Abstract
Background
Tics are the hallmark of Tourette syndrome (TS). However, TS patients may have a particular vulnerability to develop other movement disorders (MDs), such as dystonia, chorea, stereotypy, and other hyperkinetic disorders that may be wrongly attributed to tics.
Materials and methods
We studied a cohort of 201 patients with motor and phonic tics associated with TS to determine if they have additional, co-existent, MDs.
Results
There were 67 (33.3%) patients with comorbid non-tic MDs. Phenomenology-wise, piano-playing movements resembling chorea or myoclonus, were the most common non-tic movement, observed in 11% of cases, followed by stereotypies (8.0%), tremor, dystonia and parkinsonism, 5.0% each. Drug-induced was the most common etiology (6.0%), followed by functional movement disorders (5.0%) and tardive phenomena (5.0%). No clear etiology was identified in most patients. Piano-playing movements, were associated with a younger age at onset (P = 0.004) and younger age at presentation (P < 0.001). Patients with drug-induced movements and tardive phenomena had a lower frequency of craniofacial tics. FMDs, and idiopathic MDS showed no specific associations with TS. Tic severity was not a predictor of any co-existent MD.
Conclusion
About a third of patients with TS present with comorbid MDs which should be differentiated and distinguished from tics as their etiopathogenesis and treatment may be different.
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Dr. Baizabal-Carvallo: Research project: conception, organization, execution; manuscript: writing of the first draft, review and critique. Dr. Jankovic: Research project: conception, organization, execution. Statistical analysis: design, execution, review and critique.
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None for all authors. Financial Disclosures for the previous 12 months: Royalties: Dr. Baizabal-Carvallo has received royalties from Medlink Neurology, Editorial Boards: Dr. Baizabal-Carvallo serves as Associated Editor in BMC Neurology. Dr. Jankovic: Research Support: Allergan, Inc; Allon Therapeutics; Biotie; Ceregene, Inc; Chelsea Therapeutics; Diana Helis Henry Medical Research Foundation; EMD Serono; Huntington’s Disease Society of America; Huntington Study Group; Impax Pharmaceuticals; Ipsen Limited; Lundbeck Inc; Medtronic; Merz Pharmaceuticals; Michael J Fox Foundation for Parkinson Research; National Institutes of Health; National Parkinson Foundation; Neurogen; St. Jude Medical; Teva Pharmaceutical Industries Ltd; University of Rochester; Parkinson Study Group. Consultant or Advisory Committee Member: Allergan, Inc; AstraZeneca, Chelsea Therapeutics; EMD Serono; Lundbeck Inc; Merz Pharmaceuticals; Michael J Fox Foundation for Parkinson Research; Neurocrine Biosciences, Inc; Teva Pharmaceutical Industries Ltd. Editorial Boards: Elsevier; Medlink: Neurology; Neurology in Clinical Practice; Neurotoxin Institute; Scientiae; UpToDate.
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Supplementary Information
Below is the link to the electronic supplementary material.
Video 1: This is an 11-year-old male with a 5-year history of motor, chiefly facial, tics, exhibiting jerky continuous piano-playing movements in both upper limbs (AVI 94332 kb)
Video 2: This is a 15-year-old male with an 8-year history of motor tics and piano-playing movements in both hands (AVI 77787 kb)
Video 3: This is an 8-year-old male with a 3-year history of oculogyric, neck and shoulder tics, who exhibits upper and lower limb repetitive movements consistent with stereotypies (AVI 59267 kb)
Video 4: This is a 24-year-old female with a childhood onset of tics and fixed dystonic flexion of fingers of the left hand and flexion of the left elbow (AVI 76676 kb)
Video 5: This is a 21-year old male patient with a 9-year history of complex motor tics who also manifests episodic dystonic postures in the left hand (AVI 96431 kb)
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Baizabal-Carvallo, J.F., Jankovic, J. Beyond tics: movement disorders in patients with Tourette syndrome. J Neural Transm 128, 1177–1183 (2021). https://doi.org/10.1007/s00702-021-02386-0
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DOI: https://doi.org/10.1007/s00702-021-02386-0