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Dystonic motor and phonic tics in Tourette syndrome

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Abstract

Background

Dystonic tics differ from clonic tics by their slower and more sustained nature. Dystonic tics are often present in patients with Tourette syndrome (TS) and other tic-disorders. However, their phenomenology and impact on overall impairment have not been extensively studied.

Materials and methods

We assessed clinical history and tic duration in video-recordings from patients with TS evaluated at our movement disorders clinic. Dystonic tics were defined as those lasting ≥ 1000 ms (ms).

Results

Of the total of 201 patients with TS, there were 156 with video-recordings suitable for tic duration analysis, of their tics, 57 (36.5%) of whom had dystonic motor tics, including 9 (5.7%) with dystonic phonic tics. Dystonic motor tics had a duration range between 1033 and 15,000 ms and dystonic phonic tics between 1132 and 17,766 ms. Patients with dystonic tics were older 24.4 vs. 16.5 years (P = 0.005) and had an older age at onset 12.9 vs. 7.2 years (P < 0.001), than patients without dystonic tics. The bivariate analysis showed an association between the presence of dystonic tics, greater tic severity and wider body distribution. The multivariate regression analysis showed a statistical association with older age at evaluation (P = 0.001), greater tic severity on video-recordings (P = 0.001) and co-occurrence with complex motor tics (P = 0.020). The presence of dystonic tics increased the risk for being considered for deep brain stimulation therapy, odds ratio: 15.7 (P = 0.002).

Conclusion

Dystonic tics, observed in about a third of patients with TS, are associated with increased severity of TS.

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Data availability

Available under reasonable request.

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Acknowledgements

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Authors and Affiliations

  1. Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA

    José Fidel Baizabal-Carvallo & Joseph Jankovic

  2. Department of Sciences and Engineering, University of Guanajuato, Ave León 428, Jardines del Moral, C.P. 37320, León, Guanajuato, México

    José Fidel Baizabal-Carvallo

  3. Instituto Politécnico Nacional, Mexico city, Mexico

    Marlene Alonso-Juarez

Authors
  1. José Fidel Baizabal-Carvallo
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  2. Marlene Alonso-Juarez
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  3. Joseph Jankovic
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Contributions

Dr. B-C: gathered and analyzed the data, made the statistical analysis, conceptualized, wrote the first draft, and reviewed the manuscript; Dr. A-J: gathered and analyzed data; Dr. J: gathered the data, conceptualized and reviewed the manuscript.

Corresponding author

Correspondence to José Fidel Baizabal-Carvallo.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

The Baylor College of Medicine Internal Review Board provided consent for case publications after written approval by patients or family members.

Consent to participate

Patients provided written informed consent to participate in scientific research.

Consent for publication

Patients provided written informed consent for publication in a scientific journal.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 This is 11-year-old boy with tics since the age of four has dystonic tic predominantly involving his face (blepharospasm and facial grimacing) lasting 1030 milliseconds (MOV 909 KB)

Supplementary file2 This 8-year-old boy has tics with sustained abdominal contractions lasting 4350 milliseconds. Eye-blinking tics are observed at the end of video (MOV 990 KB)

Supplementary file3 This is a 23-year-old man with cervical, truncal and shoulder dystonic (“stretching”) tics lasting 9266 milliseconds (AVI 85196 KB)

Supplementary file4 This 12-year-old boy with severe TS has simple dystonic phonic tics manifested by expiratory sound lasting over 2000 milliseconds (see Figure 1A) (AVI 23708 KB)

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Baizabal-Carvallo, J.F., Alonso-Juarez, M. & Jankovic, J. Dystonic motor and phonic tics in Tourette syndrome. J Neurol 269, 5312–5318 (2022). https://doi.org/10.1007/s00415-022-11174-z

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  • DOI: https://doi.org/10.1007/s00415-022-11174-z

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