Tics and Tourette Syndrome Flashcards
Tic
Sudden, involuntary, recurrent, nonrhythmic motor movement or vocalization generally preceeded by urge. Often display suggestibility.
They are a hallmark feature of neurodevelopmental disorders with onset in childhood called “tic disorders”
These include: Tourette syndrome, Chronic tic disorder (motor or vocal type), and provisional tic disorder.
Tourette syndrome clinical criteria
- At least 2 motor tics and at least one vocal tic
- Present for at least one year
- Onsets prior to age 18
- Symptoms not secondary to medication or another medical condition (seizure, Huntington’s, postviral encephalitis)
___ and ___ are the two hallmarks of the tics in Tourette syndrome
Suggestibility and excellent clinical insight are the two hallmarks of the tics in Tourette syndrome
Suggestibility: Discussing the tics reproduces the urge to perform the tics in the patient despite attempts to control them. True of all tics.
Excellent clinical insight: Patients are fully aware of their tics and can even temporarily suppress them. As a consequence, they function excellently in an environment in which their tics are accepted.
Patients with Tourette’s do not have altered ___
Patients with Tourette’s do not have altered cogitive or intellectual function
They just have tics.
Tics vs compulsions
- Tic: Brief, episodic, simple movements or sounds
- Compulsion: Semi-voluntary actions that are not simple movements
Types of simple tic
- Clonic: muscle “jerks”
- Dystonic: Transiently increased tone
- Atonic: Transiently decreased tone
Complex motor tics
Coordinated movements that involve multiple muscles and often resemble normal movements
For example: Head shaking, touching, hitting. Also includes linguistically meaningful vocalizations, such as copralalia or palilalia.
A complex motor tic should be considered a compulsion if it is preceded by an obsessive thought, anxiety, or fear.
Parakinesia
When a patient integrates a complex motor tic into a seemingly planned, purposeful movement
Similar behavior is seen in chorea.
Palilalia
Form of complex motor tic sometimes seen in Tourette’s
The patient compulsively repeats one’s own words or sentences or mimics the words or sentences of another.
Sometimes called “echo”, for obvious reasons.
Coprapraxia
Complex motor tic in which a patient briefly exhibits obscene gestures
Timecourse of tics
Typically onset between ages 5-9
Tend to increase in frequency and intensity during puberty (age 8-12)
Most patients show symptom improvement or become tic-free in late adolescence. A minority of patients continue to have tics into adulthood.
In contrast to other movement disorders, tics may also occur during ___
In contrast to other movement disorders, tics may also occur during sleep
And all stages of sleep, at that.
Common comorbidities of Tourette’s
ADHD
OCD/OCB
Learning disability
Mood disorder
Sleep disorder
Social skill deficits
Tourette’s disease exists on a spectrum with two other disorders:
ADHD and OCD
The three disorders are often seen in various combinations within a family history.
Treatment of Tourette’s syndrome
-
Behavioral
- Education of patients and caregivers, who should in turn educate teachers, coaches, principals
- Behavioral therapy
-
Pharmacologic
- First-line agent: Guanfacine (used over clonidine as it has less sedative effects) or atypical antipsychotic
- Alpha-2 agonists: Guanfacine and clonidine
- Atypical antipsychotics: Risperidone, olanzapine, quetiapine, aripiprazole
- Dopamine depleters: Tetrabenazine
- Neuroleptics: Haloperidol, pimozide (most effective, but most side effects)
