www.elsevier.com/locate/comppsych Sensory phenomena related to tics, obsessive-compulsive symptoms, and global functioning in Tourette syndrome ⁎ Yukiko Kanoa, , Natsumi Matsudab, Maiko Nonakab, Miyuki Fujioc, Hitoshi Kuwabarad, Toshiaki Konoe aDepartment of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bukyo-ku, Tokyo 113-8655, Japan bDepartment of Child Psychiatry, The University of Tokyo Hospital, 7-3-1 Hongo, Bukyo-ku, Tokyo 113-8655, Japan cCourse of Clinical Psychology, Graduate School of Education, The University of Tokyo, 7-3-1 Hongo, Bukyo-ku, Tokyo 113-0033, Japan dDisability Services Office, The University of Tokyo, 7-3-1 Hongo, Bukyo-ku, Tokyo 113-0033, Japan eDepartment of Forensic Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira-shi, Tokyo 187-8551, Japan Abstract Objectives: Sensory phenomena, including premonitory urges, are experienced by patients with Tourette syndrome (TS) and obsessive- compulsive disorder (OCD). The goal of the present study was to investigate such phenomena related to tics, obsessive-compulsive symptoms (OCS), and global functioning in Japanese patients with TS. Methods: Forty-one patients with TS were assessed using the University of São Paulo Sensory Phenomena Scale (USP-SPS), the Premonitory Urge for Tics Scale (PUTS), the Yale Global Tic Severity Scale (YGTSS), the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS), and the Global Assessment of Functioning (GAF) Scale. Results: USP-SPS and PUTS total scores were significantly correlated with YGTSS total and vocal tics scores.
    [Show full text]