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Tic Disorder


Presentation

  • Abstract Although tics are considered the hallmark of Tourette syndrome, arguably tics may not be the only or primary presenting symptom.[ncbi.nlm.nih.gov]
  • As a diagnosis of TS/CTD requires tics to be present for at least one year, children in these tic suppression studies had been living with tics for quite some time.[ncbi.nlm.nih.gov]
  • First, we present the highest level of evidence by reporting the findings of existing Cochrane reviews in this field.[ncbi.nlm.nih.gov]
  • The present report concerns a previously healthy 12-y-old boy who presented with motor tics. The patient underwent an extensive work-up to identify the underlying etiologies and risk factors predisposing him to tic disorder.[ncbi.nlm.nih.gov]
  • However, even when tics are simple jerks, more complex forms of tics may also be present, allowing one to establish the diagnosis by "the company it keeps."[web.archive.org]
Nasal Irritation
  • Certain behaviors (eg, nose picking, which may initially arise as a response to dry nasal membranes and nasal irritation or itching) can later develop into a cycle that is difficult to break.[emedicine.medscape.com]
Nasal Discharge
  • Nose picking is the insertion of a finger into a nostril and may involve the removal of nasal discharge (ie, snot or “boogers”).[emedicine.medscape.com]
Hearing Impairment
  • impairment or other sensory deficits Consultation with a developmental-behavioral pediatrician, a child psychologist, or a child psychiatrist may be indicated.[emedicine.medscape.com]
Oculogyric Spasm
  • The exceptions are (1) opsoclonus (dancing eyes), which is a form of myoclonus, (2) ocular myoclonus (rhythmic vertical oscillations at a rate of 2 Hz) that often accompanies palatal myoclonus, and (3) oculogyric spasms (a sustained deviation of the eyes[web.archive.org]
Muscle Twitch
  • Unlike tics, the majority of muscle twitches are isolated occurrences, not repeated actions. Muscle twitches are also known as myoclonic jerks. They are entirely involuntary and cannot be controlled or suppressed.[webmd.com]
  • A simple tic is purposeless, such as an eye blink, any other muscle twitch, a grunt, or a production of a noise. A complex tic consists of a muscle movement with a purpose, such as scratching, throwing, or chewing.[childbrain.com]
Torticollis
  • Motor tics that involve brief twisting or posturing are called dystonic tics (eg, torticollis, blepharospasm), whereas those that involve sustained or prolonged movements or contraction of muscles are labeled tonic tics (eg, prolonged bending of the trunk[web.archive.org]
Epistaxis
  • […] breakdown, deformities of the fingers and thumbs, and paronychia Nail biting - Extremely short fingernails, paronychia, oral herpes, herpetic whitlow, damaged dentition, apical root resorption, fractures to the incisors, and gingivitis Nose picking - Epistaxis[emedicine.medscape.com]
Hand Tremor
  • For each participant, clinical and instrumental assessment (accelerometer, electromyography [EMG], graphic tablet) of hand tremor was performed.[ncbi.nlm.nih.gov]
Profound Mental Retardation
  • Each case was matched with four controls from the Finnish Population Register (FPR), without diagnoses of OCD, TS/CT or severe or profound mental retardation.[ncbi.nlm.nih.gov]
Resting Tremor
  • Frequency and severity of tremor were assessed in three positions: at rest (rest tremor), with hands extended (postural tremor), during the 'finger-to-nose' test and during Archimedes spiral drawing (kinetic tremor).[ncbi.nlm.nih.gov]
Radiculomyelopathy
  • Although the disability with Tourette's syndrome is often confined to social embarrassment, severe motor tics may lead to physical injury, including fractures, cervical radiculomyelopathy, joint dislocation, and falls.[web.archive.org]
Recurrent Headache
  • headaches Breath-holding spells - Injury (from a fall), seizure Head banging - Callus formation, abrasions, contusions; skull fractures, eye injuries, and dental injuries are rare See Presentation for more detail.[emedicine.medscape.com]

Workup

  • See DDx and Workup for more detail. Management Childhood habits that do not interfere with everyday functioning often require no treatment.[emedicine.medscape.com]
  • […] direct physiologic effects of a substance (eg, stimulants) or a general medical condition (eg, Huntington disease or postviral encephalitis) Criteria have never been met for Tourette’s disorder or persistent (chronic) motor or vocal tic disorder See Workup[emedicine.com]

Treatment

  • Subsequently, we provide the first comprehensive overview of all reports on pharmacological treatment options for TS through a MEDLINE, PubMed, and EMBASE search for all studies that document the effect of pharmacological treatment of TS and other tic[ncbi.nlm.nih.gov]
  • In total, two courses of treatment were given.[ncbi.nlm.nih.gov]
  • Treatment options were considered from multiple perspectives: psychoanalytically oriented psychotherapy, conventional pharmacotherapy, family interventions, cognitive-behavioral therapy, and learning-supportive strategies.[ncbi.nlm.nih.gov]
  • Treatment effects were assessed with an extensive battery of parent-, teacher-, child-, and physician-completed rating scales and laboratory tasks.[ncbi.nlm.nih.gov]
  • Methylphenidate is an effective short-term treatment for oppositional behavior in children with comorbid ADHD and chronic multiple tic disorder.[ncbi.nlm.nih.gov]

