Patient 1: The parents of a 16-year-old boy ask that their son be urgently evaluated for an exacerbation of his tics. He was diagnosed with Gilles de la Tourette’s syndrome (GTS) at age 5 years and never required pharmacotherapy for his tics. Since the start of the school year and the transition to junior high school, he has developed frequent grunting, coughing, and shouting. These vocal tics are extremely disruptive and socially embarrassing. Classmates have commented, some heckling him, and one concerned student asked him if he was taking illicit drugs. The boy refuses to go to school and his grades are dropping. He recently had a bad cold, and started taking pseudonephrine, and feels his tics are even worse. On examination, there are mild multifocal motor tics, and severe repetitive vocal tics. The remainder of the examination is normal.
KeywordsAttention Deficit Hyperactivity Disorder Botulinum Toxin Choreic Movement Pediatric Autoimmune Neuropsychiatric Disorder Associate With Streptococcal Tardive Syndrome
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