A 2-year longitudinal follow-up of quantitative assessment neck tics in Tourette’s syndrome

Background Neck motor tics in Tourette’s syndrome can cause severe neck complications. Although addressed in a few longitudinal studies, the clinical course of Tourette’s syndrome has not been quantitatively assessed. We had previously developed a method for quantifying the angular movements of neck tics using a compact gyroscope. Here, we present a follow-up study aimed at elucidating the clinical course of neck tics at both the group and individual levels. Methods Eleven patients with Tourette’s syndrome from our previous study participated in the present study, and their neck tics were recorded during a 5-min observation period. The severity of neck symptoms was assessed using the Yale Global Tic Severity Scale. The peak angular velocities and accelerations, tic counts, and severity scores in our previous study (baseline) and the present study (2-year follow-up) were compared at the group and individual levels. The individual level consistency between baseline and follow-up were calculated using intra-class correlation coefficients (ICCs, one-way random, single measure). Results At the group level, no significant change was observed between baseline and follow-up. At the individual level, angular velocity (ICC 0.73) and YGTSS scores (ICC 0.75) had substantial consistency over the two time points, and angular acceleration (ICC 0.59) and tic counts (ICC 0.69) had moderate consistency. Conclusions The intensity and frequency of neck tics did not change over time. Therefore, quantification of angular neck motor tics will aid in identifying patients with neck tics at high risk for severe neck complications.

Repetitive throat clearing, blinking, and grimacing

Tourette’s disorder requires the presence of multiple motor tics and at least one vocal tic that have been present for at least one year. A tic is a sudden, rapid, recurrent, nonrhythmic motor movement or vocalization. Tics are often associated with a premonitory urge and may be temporarily suppressed. They typically begin between the age of four and six years, peak in severity in early adolescence, and then diminish. The majority of individuals spontaneously achieve remission by early adulthood. Because tic disorders commonly co-occur with psychiatric disorders, they should be screened for in every psychiatric interview. Treatment should begin with psychoeducation and focus on symptom reduction rather than remission. Behavioral interventions, including habit reversal therapy, may be considered. Medications, such as antipsychotics and alpha2 adrenergic agonists, should be considered if tics cause severe impairment and are moderate to severe.

CLASSIFICATION OF THE COMORBID SYMPTOMATIC GROUPS ON AUTISM SPECTRUM DISORDER DIAGNOSIS

A total of 126 people with a nuclear diagnosis of autism spectrum disorder (ASD) participated in this study, corresponding to Galicia Community (Spain), found through survey regarding significantly more common symptoms related this disorder nuclear diagnosis. Hence, main aim is delimiting symptoms symptomatic groups that co-occur to each other, regarding basic diagnosis of ASD, in order elaborate predictive processes of comorbid recurrence along ASD diagnosis and develop the related psycho- educational approach. Data analysis, achieved throughout CLUSTER K-MEDIAS test of SPSS statistic, 23 version, allowed conclude there´s an interaction of symptoms recurrent themselves, which let conclude a classification of 3 symptomatic groups that make up basic comorbidity of ASD diagnosis: 1) group I, formed by epilepsy (2.00) and severe cognitive deficit (1.86) interaction, 2) II group, with significant interrelated scores in schizotypal features (.82) and anxiety processes (.77), and 3) III group, characterized by interaction between motor tics (1.92), cognitive deficit (1.54), hypersensitivity (1.23) and severe behavior problems (1.38). It´s possible conclude these symptomatic groups are predictors variables of comorbidity associated with ASD to carry out effective psycho- social- educational implementation to people with ASD.

Quetiapine associated tics in a pediatric patient post overdose on re-initiation: An interesting clinical scenario