Prognosis

  • However, fully explanatory models are needed that would allow for more accurate prognosis and the development of targeted and efficacious treatments.[ncbi.nlm.nih.gov]
  • […] value in prognosis. 4] Mild forms need not require treatment if they are socially functional. 15.[slideshare.net]
  • Prognosis Without treatment, it is expected that tics will have a waxing and waning course with exacerbations during stressful periods.[online.epocrates.com]
  • Shoulder shrugging Eye blinking Lip biting Facial grimacing Clearing of the throat Humming, sniffing, snorting, or squealing Child may report an uncomfortable feeling in his body before a tic occurs; this is called a “premonitory urge” Treatment and Prognosis[childmind.org]
  • Outlook (Prognosis) Simple childhood tics usually disappear over a period of months. Possible Complications There are usually no complications. A chronic motor tic disorder can develop.[health.ridgeviewmedical.org]

Etiology

  • Comorbidity data and family and linkage studies support the hypothesis that these phenotypes, in some cases, share a common etiology.[ncbi.nlm.nih.gov]
  • Psychological, neuropsychiatric, and neuroimmunological formulations of etiology were considered.[ncbi.nlm.nih.gov]
  • We suggest that there might be a causal relationship between ABGA and the clinical syndrome in these cases and that ABGA should be considered as a possible etiology for adult-onset tics. (c) 2004 Movement Disorder Society.[ncbi.nlm.nih.gov]
  • The patient underwent an extensive work-up to identify the underlying etiologies and risk factors predisposing him to tic disorder. Based on the clinical and laboratory results, a diagnosis of SREAT was made.[ncbi.nlm.nih.gov]
  • Teacher reports conflicted regarding the possible etiology of these behaviors. Hence, a functional analysis was conducted in the classroom to determine if the behaviors were maintained by operant variables.[ncbi.nlm.nih.gov]

Epidemiology

  • As a result, after having examined the most relevant literature, authors sought to critically identify and discuss main epidemiologic, socio-demographic and clinical features characterising OCTD patients, along with other specific aspects including Health-Related[ncbi.nlm.nih.gov]
  • CONCLUSIONS: The prevalence of tic disorders in Israel, as measured by a direct question in this epidemiological study, and associated comorbidities concurs with previous reports.[ncbi.nlm.nih.gov]
  • We propose simple algorithms to further increase the confidence in the validity of these codes for epidemiological research. Published by the BMJ Publishing Group Limited.[ncbi.nlm.nih.gov]
  • Robertson MM: The prevalence and epidemiology of Gilles de la Tourette syndrome.[f1000research.com]
  • This paper reviews clinical, pathophysiological, epidemiological and treatment issues of tic disorders. The clinical presentation of tic disorders with simple and complex motor or vocal tics is reviewed in detail.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • These results are consistent with previous functional neuroimaging studies at rest that have widely involved the orbitofrontal cortex in the pathophysiology of the OCD.[ncbi.nlm.nih.gov]
  • The clinical entity pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) has led some to suggest that the pathophysiology of tics in some individuals might involve a postinfectious autoimmune component.[ncbi.nlm.nih.gov]
  • The exact pathophysiological mechanisms are unknown, but the disorders are likely to be due to disturbances of the cortico-striatal-thalamo-circuitry. Comorbid conditions such as anxiety, obsessive-compulsive disorder, and ADHD are common.[bestpractice.bmj.com]
  • This review aims to guide clinicians in the recognition of the phenomenology, pathophysiology, and treatment of these disorders.[journals.lww.com]
  • This paper reviews clinical, pathophysiological, epidemiological and treatment issues of tic disorders. The clinical presentation of tic disorders with simple and complex motor or vocal tics is reviewed in detail.[ncbi.nlm.nih.gov]

Prevention

  • Such infections may be prevented by the prophylactic (preventative dose) administration of antibiotics, such as penicillin.[clinicaltrials.gov]
  • The guidelines also emphasize the importance of facilitating the dissemination of several behavioral treatment approaches, such as "Exposure Response Prevention", yet the most well documented being "Habit Reversal Training".[ncbi.nlm.nih.gov]
  • We provide short-term intensive treatment to target symptoms using Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) treatment strategies.[weillcornell.org]
  • Preventing tics is better than controlling them. Giving yourself free rein in terms of your actions, thoughts and emotions can reduce tension and hyperactivation, thereby preventing tics.[iusmm.ca]
  • Tics and Tourette’s Syndrome-oriented services at BCSC: Neuropsychological Assessment Comprehensive Behavioral Intervention for Tics (CBIT) Exposure and Response Prevention (ERP)[bostonchildstudycenter.com]

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