Abstract
Purpose
Tics can be considered hyperkinetic movements akin to restless leg syndrome (RLS). Drawing the analogy of iron deficiency as an etiology of RLS, it is conceivable that iron deficiency may underlie or worsen tics in Tourette syndrome (TS). The purpose of this study was to evaluate the relationship between serum ferritin levels and tic severity, as well as consequent impact on life, in children with TS.
Methods
Children <18 years, diagnosed with TS during 2009–2015, were reviewed. Only those with serum ferritin testing were included. The following data were collected: tic severity, impact on life, medication, comorbidities, blood count, and serum ferritin at diagnosis and follow-up.
Results
In fifty-seven patients, M:F = 2:1, serum ferritin was 48.0 ± 33.28 ng/mL, tic severity score 2.3 ± 0.80, impact on life score 2.2 ± 0.93, and composite score 4.57 ± 1.6. Serum ferritin was not influenced by comorbid obsessive compulsive disorder (OCD), attention deficit hyperactive disorder (ADHD), or anxiety (P > 0.16). Thirty-eight percent with low serum ferritin (≤50 ng/mL) (n = 37) had severe tics (>5 composite score), compared with 25% in normal ferritin group (n = 20). Over 6–12 months, tic severity score improved in both iron treated groups, deficient (2.70 to 1.90) and sufficient (2.40 to 1.95), whereas tics worsened or remained the same when not treated with iron.
Conclusions
Our data suggest iron deficiency may be associated with more severe tics with higher impact on TS children, independent of the presence of OCD, ADHD, or anxiety. Iron supplementation showed a trend towards improvement of tic severity upon follow-up. We suggest a double-blind, placebo-controlled prospective study to reach a definite conclusion.
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We sincerely acknowledge the help provided by Ashley Falke for the editorial help in preparing the manuscript.
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Debabrata Ghosh, study concept and design, collection and organization of data, reviewed results, and revised manuscript at all stages,
Elizabeth Burkman, collection and organization of data, wrote first draft of manuscript.
All co-authors have seen and approved the submitted version of the paper, accept responsibility for its content, and agree to the order of author names. The Editors reserve the right to require authors to submit their original data for comparison with the manuscript’s illustrations, tables, and results.
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Dr. Debabrata Ghosh reports no disclosures in relation to this manuscript.
Elizabeth Burkman reports no disclosures.
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Both authors report no conflict of interests.
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This study was accepted and showcased as one of the Berlin’s Top Abstracts at the 20th International Congress of Movement Disorders Society.
Statistical analysis conducted, under the assistance of an institutional biostatistician, by Dr. Debabrata Ghosh, MD, Nationwide Children’s Hospital
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Ghosh, D., Burkman, E. Relationship of serum ferritin level and tic severity in children with Tourette syndrome. Childs Nerv Syst 33, 1373–1378 (2017). https://doi.org/10.1007/s00381-017-3424-z
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DOI: https://doi.org/10.1007/s00381-017-3424-z