The COVID-19 pandemic has led to a multitude of new medical and psychiatric complications and new presentations that were either never seen before or not seen to the extent that they are presenting now. [1,2]. Increased number of suicide attempts and worsening severity of suicide attempts have been noted in the past year since the COVID-19 pandemic has started [1]. Psychotropic medications can often have lesser-known side effects and movement disorders, including tics, can be one of them [3]. Tics are recurrent, simple or complex behaviors that can be motor or phonic in nature [4,5]. Simple motor tics are often observed as rapid movements while complex motor tics are more synchronized and elaborate. Additionally, noises or brief sounds are examples of simple vocal tics, while speaking a string of words or syllables are more characteristic of a complex vocal tic [4]. The underlying pathogenesis of tics and tic disorders has not been well elucidated, dopaminergic hypothesis being the most widely accepted; however, multiple areas of the brain are speculated to be involved [4,6]. Common treatment options for tic disorders include alpha-2 agonists, clonidine and guanfacine, and antipsychotics [4,7]. Previous literature identifies two case reports that documented tics related to quetiapine. One report described a pediatric bipolar patient who developed tics proportional to quetiapine dose [8], and the other report identified an adult patient with schizophrenia who developed tics during quetiapine therapy [9]. In this article, we describe a pediatric patient who presented after overdosing on quetiapine, lamotrigine and sertraline and developed tics after re-initiation of quetiapine at a much lower dose. To the best of our knowledge, this is the first case of its kind where tics, which were previously absent, developed on re-initiation of quetiapine after an overdose.

Tourette’s syndrome associated with Attention Deficit Hyperactivity Disorder: a case report

Context: The treatment of Giles de la Tourette Syndrome associated with Attention Deficit Hyperactivity Disorder (ADHD) has little scientific evidence. Case report: 7- year-old child, who started motor tics and vocalizations, compatible with Tourette Syndrome, 6 months after starting the treatment of ADHD with psychostimulant, methylphenidate 20mg/day. He used imipramine, quetiapine and haloperidol, but only showed control of ADHD and tics using Ritalin LAR 30mg/day and risperidone. The hypothesis of a cause-effect relationship of the use of methylphenidate with the appearance of tremors and tics was considered. Theoretical survey and discussion on the syndrome and its clinical management associated with comorbidity, the lack of studies on the long-term effects of methylphenidate and the importance of treating comorbidities taking into account side effects of medications and not just resolution of symptoms, so that effects do not outweigh the benefits compromising neurodevelopment and learning in childhood and adolescence. Conclusions: This case showed no improvement with the use of the atypical antipsychotic (quetiapine), but corroborates the findings of treatment of inattention, hyperactivity and impulsivity with the use of methylphenidate (Ritalin LAR) and motor tics and screams with haloperidol (partial improvement) and risperidone (complete cessation).

Psychomotor consequences in children with Tourette’s Syndrome

Background: Tourette’s Syndrome (TS) has a neuropsychiatric aspect and a chronic repertoire of motor-phonic tics. The common onset is in infants and remission in adults. Objective: investigate psychomotor consequences in children with TS. Design and settings: literature review. Methods: eleven studies were selected from a group of 20 after searching the MEDLINE database for “psychomotor performance OR psychomotor development” and “Tourette’s Syndrome”. Only articles with full texts available and published from 2011-2021 were included. Results: the response time (RT) of children with TS was longer. Throughout Do/Don’t tasks, with/without false alarms, the RT was lower while the accuracy of movement (AM) was greater. A study on RT and AM with different levels of complexity showed greater difficulty in ST group (p<0.001) with RT increasing according to complexity. Many children with TS also had ADHD, and when comparing them to the ones only with TS, the ADHD+TS group made more mistakes while having the same RT. The ADHD+TS group also had a response blockage in non-sequential tests and lower TS in sequential tests (p=0.006). Studies showed an association between motor tics and forgetfulness rate (FR), with these being inversely proportional. Conclusion: children with TS have greater RT and the response to uni and bimodal stimuli differ, with greater AM and lower RT to single stimulus. More severe tics were associated with better content retention. Other psychiatric disorders are common, especially ADHD, requiring further studies to link the consequences of each pathology accordingly.

Cervical Myelopathy as a Complication of Untreated Motor Tics: A Cautionary Tale

Tic disorders are common, affecting approximately 0.5 to 1% of children and adolescents. Treatment is required only when symptoms are bothersome or impairing to the patient, so many do not require intervention. However, on occasion tics may cause significant morbidity and are referred to as “malignant.” These malignant tics have resulted in cervical myelopathy, subdural hematoma secondary to head banging, biting of lips leading to infection of oral muscles, self-inflicted eye injuries leading to blindness, skeletal fractures, compressive neuropathies, and vertebral artery dissection. We describe a case of malignant tic disorder, with accompanying video segment, resulting in cervical myelopathy and quadriparesis in a child. We also discuss aggressive management strategies for neurologists to prevent potential lifelong disability. This case emphasizes that these malignant tics must be treated with all due haste to prevent such complications.